Davar Kusha, Clark Devin, Centor Robert M, Dominguez Fernando, Ghanem Bassam, Lee Rachael, Lee Todd C, McDonald Emily G, Phillips Matthew C, Sendi Parham, Spellberg Brad
Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, California, USA.
Department of Medicine, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, Alabama, Birmingham, Alabama, USA.
Open Forum Infect Dis. 2022 Dec 29;10(1):ofac706. doi: 10.1093/ofid/ofac706. eCollection 2023 Jan.
Like all fields of medicine, Infectious Diseases is rife with dogma that underpins much clinical practice. In this study, we discuss 2 specific examples of historical practice that have been overturned recently by numerous prospective studies: traditional durations of antimicrobial therapy and the necessity of intravenous (IV)-only therapy for specific infectious syndromes. These dogmas are based on uncontrolled case series from >50 years ago, amplified by the opinions of eminent experts. In contrast, more than 120 modern, randomized controlled trials have established that shorter durations of therapy are equally effective for many infections. Furthermore, 21 concordant randomized controlled trials have demonstrated that oral antibiotic therapy is at least as effective as IV-only therapy for osteomyelitis, bacteremia, and endocarditis. Nevertheless, practitioners in many clinical settings remain refractory to adopting these changes. It is time for Infectious Diseases to move beyond its history of eminent opinion-based medicine and truly into the era of evidenced-based medicine.
与所有医学领域一样,传染病学充斥着支撑诸多临床实践的教条。在本研究中,我们讨论了两个历史实践的具体例子,它们最近已被众多前瞻性研究所推翻:抗菌治疗的传统疗程以及特定感染综合征仅采用静脉注射(IV)治疗的必要性。这些教条基于50多年前的非对照病例系列,并因知名专家的观点而被放大。相比之下,120多项现代随机对照试验已证实,较短疗程的治疗对许多感染同样有效。此外,21项一致的随机对照试验表明,对于骨髓炎、菌血症和心内膜炎,口服抗生素治疗至少与仅采用静脉注射治疗一样有效。然而,许多临床环境中的从业者仍然难以接受这些变化。传染病学是时候超越其基于权威观点的医学历史,真正进入循证医学时代了。