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The overuse of antibiotics in Yimaitong not only increases the risk of side effects, but also leads to an increasing problem of drug resistance.
Studies have found that common bacterial infections caused by bacterial infections such as chronic obstructive pulmonary (COPD) acute exacerbation or simple Bronchitis, community-acquired pneumonia (CAP), urinary tract infection (UTI) and cellulitis do not require prolonged antibiotic treatment.
Based on the existing evidence, the American College of Physicians (ACP) has proposed the use of short-term antibiotics in the above-mentioned common bacterial infections.
This article introduces the respiratory diseases among them.
COPD exacerbation and acute uncomplicated bronchitis For patients with acute exacerbation of COPD or acute uncomplicated bronchitis with clinical symptoms of bacterial infection (such as difficulty breathing, purulent sputum and/or increased sputum volume), the duration of antibiotic treatment should be limited to 5 days.
Acute simple bronchitis is defined as an acute respiratory infection with a normal chest radiograph, usually caused by a virus and a self-limited infection affecting the large airways.
The ACP guidelines have recommended that patients with bronchitis should not be prescribed antibiotics unless pneumonia is suspected.
For COPD, the GOLD guidelines recommend that patients with clinical symptoms of bacterial infection (such as difficulty breathing, purulent sputum and/or increased sputum volume) use antibiotics to treat COPD exacerbation.
The choice of antibiotics should cover the most common bacterial pathogens (including Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, etc.
).
Beta lactams, tetracyclines, macrolides, second- and third-generation cephalosporins can be used Bacteria or quinolone drugs.
The GOLD guidelines recommend that patients with acute exacerbations of COPD should be given antibiotics for 5-7 days.
However, a meta-analysis of the use of short-term antibiotics for the treatment of chronic bronchitis and exacerbations of COPD (including 21 RCTs, n=10698) shows that the use of short-term antibiotics ( There was no difference in clinical improvement between patients with longer-term treatment (average 4.
9 days) and longer-term treatment (average 8.
3 days), and there was no difference in subgroup analysis between the application of different antibiotics.
Short-term antibiotic therapy is equally effective.
Community-acquired pneumonia For non-immune-compromised CAP patients, the initial antibiotic treatment should be at least 5 days.
After 5 days, whether to extend the antibiotic treatment time depends on the patient's vital signs, eating ability and mental state.
CAP usually manifests as fever, cough with purulent sputum, difficulty breathing, and chest pain.
Empirical antibiotic treatment should cover common pathogens of CAP (including Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Staphylococcus aureus, etc.
) and typical pathogens (such as Legionella, etc.
).
Healthy adults usually use ①aminopenicillin , Penicillins/enzyme inhibitor complex ②First-generation, second-generation cephalosporins ③Doxycycline, minocycline ④Respiratory quinolones ⑤Macrolide antibiotics; patients with underlying diseases can use ①Penicillins/ Enzyme inhibitor complex ②second-generation, third-generation cephalosporins ③respiratory quinolones ④one of the first three categories combined with doxycycline, minocycline or macrolides.
Based on 3 meta-analysis and multiple RCTs trials, the 2019 IDSA/ATS CAP guidelines recommend that CAP patients should use antibiotics for at least 5 days.
Whether to extend the use of antibiotics depends on the patient's vital signs, eating ability, and mental state.
One of the meta-analysis (including 21 trials, including 19 RCTs) showed that short-term treatment (≤6 days) and long-term treatment had similar efficacy and fewer serious adverse events (RR=0.
73, 95%CI 0.
55-0.
97) ), the mortality rate is low (RR=0.
52, 0.
33-0.
82).
Another retrospective study found that for every additional day of antibiotics prescribed, the risk of related adverse events would increase by 5%.
In addition, there are a series of studies on short-term antibiotic therapy for children with CAP, which also confirmed the good effectiveness of short-term treatment, but the guidelines have not yet been written, and further research is needed.
Summary Therefore, when treating such common bacterial infections, clinicians should note that the use of short-term antibiotics is not less effective than long-term antibiotic treatment, and can also reduce the risk of side effects and help control the growing problem of drug resistance.
.
References: 1.
Rachael A, Robert M.
et al.
Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians.
Ann Intern Med.
2021 Apr 6.
2.
Summary for Patients: Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians.
Ann Intern Med.
2021 Apr 6.
3.
Chinese Society of Respiratory Diseases.
Chinese Adult Community Acquired Pneumonia Diagnosis and Treatment Guidelines (2016 Year Edition)[J].
Chinese Journal of Tuberculosis and Respiration, 2016,39(4):253-279.
4.
Pernica JM, Harman S, Kam AJ, et al.
Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: The SAFER Randomized Clinical Trial.
JAMA Pediatr.
Published online March 08, 2021.