抗生素对多数鼻窦炎无效

2006-12-20 00:00 来源:丁香园 作者:doxidai
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星期一,12.18(HealthDay News)-- 新研究显示,如果这个冬天你得了轻度鼻窦炎,或较严重的感染,抗生素并不能加速你的康复过程。

比利时根特大学医院An De Sutter博士说,“在大多数情况下,鼻-鼻窦炎是一种自限性疾病,它会持续10天或者更久,但是抗生素不会影响疾病的发展。”因此,若你没有并发症或重度感染的症状,如高烧,极度疼痛,最好不要选择抗生素,只须进行对症治疗,等待自然康复就行了。

Sutter博士估计现在有50%-70%的鼻窦炎病人服用抗生素。根据大部分病例来看,尽管药物(抗生素)能有效治疗细菌性鼻窦炎,但对病毒性鼻窦炎无效,而大多数鼻窦炎是病毒感染引起的。

研究中,Sutter博士和她的同事观察了300个患轻度到中度的鼻窦炎的病人,他们中有218个接受了鼻窦X线检查。随即分配这些病人接受阿莫西林或安慰剂治疗,并要求病人每天记录症状,观察15天。研究人员发现,服用阿莫西林和服用安慰剂的病人患病持续时间一样长,247个病人在15天内就康复了。

个人在两方面的抱怨——-生病的感觉和生产力下降——可以预测鼻窦炎的康复较慢。De Sutter 博士说,“在病人中,有人会感觉到自己生病或有人感觉自己无法工作,这些病人的康复期会持续更多天,而抗生素不能加快他们的康复。”

“我们不能确切的知道为什么抗生素治疗对疾病的持续时间没有任何作用,但是,有两个可能的解释:一个是疾病和X线的异常表现不是由细菌感染引起的,又或者是由细菌引起的,但不需要抗生素,病人的免疫系统也能很快战胜感染。”

研究结果发表在11月/12月的《家庭医学年报》上。

只有在病人有严重的症状如高烧和极度疼痛或病人的免疫功能减弱的情况下,我们才建议抗生素治疗。极少数的病人才会这样。而对其他人,我们建议观察。Sutter建议医生应该把重点放在症状的缓解,而不只是开抗生素:疼痛缓解用扑热息痛可,鼻塞用鼻内去充血剂。她补充说,“一些病人也可通过吸入热蒸汽缓解症状。”

在同一本杂志上的一项相似研究中,研究人员发现,咽喉痛患者对疼痛缓解的渴望是需要抗生素的主要原因之一。他们总结,治疗这类病人最好选择镇痛类药物而不是抗生素。

Sutter相信,在多数鼻窦炎病例中,医生应限制病人用抗生素。“医生应该向病人解释抗生素服用与否对康复速度没有区别,并且还会引发不良反应。在我们的试验中,服用抗生素后较频繁的不良反应是腹泻。其他不良反应包括恶心,口腔感染,阴道感染,酵母菌感染,过敏反应和大肠炎。”

Sutter提到,过多的服用抗生素,尤其是儿童,会出现对抗生素耐药的细菌(如肺炎链球菌)引起的上呼吸道感染。“这些抗菌可能引起更难治疗的感染并可能传染他人。”

纽约布法罗市一大学的耳鼻喉学科主任,David Sherris 博士说“这是个有趣的研究,因为我们观察了大批患有急性鼻窦炎的病人。”

Sherris 说,“多数鼻窦炎患者不需要抗生素治疗,除非症状持续超过7-10天,鼻窦X线平片对急性鼻窦炎的诊断和治疗几乎没有或根本没有任何作用。”但那并不意味着影像学在鼻窦炎病例中没有一点价值,他补充。对于延长或复发的鼻窦炎或有并发症者,可选择计算机体层摄影(CT)进行检测,效果很好。“在严重情况下或症状与发现不相符时,可尽早推荐耳鼻喉专家。专家可用鼻内镜检查精确地评价CT发现的细小变化。”

尽管新研究证实了Sherris在临床实践期间得到的一些观察发现,如果使用来自美国耳鼻喉学会-头颈外科的症状诊断系统,新研究应该可以更令人信服。那将比这篇文章陈述的更加完善,即使不是完美无缺,也可以更好地诊断急性鼻窦炎。

Sherris还指出了研究人员对抗生素的选择错误。他说,“除非用很高剂量,阿莫西林不是一个好的治疗急性鼻窦炎的一线抗生素。阿莫西林-克拉维酸(奥格门汀)是一个较好的选择,现在美国很普遍。如果对青霉素过敏,医师们应该考虑阿奇霉素或呼吸喹诺酮。”

Antibiotics Mostly Useless for Sinusitis

MONDAY, Dec. 18 (HealthDay News) -- If you develop a mild sinus infection this winter -- or even a moderately severe one -- antibiotics won't necessarily speed your recovery, new research shows.

