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目的基于疾病负担,循证评价与遴选我国乡镇卫生院治疗社区获得性肺炎(CAP)的药物。方法按照本系列研究之二制定的方法、标准和流程,参考国内外循证或权威指南的推荐意见,并结合国内相关临床研究证据,循证评价并推荐治疗CAP药物。数据处理采用RevMan 5.1、GRADEpro 3.6等软件。结果①共纳入指南12个(国外10个,国内2个),其中10个为循证制定,2个为结合专家意见制定;②阿莫西林克拉维酸钾治疗CAP有效率77.1%,不良反应发生率18.8%,主要为胃肠道反应、皮疹;哌拉西林/他唑巴vs.头孢呋辛有效率和细菌清除率分别为92.1%vs.89%和88.9%vs.85.5%;阿奇霉素与头孢呋辛的疗效无差异[RR=0.98,95%CI(0.9,1.06)],但阿奇霉素退热时间[MD=–0.98,95%CI(–1.24,–0.55)]和咳嗽消失时间[MD=–1.36,95%CI(–1.94,–0.78)]更快;头孢曲松、头孢噻肟、莫西沙星和左氧氟沙星有效率均>80%,且莫西沙星疗效更优[RR=1.08,95%CI(1.02,1.13),P=0.004];美罗培南有效率和细菌清除率为90%和83.3%,不良反应发生率为3.33%,主要为腹泻。结论①强推荐阿莫西林、阿莫西林克拉维酸钾、氨苄西林舒巴坦、哌拉西林/他唑巴坦、多西环素、阿奇霉素、克拉霉素、头孢呋辛、头孢曲松、头孢噻肟、左氧氟沙星、莫西沙星、厄他培南、美罗培南、亚胺培南和万古霉素;②弱推荐青霉素G、环丙沙星和红霉素;③建议针对常见病原菌,当地抗生素敏感性标准,CAP严重程度及患者危险因素选择最优抗生素。
Objective To evaluate and select evidence-based medicine for community-acquired pneumonia (CAP) in township hospitals in China based on the burden of disease. Methods According to the methods, standards and procedures developed in this series of studies, refer to the recommendations of evidence-based or authoritative guidelines at home and abroad, and combine the evidence of clinical research in China with evidence-based evidence to recommend and recommend the treatment of CAP drugs. Data processing using RevMan 5.1, GRADEpro 3.6 and other software. Results ① A total of 12 guidelines were included (10 in abroad and 2 in China), of which 10 were evidence-based and 2 were based on expert opinion. ② The effective rate of amoxicillin and clavulanate in treatment of CAP was 77.1%, adverse reactions The incidence rate was 18.8%, mainly gastrointestinal reactions and skin rash. The effective rates of piperacillin / tazobactar and cefuroxime were 92.1% vs.89% and 88.9% vs.85.5% respectively. The azithromycin and azithromycin There was no difference in the efficacy of cefuroxime [RR = 0.98,95% CI (0.9,1.06)], but the duration of azithromycin withdrawal [MD = -0.98,95% CI -1.24, -0.55] and cough disappearance time = -1.36, 95% CI (-1.94, -0.78)]. The effective rates of ceftriaxone, cefotaxime, moxifloxacin and levofloxacin were all more than 80%, and moxifloxacin had better curative effect [RR = 1.08, 95% CI (1.02, 1.13), P = 0.004]. Meropenem had an effective rate of 90% and bacterial clearance of 83.3%. The incidence of adverse reactions was 3.33%, mainly diarrhea. Conclusion ①It is strongly recommended that amoxicillin, amoxicillin potassium clavulanate, ampicillin sulbactam, piperacillin / tazobactam, doxycycline, azithromycin, clarithromycin, cefuroxime, ceftriaxone, Cefotaxime, levofloxacin, moxifloxacin, ertapenem, meropenem, imipenem and vancomycin; ② weak recommended penicillin G, ciprofloxacin and erythromycin; ③ recommended for common pathogens, local antibiotics Sensitivity criteria, CAP severity and patient risk factors choose the best antibiotics.