慢性阻塞性肺疾病急性加重期的抗生素治疗

Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease.

作者信息

Anthonisen N R, Manfreda J, Warren C P, Hershfield E S, Harding G K, Nelson N A

出版信息

Ann Intern Med. 1987 Feb;106(2):196-204. doi: 10.7326/0003-4819-106-2-196.

Abstract

The effects of broad-spectrum antibiotic and placebo therapy in patients with chronic obstructive pulmonary disease in exacerbation were compared in a randomized, double-blinded, crossover trial. Exacerbations were defined in terms of increased dyspnea, sputum production, and sputum purulence. Exacerbations were followed at 3-day intervals by home visits, and those that resolved in 21 days were designated treatment successes. Treatment failures included exacerbations in which symptoms did not resolve but no intervention was necessary, and those in which the patient's condition deteriorated so that intervention was necessary. Over 3.5 years in 173 patients, 362 exacerbations were treated, 180 with placebo and 182 with antibiotic. The success rate with placebo was 55% and with antibiotic 68%. The rate of failure with deterioration was 19% with placebo and 10% with antibiotic. There was a significant benefit associated with antibiotic. Peak flow recovered more rapidly with antibiotic treatment than with placebo. Side effects were uncommon and did not differ between antibiotic and placebo.

摘要

在一项随机、双盲、交叉试验中，比较了广谱抗生素和安慰剂治疗慢性阻塞性肺疾病急性加重期患者的效果。急性加重期根据呼吸困难加重、痰液生成和痰液脓性来定义。每隔3天进行一次家访以跟踪急性加重期情况，那些在21天内缓解的被指定为治疗成功。治疗失败包括症状未缓解但无需干预的急性加重期，以及患者病情恶化需要干预的急性加重期。在173名患者的3.5年时间里，共治疗了362次急性加重期，180次用安慰剂治疗，182次用抗生素治疗。安慰剂的成功率为55%，抗生素的成功率为68%。病情恶化的失败率安慰剂组为19%，抗生素组为10%。抗生素治疗有显著益处。与安慰剂相比，抗生素治疗使峰值流速恢复得更快。副作用不常见，抗生素组和安慰剂组之间无差异。