"In the vast majority of cases, rhinosinusitis is a self-limiting disease," said Dr. An De Sutter, of Ghent University Hospital in Belgium. "It can last 10 days or longer, but antibiotics do not influence the course of the disease."

So, if you don't have signs of complications or severe infection, such as a high fever or extreme pain, your best bet is to forgo antibiotics, rely on symptomatic treatments and wait for a natural recovery, De Sutter said.

De Sutter estimates that 50 percent to 70 percent of sinusitis patients are prescribed antibiotics. Although the drugs can effectively treat patients who develop bacterial sinusitis, they are ineffective against viral sinusitis, which represents the majority of cases.

In the study, De Sutter and her colleagues looked at 300 patients with mild to moderately severe sinusitis, 218 of whom received sinus X-rays. They randomly assigned patients to receive either amoxicillin or a placebo, asked them to keep a symptom diary and observed them for 15 days.

The researchers found that neither typical sinusitis signs and symptoms nor abnormal X-rays had any value in predicting the course of the disease. They also found that the disease lasted as long in patients taking amoxicillin as it did in patients taking a placebo, and that 247 of the patients recovered within 15 days.

Only two subjective complaints -- a general feeling of illness and reduced productivity -- predicted a slower recovery from sinusitis. "In patients who feel ill or who do not feel able to work, recovery will take a few days longer," De Sutter said. "But antibiotic treatment does not speed recovery in these patients."

"We don't know for sure why antibiotic treatment seemed to have no effect on the duration of the illness," De Sutter said. "But there two possible explanations: Either the illness and X-ray abnormalities were not caused by a bacterial infection, or if they were, the patients' immune systems were able to overcome the infection just as quickly without antibiotics."

The results of the study are published in the November/December issue of the Annals of Family Medicine.

"We advise antibiotic treatment only when patients have severe symptoms such as high fever and bad pain or if they have impaired immune function," De Sutter said. "This is a very small minority of patients. For all others, we advise 'watchful waiting.' "

Instead of prescribing antibiotics, doctors should focus on symptom relief: paracetamol for pain relief and intranasal decongestants in case of a blocked nose, De Sutter suggested. "Some patients experience subjective relief by inhaling hot steam," she added.

In a similar study in the same journal, researchers found the desire for pain relief was one of the main reasons why sore-throat patients demand antibiotics. They concluded that it may be preferable to treat such patients with pain medications instead of antibiotics.

In most sinusitis cases, De Sutter believes that doctors should resist patient demand for antibiotics. "Doctors should explain to patients that antibiotics do not make a difference in the speed of recovery and can cause side effects," De Sutter said. "In our trial, diarrhea was more frequent with antibiotics. Other known side effects include nausea, oral or vaginal mold or yeast infection, allergic reactions and colitis."

The over-prescription of antibiotics, especially in children, also can cause the upper respiratory tract to become colonized with antibiotic-resistant bacteria such as S. pneumoniae, De Sutter said. "These resistant bacteria may cause infections that are more difficult to treat and may be passed on to other people."

"This is an interesting study because it looked at a large population of people with acute sinusitis," said Dr. David Sherris, chairman of otolaryngology at the University at Buffalo in New York.

"Most people do not need antibiotic therapy unless symptoms persist for more than seven to 10 days," Sherris said. "Plain X-rays of the sinuses add little or nothing to the diagnosis and treatment of acute sinusitis."

But that doesn't mean that imaging is of no value in sinusitis cases, he added. With prolonged or recurrent sinusitis or complications, computed tomography (CT) is the test of choice and works well, he noted.

"Early referral to an otolaryngologist is indicated in the most severe cases or where symptoms are out of proportion with findings," Sherris said. "The specialist can perform nasal endoscopy and accurately assess the most subtle CT scan findings."

Although the new study confirms some observations that Sherris has made during years of clinical practice, it would have been stronger if it had used the symptom system from the American Academy of Otolaryngology Head and Neck Surgery, Sherris said. "It is more complete than the one presented in this article, and though not infallible, is better to diagnose acute sinusitis."

Sherris also faulted the researchers' choice of antibiotics. "Amoxicillin, unless used in very high doses, is not a good first line antibiotic in acute sinusitis," he said. "Amoxicillin-clavulanate [augmentin] is a better choice, and is now generic in the United States. If there is an allergy to penicillin, physicians should consider azithromycin or a respiratory quinolone."

http://www.nlm.nih.gov/medlineplus/news/fullstory_42783.html


编辑:蓝色幻想

编辑: 张靖

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