今日の臨床サポート

誤嚥性肺炎

著者: 相野田祐介 東京医科大学八王子医療センター感染症科/日比谷クリニック渡航者外来/東京都立松沢病院感染症科

監修: 具芳明 東京医科歯科大学大学院医歯学総合研究科 統合臨床感染症学分野

著者校正/監修レビュー済:2021/07/07
参考ガイドライン:
  1. 米国胸部学会(ATS)/米国感染症学会(IDSA):成人市中肺炎診断治療ガイドライン 2019(https://www.idsociety.org/practice-guideline/community-acquired-pneumonia-cap-in-adults/
患者向け説明資料

概要・推奨   

  1. 誤嚥性肺炎の抗菌薬は、明らかな嫌気性菌の関与が考慮される状況(肺化膿症・膿胸)などの所見がある場合には、β-ラクタマーゼ産生型嫌気性菌カバーのあるものを選択することが推奨されている(推奨度2)
  1. メトロニダゾール単剤の治療は推奨されていない。メトロニダゾールを用いる場合には、必ず口腔内レンサ球菌などに感受性のある薬剤([ペニシリンG[PCG]やアモキシシリン[AMPC]など)を併用する必要がある(推奨度3)
  1. 誤嚥性肺炎の予防目的での経皮内視鏡下胃瘻造設術(percutaneous endoscopic gastrostomy、PEG)実施は、単独では明らかなエビデンスがないため推奨されない(推奨度3)
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要とな
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧には
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契 約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要と なります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必 要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要とな
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要と
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
相野田祐介 : 特に申告事項無し[2021年]
監修:具芳明 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行った(変更なし)。

病態・疫学・診察

疾患情報  
  1. 誤嚥性肺炎とは、細菌が唾液や胃液とともに肺に流れ込んで生じる肺炎である。誤嚥が背景にある状態の肺炎では、常に考慮する。
  1. 国際的に定められた明確な診断基準はないが、肺炎全体の20~35%、市中肺炎の5~15%が誤嚥性肺炎と考えられるという報告もある。
  1. 国内では「嚥下性肺疾患の診断と治療に関する研究班」が、肺炎(画像上、肺野に浸潤影を認める+発熱や炎症反応上昇や気道症状のうち2つ以上)に加えて明らかな誤嚥が確認されたり誤嚥物が気道から引けたりした場合を「確実例」とし、項目がすべてそろわない場合や嚥下機能障害の可能性がある場合などを「ほぼ確実例」や「疑い例」としている。
  1. 誤嚥のエピソードだけで安易に誤嚥性肺炎と判断しない。特に胃酸の誤嚥に伴う肺障害は通常抗菌薬不要で24~48時間で軽快する。
  1. 誤嚥のみにとらわれず、背景(市中肺炎なのか院内肺炎なのか)を考慮して、口腔内・消化管内常在菌のみでなく、市中肺炎起因菌による肺炎の可能性や院内肺炎起因菌による肺炎の可能性も常に考慮する。
  1. 胃酸など消化管内容物の誤嚥による化学性の肺炎との鑑別が困難な場合かつ重症例で治療を始めた場合でも、治療開始後、感染症らしくなければ抗菌薬中止を検討する。
 
誤嚥性肺炎のイメージ図

出典

問診・診察のポイント  
  1. 誤嚥リスクの確認。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

最新のエビデンスに基づいた二次文献データベース「今日の臨床サポート」。
常時アップデートされており、最新のエビデンスを各分野のエキスパートが豊富な図表や処方・検査例を交えて分かりやすく解説。日常臨床で遭遇するほぼ全ての症状・疾患から薬剤・検査情報まで瞬時に検索可能です。

まずは15日間無料トライアル
本サイトの知的財産権は全てエルゼビアまたはコンテンツのライセンサーに帰属します。私的利用及び別途規定されている場合を除き、本サイトの利用はいかなる許諾を与えるものでもありません。 本サイト、そのコンテンツ、製品およびサービスのご利用は、お客様ご自身の責任において行ってください。本サイトの利用に基づくいかなる損害についても、エルゼビアは一切の責任及び賠償義務を負いません。 また、本サイトの利用を以て、本サイト利用者は、本サイトの利用に基づき第三者に生じるいかなる損害についても、エルゼビアを免責することに合意したことになります。  本サイトを利用される医学・医療提供者は、独自の臨床的判断を行使するべきです。本サイト利用者の判断においてリスクを正当なものとして受け入れる用意がない限り、コンテンツにおいて提案されている検査または処置がなされるべきではありません。 医学の急速な進歩に鑑み、エルゼビアは、本サイト利用者が診断方法および投与量について、独自に検証を行うことを推奨いたします。

