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抗生素按照化學(xué)結(jié)構(gòu)可以分為：喹諾酮類抗生素、β-內(nèi)酰胺類抗生素、大環(huán)內(nèi)酯類、氨基糖苷類抗生素等；按照用途可以分為抗細(xì)菌抗生素、抗真菌抗生素、抗腫瘤抗生素、抗病毒抗生素及其他微生物藥物（如麥角菌產(chǎn)生的具有藥理活性的麥角堿類，有收縮子宮的作用）等。
有的抗生素抗菌范圍很廣，稱廣譜抗生素；相反，則稱窄譜抗生素。比如氯霉素、四環(huán)素對(duì)于革蘭陽(yáng)性菌、陰性菌、立克次體、衣原體、支原體、螺旋體等都有不同程度的抑制作用，所以被稱為廣譜抗生素。而青霉素只對(duì)革蘭陽(yáng)性菌有抗菌作用，而對(duì)革蘭陰性菌、立克次體、結(jié)核桿 菌等無(wú)效，故屬于窄譜抗生素。
下面來(lái)看一則最新的關(guān)于廣譜VS窄譜抗生素用于兒童呼吸道感染的研究報(bào)道： 廣域與窄譜抗生素聯(lián)合治療急性呼吸道感染患兒的失效率、不良事件和生活質(zhì)量分析
背景 急性呼吸道感染在兒童疾病發(fā)病率中占很大比例，而廣譜抗生素用于兒童急性呼吸道感染的治療也在增加。目前，業(yè)界對(duì)于廣譜治療相比窄譜治療是否可以改善療效，尚無(wú)定論。
實(shí)驗(yàn)?zāi)康?/span> 比較廣譜和窄譜抗生素治療小兒急性呼吸道感染的療效。
實(shí)驗(yàn)設(shè)計(jì)與受試者 一個(gè)回顧性隊(duì)列研究以評(píng)估臨床結(jié)果；一個(gè)前瞻性隊(duì)列研究，以評(píng)估患兒主導(dǎo)的結(jié)果。 受試者為年齡在6個(gè)月至12歲之間診斷為急性呼吸道感染的患兒,他們來(lái)自賓夕法尼亞州和新澤西州的初級(jí)兒童護(hù)理中心，這些患兒在2015年1月至2016年4月期間，按規(guī)定口服抗生素。對(duì)兩組患者分別進(jìn)行分層和傾向分析，以解釋臨床醫(yī)師和病人級(jí)特征的混淆。
主要結(jié)果和措施 在回顧性隊(duì)列中，主要結(jié)果為診斷后14天出現(xiàn)治療失敗和不良反應(yīng)。在前瞻性隊(duì)列中，主要的結(jié)果是生活質(zhì)量，其他患兒主導(dǎo)的結(jié)果，以及患兒自述的不良反應(yīng)。
實(shí)驗(yàn)結(jié)果 30159名兒童在回顧性隊(duì)列（19179例發(fā)生急性中耳炎;6746例發(fā)生A組鏈球菌性咽炎;4234例發(fā)生急性鼻竇炎），其中4307例(14%)使用廣譜抗生素，其中包括阿莫西林-克拉維酸，頭孢菌素，和大環(huán)內(nèi)脂類。廣譜治療與較低的治療失敗率沒有明顯關(guān)系(廣譜抗生素的治療失敗率為3.4%，窄譜抗生素為3.1%);風(fēng)險(xiǎn)差異完全匹配分析,0.3%(95% CI,0.4%-0.9%))。有2472名兒童分配到了前瞻性隊(duì)列研究（1100例發(fā)生急性中耳炎；705例發(fā)生A組鏈球菌性咽炎；667例發(fā)生急性鼻竇炎），其中868例(35%)使用廣譜抗生素。廣譜抗生素與稍差的兒童生活質(zhì)量相關(guān)(廣譜抗生素90.2分，窄譜抗生素91.5分);得分差異完全匹配分析,1.4%(95% CI,??0.4%- 2.4%))但與其他患兒主導(dǎo)的結(jié)果無(wú)關(guān)。廣譜治療與臨床醫(yī)生記錄的不良事件風(fēng)險(xiǎn)較高有關(guān)(廣譜抗生素3.7%，窄譜抗生素2.7%;完全匹配分析的風(fēng)險(xiǎn)差異，1.1%[95% CI,0.4% - 1.8%])和患兒自述的不良反應(yīng)同樣相關(guān)(廣譜抗生素的35.6%,窄譜抗生素的25.1%;完全匹配分析的風(fēng)險(xiǎn)差異，12.2%[95% CI,7.3%-17.2%]。
結(jié)論 在患有急性呼吸道感染的兒童中，廣譜抗生素與較窄譜抗生素相比，與較好的臨床結(jié)果或患兒主導(dǎo)的結(jié)果沒有明顯相關(guān)性，但與較高的不良事件發(fā)生率相關(guān)。這些數(shù)據(jù)支持對(duì)大多數(shù)急性呼吸道感染兒童應(yīng)使用窄譜抗生素。
Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections
Importance Acute respiratory tract infections account for the majority of antibiotic exposure in children, and broad-spectrum antibiotic prescribing for acute respiratory tract infections is increasing. It is not clear whether broad-spectrum treatment is associated with improved outcomes compared with narrow-spectrum treatment.
Objective To compare the effectiveness of broad-spectrum and narrow-spectrum antibiotic treatment for acute respiratory tract infections in children.
