Somayaji R, Goss C H
Departments of Medicine and Microbiology, Immunology & Infectious Disease, University of Calgary, Calgary, Alberta CA.
Departments of Medicine and Pediatrics, University of Washington School of Medicine, Seattle WA.
Curr Pulmonol Rep. 2019 Dec;8(4):160-165. doi: 10.1007/s13665-019-00235-w. Epub 2019 Nov 26.
a)We conducted a review of the current evidence relating to antibiotic duration in the short and long-term management of non-cystic fibrosis bronchiectasis.
b)In non-cystic fibrosis pulmonary exacerbations, evidence is primarily based on expert consensus and recent guidelines recommend antibiotic durations of approximately 14 days. Chronic antibiotics (oral or inhaled) are recommended in patients with frequent exacerbations or with chronic airways infection. Macrolides are the best studied therapies for long-term use with evidence for effect limited to a 12 month duration. Encouragingly, there are increased efforts to develop registries and conduct larger population level studies to improve patient care.
c)There is a paucity of evidence for optimal antibiotic strategies in exacerbations and chronic maintenance in persons with non-cystic fibrosis bronchiectasis. Rationally designed studies which utilize a registry and population-based approach will be critical to build evidence-based strategies to optimize management of non-cystic fibrosis bronchiectasis.
a)我们对非囊性纤维化支气管扩张症短期和长期管理中抗生素使用时长的现有证据进行了综述。
b)在非囊性纤维化肺部加重期，证据主要基于专家共识，近期指南推荐抗生素使用时长约为14天。对于频繁加重或患有慢性气道感染的患者，推荐使用慢性抗生素（口服或吸入）。大环内酯类药物是长期使用研究最多的疗法，其有效性证据仅限于12个月的疗程。令人鼓舞的是，人们加大了力度建立登记系统并开展更大规模的人群水平研究以改善患者护理。
c)在非囊性纤维化支气管扩张症患者的加重期和慢性维持治疗中，缺乏关于最佳抗生素策略的证据。利用登记系统和基于人群的方法进行合理设计的研究对于建立循证策略以优化非囊性纤维化支气管扩张症的管理至关重要。