文献 

著者: Ryo Momosaki, Hideo Yasunaga, Hiroki Matsui, Hiromasa Horiguchi, Kiyohide Fushimi, Masahiro Abo
雑誌名: Arch Phys Med Rehabil. 2015 Feb;96(2):205-9. doi: 10.1016/j.apmr.2014.09.014. Epub 2014 Oct 7.
Abstract/Text OBJECTIVE: To clarify the effect of early rehabilitation by physical therapists on in-hospital mortality among elderly patients with aspiration pneumonia.
DESIGN: A retrospective cohort study.
SETTING: A total of 1161 acute-care hospitals across Japan.
PARTICIPANTS: Consecutive patients (age, 70-100 y) (N=68,584) from July 2010 to March 2012 in the Japanese Diagnosis Procedure Combination inpatient database with aspiration pneumonia on admission who underwent early physical therapist-guided rehabilitation (n=16,835) and who did not undergo rehabilitation administered by physical therapists (n=51,749).
INTERVENTIONS: Early rehabilitation was defined as physical rehabilitation administered by a physical therapist, initiated within 3 days of admission, and undertaken for at least 7 days.
MAIN OUTCOME MEASURE: Thirty-day in-hospital mortality.
RESULTS: The 30-day in-hospital mortality rates were 5.1% and 7.1% in the early rehabilitation group and the control group, respectively. The multivariable logistic regression model showed that the early rehabilitation group had a significantly lower in-hospital mortality rate (odds ratio, .71; 95% confidence interval [CI], .64-.79; P<.001). Among patients without severe pneumonia, we found no significant difference in mortality rates between patients who underwent early rehabilitation and those who did not undergo rehabilitation by physical therapists. The instrumental variable analysis confirmed that early rehabilitation was associated with a reduced risk for in-hospital mortality (risk difference, -1.9%; 95% CI, -2.3% to -1.5%; P<.001; number needed to treat, 53 [95% CI, 43-67]).
CONCLUSIONS: The data suggest that early rehabilitation by physical therapists was associated with a reduction in 30-day in-hospital mortality rates in elderly patients with severe aspiration pneumonia.

Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID 25301440  Arch Phys Med Rehabil. 2015 Feb;96(2):205-9. doi: 10.10・・・
著者: F Gudiol, F Manresa, R Pallares, J Dorca, G Rufi, J Boada, X Ariza, A Casanova, P F Viladrich
雑誌名: Arch Intern Med. 1990 Dec;150(12):2525-9.
Abstract/Text Thirty-seven adult patients with anaerobic lung infections (27 lung abscesses and 10 necrotizing pneumonias) were submitted to transthoracic needle-aspiration and/or bronchoscopic specimen brush cultures before therapy and thereafter in all cases considered to be failures. Patients were randomly assigned to receive either clindamycin, 600 mg intravenously every 6 hours, or penicillin G, 2 million U every 4 hours for no less than 8 days, until clinical and radiological improvement became apparent. Treatment was continued orally with clindamycin, 300 mg every 6 hours, or penicillin V, 750 mg every 6 hours, until completing a minimum of 4 weeks. Ten of the 47 anaerobes initially isolated from the lung (nine Bacteroides melaninogenicus and one Bacteroides capillosus) were resistant to penicillin, but none were resistant to clindamycin. Five of the nine patients harboring these penicillin-resistant Bacteroides received penicillin, and all failed to respond to therapy. Overall, eight of the 18 patients in the penicillin group and one of 19 in the clindamycin group failed to respond to therapy. These drugs were equally well tolerated in both groups. The presence of penicillin-resistant Bacteroides is a frequent cause of penicillin failure in patients with anaerobic lung infections. In this setting, clindamycin appears to be the current therapy of choice for initial treatment.

