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【medical-news】鼻窦炎：对抗生素无反应
A placebo is likely to be just as effective as common acute sinusitis treatments involving a topical steroid and an antibiotic, according to an article published in the Journal of the American Medical Association (JAMA), 5th December issue.
Sinus infection (acute sinusitis) is often diagnosed and treated without clinical information, even though it is a common clinical problem which has symptoms similar to those found in other illnesses, the authors explain.
92% of patients in the UK and 85-98% of those in the USA are prescribed antibiotics, even though a bacterial cause is uncertain. The writers say "Because there are no satisfactory studies of microbiological etiology from typical primary care patient practices, wide-scale overtreatment is likely occurring."
The widespread use of antibiotics may be having an impact on raised antibiotic resistance rates in the community. While topical steroids are commonly used to treat acute sinusitis, research on their effectiveness has been limited.
Ian G. Williamson, M.D., of the University of Southampton, England, and team carried out a double-blind randomized placebo-controlled trial to find out how effective amoxicillin (an antibiotic) and budesonide (a topical steroid) were for the treatment of acute maxillary sinusitis (rhinosinusitis - inflammation of the nasal cavity and sinuses).
240 adult patients were included in the trial. They all had non-recurrent sinusitis and were being treated at 58 GP (General Practitioner) practices, during the period Nov 2001 - Nov 2005.
They were randomly selected into one of four groups:
1. antibiotic and nasal steroid (500 mg of amoxicillin 3 times per day for 7 days and 200 μg of budesonide in each nostril once per day for 10 days)
2. placebo antibiotic and nasal steroid
3. antibiotic and placebo nasal steroid
4. placebo antibiotic and placebo nasal steroid
The researchers found that:
-- 29% of those receiving amoxicillin had symptoms lasting more than ten days
-- 36% of patients not receiving amoxicillin had symptoms lasting for more than ten days
-- 31.4% of those receiving topical budesonide had symptoms lasting for more than ten days
-- 31.4% of those not receiving budesonide had symptoms lasting for more than ten days
Further analysis found that nasal steroids were much more effective for those whose symptoms were less severe at baseline.
The researchers wrote "Our main conclusions are that among patients with the typical features of acute bacterial sinusitis, neither an antibiotic nor a topical steroid alone or in combination are effective in altering the symptom severity, the duration, or the natural history of the condition. Topical steroids are likely to be effective in those with such features but who have less severe symptoms at presentation to the physician," the authors write.
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粗译
Placebo As Good As Common Treatments For Sinus Infections
安慰剂与普通治疗方法在治疗鼻窦炎的疗效方面无差别
A placebo is likely to be just as effective as common acute sinusitis treatments involving a topical steroid and an antibiotic, according to an article published in the Journal of the American Medical Association (JAMA), 5th December issue.
依据美国医疗协会杂志12月第5期中的一篇文章,包括经典的类固醇类药物与抗生素在内的常用治疗急性鼻窦炎的治疗方法在疗效方面与安慰剂无差别.
Sinus infection (acute sinusitis) is often diagnosed and treated without clinical information, even though it is a common clinical problem which has symptoms similar to those found in other illnesses, the authors explain.
作者解释说,一个常见的临床问题是,尽管与其他疾病的症状相似,但窦感染(急性鼻窦炎)往往在没有充分临床信息的情况下被确诊并予以治疗.(对此不确定,请高手指点)
92% of patients in the UK and 85-98% of those in the USA are prescribed antibiotics, even though a bacterial cause is uncertain. The writers say "Because there are no satisfactory studies of microbiological etiology from typical primary care patient practices, wide-scale overtreatment is likely occurring."
在致病菌不清的情况下,仍有92%的英国鼻窦炎患者与85-98%的美国鼻窦炎患者被开具抗生素处方.作者谈到,由于没有令人满意的来自典型患者治疗实践的微生物病因学研究,因此大范围内采取过度治疗也就不时发生.
The widespread use of antibiotics may be having an impact on raised antibiotic resistance rates in the community. While topical steroids are commonly used to treat acute sinusitis, research on their effectiveness has been limited.
抗生素的广泛使用可能对社区的抗生素耐药率升高产生重要影响.经典醛固酮类药物常用于急性鼻窦炎的治疗,但仅有有限的有效性研究.
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作者:admin@医学,生命科学 2010-10-08 05:11
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