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通过根据初级保健中患者的需求定制呼吸道感染的治疗时长来优化抗生素暴露。

Optimising antibiotic exposure by customising the duration of treatment for respiratory tract infections based on patient needs in primary care.

作者信息

Llor Carl, Frimodt-Møller Niels, Miravitlles Marc, Kahlmeter Gunnar, Bjerrum Lars

机构信息

University Institute in Primary Care Research Jordi Gol, Catalan Institute of Health, Barcelona, Spain.

CIBER de Enfermedades Infecciosas, Madrid, Spain.

出版信息

EClinicalMedicine. 2024 Jul 3;74:102723. doi: 10.1016/j.eclinm.2024.102723. eCollection 2024 Aug.

Abstract

Primary care antimicrobial stewardship programs have limited success in reducing antibiotic use, prompting the search for new strategies. Convincing general practitioners to resist antibiotic prescription amid uncertainty or patient demands usually poses a significant challenge. Despite common practice, standard durations for common infections lack support from clinical studies. Contrary to common belief, extending antibiotic treatment beyond the resolution of symptoms does not seem to prevent or reduce antimicrobial resistance. Shortening the duration of antibiotic therapy has shown to be effective in mitigating the spread of resistance, particularly in cases of pneumonia. Recent hospital randomised trials suggest that ending antibiotic courses by day three for most lower respiratory tract infections is effective and safe. While community studies are scarce, it is likely that these shorter, tailored courses to meet patients' needs would also be effective and safe in primary care. Therefore, primary care studies should investigate the outcomes of advising patients to discontinue antibiotic treatment upon symptom resolution. Implementing patient-centred, customised treatment durations, rather than fixed courses, is crucial for meeting individual patient needs.

摘要

基层医疗抗菌药物管理计划在减少抗生素使用方面成效有限,这促使人们寻找新策略。在存在不确定性或患者要求的情况下,要说服全科医生拒绝开具抗生素处方通常是一项重大挑战。尽管是常见做法,但常见感染的标准疗程缺乏临床研究的支持。与普遍看法相反,在症状缓解后延长抗生素治疗似乎并不能预防或降低抗菌药物耐药性。缩短抗生素治疗疗程已被证明可有效减轻耐药性的传播,尤其是在肺炎病例中。近期的医院随机试验表明,对于大多数下呼吸道感染,在第三天结束抗生素疗程是有效且安全的。虽然社区研究较少,但这些为满足患者需求而制定的较短、个性化疗程在基层医疗中可能同样有效且安全。因此,基层医疗研究应调查建议患者在症状缓解后停止抗生素治疗的效果。实施以患者为中心的定制治疗疗程,而非固定疗程,对于满足个体患者需求至关重要。

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