PMID 1978771  Arch Intern Med. 1990 Dec;150(12):2525-9.
著者: Maiko Kadowaki, Yoshiki Demura, Shiro Mizuno, Daisuke Uesaka, Shingo Ameshima, Isamu Miyamori, Takeshi Ishizaki
雑誌名: Chest. 2005 Apr;127(4):1276-82. doi: 10.1378/chest.127.4.1276.
Abstract/Text BACKGROUND: As the number of elderly people has increased in Japan, the occurrence of aspiration pneumonia has also increased. Guidelines for the treatment of pneumonia have been proposed, in which the use of antibiotics, such as beta-lactam plus beta-lactamase inhibitor, clindamycin, and carbapenem, has been recommended as effective against anaerobic bacteria in the treatment of aspiration pneumonia. However, to our knowledge, a prospective comparison of these antibiotics regarding their clinical efficacy in aspiration pneumonia has not been performed.
STUDY OBJECTIVES: We compared the effects of IV administration of a half dose of ampicillin/sulbactam (SBT/ABPC), normal dose of SBT/ABPC, IV clindamycin, and IV panipenem/betamiprom (PAPM/BP) for treatment of mild-to-moderate aspiration pneumonia in elderly patients.
DESIGN: Randomized prospective study.
PATIENTS: One hundred adult patients with compatible signs and symptoms of aspiration pneumonia.
ASSESSMENTS: Patients were assessed before, during, and after treatment regarding symptoms, as well as results of laboratory values, chest radiograph examinations, and sputum bacterial cultures.
RESULTS: We found few differences between the groups regarding cure rate, duration of IV medication, and occurrence of adverse effects with the tested therapies. However, clindamycin therapy was less expensive and was associated with a lower rate of posttreatment occurrence of methicillin-resistant Staphylococcus aureus.
CONCLUSIONS: Clindamycin therapy for mild-to-moderate aspiration pneumonia is clinically effective, and provides economic advantages as compared to SBT/ABPC or PAPM/BP therapy.

PMID 15821205  Chest. 2005 Apr;127(4):1276-82. doi: 10.1378/chest.127.・・・
著者: C A Perlino
雑誌名: Arch Intern Med. 1981 Oct;141(11):1424-7.
Abstract/Text Metronidazole has important in vitro bactericidal activity against strict anaerobic bacteria and has been used successfully in the treatment of infection due to these organisms. In this randomized study, the efficacy of metronidazole was compared with clindamycin in the treatment of patients with anaerobic lung abscess or necrotizing pneumonia. Six patients with lung abscesses and one with necrotizing pneumonia received metronidazole; six patients with lung abscesses, three with necrotizing pneumonia, and one with pneumonia and empyema received clindamycin. Three patients with lung abscesses and one with necrotizing pneumonia failed to respond to metronidazole treatment. One clindamycin-treated patient died of causes unrelated to antibiotic therapy. The results of this study suggest that metronidazole treatment of anaerobic pulmonary infections is less effective than currently available therapy.

PMID 7025777  Arch Intern Med. 1981 Oct;141(11):1424-7.
著者: C V Sanders, B J Hanna, A C Lewis
雑誌名: Am Rev Respir Dis. 1979 Aug;120(2):337-43.
Abstract/Text Using metronidazole in oral dosages of 1.5 to 2 g daily, we treated 13 adults who had anaerobic pleuropulmonary infections, including 11 with lung abscess, one with necrotizing pneumonia, and one with thoracic empyema. Five patients (four with lung abscess and one with necrotizing pneumonia) were cured. The lung abscesses of 5 patients did not respond. For 3 patients (one with epigastric distress who refused metronidazole, one with undrained empyema, and one who died while receiving metronidazole), therapy could not be evaluated. Side effects included leukopenia (2 patients), leukopenia and neutropenia (one), neutropenia (one), dark urine (two), bitter taste (two), and epigastric distress (one). In light of our findings, metronidazole is not uniformly effective in the treatment of anaerobic pleuropulmonary infections.