Design, Setting, and Participants A retrospective cohort study assessing clinical outcomes and a prospective cohort study assessing patient-centered outcomes of children between the ages of 6 months and 12 years diagnosed with an acute respiratory tract infection and prescribed an oral antibiotic between January 2015 and April 2016 in a network of 31 pediatric primary care practices in Pennsylvania and New Jersey. Stratified and propensity score–matched analyses to account for confounding by clinician and by patient-level characteristics, respectively, were implemented for both cohorts.
Main Outcomes and Measures In the retrospective cohort, the primary outcomes were treatment failure and adverse events 14 days after diagnosis. In the prospective cohort, the primary outcomes were quality of life, other patient-centered outcomes, and patient-reported adverse events.
Results Of 30?159 children in the retrospective cohort (19?179 with acute otitis media; 6746, group A streptococcal pharyngitis; and 4234, acute sinusitis), 4307 (14%) were prescribed broad-spectrum antibiotics including amoxicillin-clavulanate, cephalosporins, and macrolides. Broad-spectrum treatment was not associated with a lower rate of treatment failure (3.4% for broad-spectrum antibiotics vs 3.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 0.3% [95% CI, ?0.4% to 0.9%]). Of 2472 children enrolled in the prospective cohort (1100 with acute otitis media; 705, group A streptococcal pharyngitis; and 667, acute sinusitis), 868 (35%) were prescribed broad-spectrum antibiotics. Broad-spectrum antibiotics were associated with a slightly worse child quality of life (score of 90.2 for broad-spectrum antibiotics vs 91.5 for narrow-spectrum antibiotics; score difference for full matched analysis, ?1.4% [95% CI, ?2.4% to ?0.4%]) but not with other patient-centered outcomes. Broad-spectrum treatment was associated with a higher risk of adverse events documented by the clinician (3.7% for broad-spectrum antibiotics vs 2.7% for narrow-spectrum antibiotics; risk difference for full matched analysis, 1.1% [95% CI, 0.4% to 1.8%]) and reported by the patient (35.6% for broad-spectrum antibiotics vs 25.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 12.2% [95% CI, 7.3% to 17.2%]).
Conclusions and Relevance Among children with acute respiratory tract infections, broad-spectrum antibiotics were not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, and were associated with higher rates of adverse events. These data support the use of narrow-spectrum antibiotics for most children with acute respiratory tract infections.
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來(lái)自： 昵稱41082923 > 《醫(yī)學(xué)》
