抽象
Due to the risk of delaying antibiotherapy, NSAID should not be given if an ongoing infection hasn't been ruled outhttp://ow.ly/LCQMZ
来自作者:
我们注意到E. Crawford和同事的信并感谢他们在我们工作中的兴趣。
我们的回顾研究[1]发现患有肺炎球菌群落(ICU)的患者患有肺炎球菌的肺炎(CAP),我们能够将两个不同的群体区分开于暴露于非甾体类抗炎药(NSAID)。令人惊讶的是,患有NSAIDS的患者群体大幅上涨(平均年龄在20岁)和更健康的情况下比那些没有。违反直视,更年轻,更健康的患者团体需要ICU和器官失败支持与病人和更老的人类似的方式。我们提出了暴露于NSAID的假设可能会导致这种情况,可能是通过延迟迹象和延迟抗生素处方。因为我们的结果符合其他传染性环境中NSAID的危险的其他数据[2], such as soft tissue infections [3], our conclusion was one of caution regarding the use of NSAID in the context of an infection in progress.
E. Crawford和同事认为,我们的数据不支持我们的结论,并且对于已经存在的胸腔积液已经提供了NSAID的结论。
他们错误地说明抗生素处方没有延迟。相反,我们发现暴露于NSAID的患者在初始医学咨询后4.5天接受抗生素,而未接受NSAID的人初期接受抗生素,初步磋商后2.5天。有趣的是,两组症状发作到初步咨询的时间在两组中相同,表明症状的严重程度和整体介绍的程度在开始时相似。在一个持续的传染过程中,这种延迟可能会产生严重的后果,并且可能会解释,与E. Crawford和同事的假设相反,仍然在暴露患者中的更大胸腔受累,尽管我们同意我们的结果并不明确证明NSAIDs的证明责任。我们还承认我们研究的回顾性和限制。
Nonetheless, NSAIDs are not the innocuous medication E. Crawford and co-workers suggest they arei.e.他们可以在社区中广泛开场。与NSAID相关的过度死亡超过了美国的六千例患者[4] and costs associated with side effects from NSAIDs reaches €59 million in the Netherlands annually [5]。
We are not “extrapolating data from intensive care populations to guide treatment of all patients in the wider community”, since the data we gathered came from the community!
And guiding treatment is precisely a key issue! Surprisingly (or not…), NSAIDs do not appear in the USA [6.],欧洲[7] or French [8] guidelines on management of CAP and lower respiratory tract infections. They solely appear in the British Thoracic Society guidelines, and only after paracetamol “for symptomatic treatment of pleuritic chest pain of pneumonia treated in the community“[9]。Importantly, paracetamol is recommended with a weak level of evidence (D) but NSAIDs appear without any evidence whatsoever. In addition, use of NSAIDs do not appear in the BTS guidelines for the management of pleural infection [10]。Hence, there is no data to support the use of NSAIDs as an adjunct therapy for CAP.
社区中的诊断并不是一件容易的任务,特别是在年轻人身上。我们的担忧是,正是因为它们具有更年轻,更健康,具有更少的合并症,它们越少(或更少及时)抗生素。迄今为止,缓解痛苦是必要和可尊重的目标,但迄今为止,没有研究表明NSAIDS在肺氨基甲酰胺中的优越性,患有肺炎的胸腔胸部疼痛,而有充足的证据证明延迟抗疗法的不利后果。
Caution warrants that general practitioners should avoid NSAIDs in patients with clinical signs suggestive of pneumonia. One should be wary of over interpreting inexistent data.
脚注
利益冲突:披露可以在本文的在线版本旁边找到www.qdcxjkg.com
- 收到March 25, 2015.
- AcceptedApril 5, 2015.
- 版权所有©2015