PMID 475154  Am Rev Respir Dis. 1979 Aug;120(2):337-43.
著者: M S Dennis, S C Lewis, C Warlow, FOOD Trial Collaboration
雑誌名: Lancet. 2005 Feb 26-Mar 4;365(9461):764-72. doi: 10.1016/S0140-6736(05)17983-5.
Abstract/Text BACKGROUND: Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients' outcomes at 6 months.
METHODS: The FOOD trials consist of three pragmatic multicentre randomised controlled trials, two of which included dysphagic stroke patients. In one trial, patients enrolled within 7 days of admission were randomly allocated to early enteral tube feeding or no tube feeding for more than 7 days (early versus avoid). In the other, patients were allocated percutaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcome was death or poor outcome at 6 months. Analysis was by intention to treat.
FINDINGS: Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 hospitals in 15 countries into the early versus avoid trial. Early tube feeding was associated with an absolute reduction in risk of death of 5.8% (95% CI -0.8 to 12.5, p=0.09) and a reduction in death or poor outcome of 1.2% (-4.2 to 6.6, p=0.7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increase in risk of death of 1.0% (-10.0 to 11.9, p=0.9) and an increased risk of death or poor outcome of 7.8% (0.0 to 15.5, p=0.05).
INTERPRETATION: Early tube feeding might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiation of PEG feeding in dysphagic stroke patients.

PMID 15733717  Lancet. 2005 Feb 26-Mar 4;365(9461):764-72. doi: 10.101・・・
著者: Mark B Loeb, Marissa Becker, Angela Eady, Cindy Walker-Dilks
雑誌名: J Am Geriatr Soc. 2003 Jul;51(7):1018-22.
Abstract/Text A systematic review was conducted to assess the effectiveness of the following interventions for prevention of aspiration pneumonia (AP) in older adults: compensatory strategy/positioning changes, dietary interventions, pharmacologic therapies, oral hygiene, and tube feeding. Data sources included a key word search of the MEDLINE, EMBASE, Cochrane Library, CINAHL, and HealthSTAR databases and hand searches of six journals. Reference lists of relevant primary and review articles were searched. Studies included were randomized, controlled trials (RCTs) enrolling adults aged 65 and older at risk of and assessed for AP. Two investigators extracted data on population, intervention, outcomes, and methodological quality. Of the 17 identified RCTs, eight met the selection criteria, two addressed dietary management or compensatory swallowing, two assessed pharmacological therapies, one assessed oral hygiene, and three assessed tube feeding. None of the eight trials reported use of blinding, and allocation concealment was unclear in five. Use of amantadine prevented pneumonia in one trial of nursing home residents. The antithrombotic agent cilostazol prevented AP in another trial but resulted in excessive bleeding. Insufficient data exist to determine the effectiveness of positioning strategies, modified diets, oral hygiene, feeding tube placement, or delivery of food in preventing AP. Considering how common the problem of AP is in older adults, larger, high-quality RCTs on the effectiveness of preventive interventions are warranted.

PMID 12834525  J Am Geriatr Soc. 2003 Jul;51(7):1018-22.
著者: Andre C Kalil, Mark L Metersky, Michael Klompas, John Muscedere, Daniel A Sweeney, Lucy B Palmer, Lena M Napolitano, Naomi P O'Grady, John G Bartlett, Jordi Carratalà, Ali A El Solh, Santiago Ewig, Paul D Fey, Thomas M File, Marcos I Restrepo, Jason A Roberts, Grant W Waterer, Peggy Cruse, Shandra L Knight, Jan L Brozek
雑誌名: Clin Infect Dis. 2016 Sep 1;63(5):575-82. doi: 10.1093/cid/ciw504.
Abstract/Text It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.

© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.
PMID 27521441  Clin Infect Dis. 2016 Sep 1;63(5):575-82. doi: 10.1093/・・・
著者: L Silvestri, H K F van Saene, A Casarin, G Berlot, A Gullo
雑誌名: Anaesth Intensive Care. 2008 May;36(3):324-38.
Abstract/Text Meta-analyses of randomised controlled trials of selective digestive decontamination have clinical outcome measures, mainly pneumonia and mortality. This meta-analysis has a microbiological endpoint and explores the impact of selective digestive decontamination on Gram-negative and Gram-positive carriage and severe infections. We searched electronic databases, Cochrane Register of Controlled Trials, previous meta-analyses and conference proceedings with no language restrictions. We included randomised controlled trials which compared the selective digestive decontamination protocol with no treatment or placebo. Three reviewers independently applied selection criteria, performed the quality assessment and extracted the data. The outcome measures were carriage and severe infection due to Gram-negative and Gram-positive bacteria. Odds ratios were pooled with the random effect model. Fifty-four randomised controlled trials comprising 9473 patients were included; 4672 patients received selective digestive decontamination and 4801 were controls. Selective digestive decontamination significantly reduced oropharyngeal carriage (odds ratio [OR] 0.13, 95% confidence interval [CI] 0.07 to 0.23), rectal carriage (OR 0.15, 95% CI 0.07 to 0.31), overall infection (OR 0.17, 95% CI 0.10 to 0.28), lower respiratory tract infection (OR 0.11, 95% CI 0.06 to 0.20) and bloodstream infection (OR 0.35, 95% CI 0.21 to 0.67) due to Gram-negative bacteria. Reduction in Gram-positive carriage was not significant. Gram-positive lower airway infections were significantly reduced (OR 0.52, 95% CI 0.34 to 0.78). Gram-positive bloodstream infections were not significantly increased (OR 1.03, 95% CI 0.75 to 1.41). The association of parenteral and enteral antimicrobials was superior to enteral antimicrobials in reducing carriage and severe infections due to Gram-negative bacteria. This meta-analysis confirms that selective digestive decontamination mainly targets Gram-negative bacteria; it does not show a significant increase in Gram-positive infection.

PMID 18564793  Anaesth Intensive Care. 2008 May;36(3):324-38.
著者: M Sukumaran, M J Granada, H W Berger, M Lee, T A Reilly
雑誌名: Mt Sinai J Med. 1980 Jul-Aug;47(4):335-40.
Abstract/Text
PMID 6997729  Mt Sinai J Med. 1980 Jul-Aug;47(4):335-40.
著者: M Lee, M Sukumaran, H W Berger, T A Reilly
雑誌名: Mt Sinai J Med. 1980 Jul-Aug;47(4):341-6.
Abstract/Text
PMID 6997730  Mt Sinai J Med. 1980 Jul-Aug;47(4):341-6.
著者: J E Wolfe, R C Bone, W E Ruth
雑誌名: Am J Med. 1977 Nov;63(5):719-22.
Abstract/Text Forty-three of 88 patients suspected of having aspirated gastric contents met stringent criteria for the diagnosis of aspiration of gastric contents. One group of 25 patients was treated with corticosteroids and a second group of 18 patients was treated without corticosteroids. The two groups were clinically well matched according to all variables except that the patients who did not receive corticosteroids had greater hypoxemia and a higher incidence of infiltration on chest roentgenogram which would indicate that these patients had received greater pulmonary injury from aspiration of gastric contents. Thirty-two per cent of the patients who received steroids died compared to 28 per cent of those who did not receive steroids. Although the mortality rate difference was not statistically significant, the occurrence of gram-negative pneumonia five days after aspiration was more frequent in the patients treated with steroids.

PMID 930946  Am J Med. 1977 Nov;63(5):719-22.
著者: Joshua P Metlay, Grant W Waterer, Ann C Long, Antonio Anzueto, Jan Brozek, Kristina Crothers, Laura A Cooley, Nathan C Dean, Michael J Fine, Scott A Flanders, Marie R Griffin, Mark L Metersky, Daniel M Musher, Marcos I Restrepo, Cynthia G Whitney
雑誌名: Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST.
Abstract/Text Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.

PMID 31573350  Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. d・・・
著者: George Dimopoulos, Dimitrios K Matthaiou, Drosos E Karageorgopoulos, Alexandros P Grammatikos, Zoe Athanassa, Matthew E Falagas
雑誌名: Drugs. 2008;68(13):1841-54.
Abstract/Text BACKGROUND: The evidence for traditionally recommended 7- to 14-day duration of antibacterial therapy for community-acquired pneumonia (CAP) is not well established.
OBJECTIVES: We endeavoured to assess the effectiveness and safety of shorter than traditionally recommended antibacterial therapy for CAP.
METHODS: We performed a meta-analysis of randomized controlled trials (RCTs) comparing short- (< or = 7 days) versus long- (> or = 2 days difference) course therapy for CAP with the same antibacterial regimens, in the same daily dosages.
RESULTS: Five RCTs involving adults (including outpatients and inpatients who did not require intensive care) and two RCTs involving children (aged 2-59 months, residing in developing countries) were included. All RCTs were double-blind and assessed patients with CAP of mild to moderate severity. No differences were found between short- (adults 3-7 days; children 3 days) and long- (adults 7-10 days; children 5 days) course regimens (adults - amoxicillin, cefuroxime, ceftriaxone, telithromycin and gemifloxacin; children - amoxicillin) regarding clinical success at end-of-therapy (six RCTs; 5107 patients [1095 adults, 4012 children]; fixed-effect model [FEM]; odds ratio [OR] = 0.89; 95% CI 0.74, 1.07), clinical success at late follow-up, microbiological success, relapses, mortality (seven RCTs; 5438 patients; FEM; OR = 0.57; 95% CI 0.23, 1.43), adverse events (five RCTs; 3214 patients; FEM; OR = 0. 90; 95% CI 0.72, 1.13) or withdrawals as a result of adverse events. No differences were found in subset analyses of adults or children, and of patients treated with no more than 5-day short-course regimens versus at least 7-day long-course regimens.
CONCLUSION: No difference was found in the effectiveness and safety of short- versus long-course antimicrobial treatment of adult and paediatric patients with CAP of mild to moderate severity.

PMID 18729535  Drugs. 2008;68(13):1841-54.
著者: Jonathan Z Li, Lisa G Winston, Dan H Moore, Stephen Bent
雑誌名: Am J Med. 2007 Sep;120(9):783-90. doi: 10.1016/j.amjmed.2007.04.023.
Abstract/Text PURPOSE: There is little consensus on the most appropriate duration of antibiotic treatment for community-acquired pneumonia. The goal of this study is to systematically review randomized controlled trials comparing short-course and extended-course antibiotic regimens for community-acquired pneumonia.
METHODS: We searched MEDLINE, Embase, and CENTRAL, and reviewed reference lists from 1980 through June 2006. Studies were included if they were randomized controlled trials that compared short-course (7 days or less) versus extended-course (>7 days) antibiotic monotherapy for community-acquired pneumonia in adults. The primary outcome measure was failure to achieve clinical improvement.
RESULTS: We found 15 randomized controlled trials matching our inclusion and exclusion criteria comprising 2796 total subjects. Short-course regimens primarily studied the use of azithromycin (n=10), but trials examining beta-lactams (n=2), fluoroquinolones (n=2), and ketolides (n=1) were found as well. Of the extended-course regimens, 3 studies utilized the same antibiotic, whereas 9 involved an antibiotic of the same class. Overall, there was no difference in the risk of clinical failure between the short-course and extended-course regimens (0.89, 95% confidence interval [CI], 0.78-1.02). In addition, there were no differences in the risk of mortality (0.81, 95% CI, 0.46-1.43) or bacteriologic eradication (1.11, 95% CI, 0.76-1.62). In subgroup analyses, there was a trend toward favorable clinical efficacy for the short-course regimens in all antibiotic classes (range of relative risk, 0.88-0.94).
CONCLUSIONS: The available studies suggest that adults with mild to moderate community-acquired pneumonia can be safely and effectively treated with an antibiotic regimen of 7 days or less. Reduction in patient exposure to antibiotics may limit the increasing rates of antimicrobial drug resistance, decrease cost, and improve patient adherence and tolerability.

PMID 17765048  Am J Med. 2007 Sep;120(9):783-90. doi: 10.1016/j.amjmed・・・

ページ上部に戻る

戻る

さらなるご利用にはご登録が必要です。

こちらよりご契約または優待日間無料トライアルお申込みをお願いします。

(※トライアルご登録は1名様につき、一度となります)


ご契約の場合はご招待された方だけのご優待特典があります。

以下の優待コードを入力いただくと、

契約期間が通常12ヵ月のところ、14ヵ月ご利用いただけます。

優待コード: (利用期限:まで)

ご契約はこちらから