Mass drug administration of antibacterials: weighing the evidence regarding benefits and risks.
Mass drug administration of antibacterials: weighing the evidence regarding benefits and risks.
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DOI：
10.1186/s40249-022-00998-6
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发表时间：
2022-06-30
影响因子：
8.1
通讯作者：
中科院分区：
文献类型：
--
作者：
大规模药物管理(MDA)是一种通过在社区广泛提供药物来改善人群健康的战略。我们对文献进行了综述，以总结与抗菌药丙二醛相关的益处和潜在风险，主要集中在阿奇霉素上，因为它拥有最大的证据基础。来自随机对照试验(RCT)的高质量证据表明，丙二醛-阿奇霉素在降低雅司病和沙眼的感染率方面是有效的。此外，随机对照试验表明，在某些低资源环境中，丙二醛-阿奇霉素降低了五岁以下儿童的死亡率，这些环境的儿童死亡率在基线水平上很高。这种死亡率的下降似乎随着时间的推移而持续，一年两次的丙二醛-阿奇霉素对1岁的 <； 儿童的影响最大。此外，观察数据表明，皮肤和软组织感染、风湿性心脏病、急性呼吸系统疾病、腹泻疾病和疟疾等感染都可以用阿奇霉素治疗，因此偶然受到丙二醛-阿奇霉素的影响。然而，丙二醛-阿奇霉素降低儿童死亡率的机制尚不清楚。在丙二醛-阿奇霉素儿童死亡率研究中进行的口头尸检产生了相互矛盾的数据，无法回答这个问题。除了好处，丙二醛-阿奇霉素还有几个重要的风险。丙二醛-阿奇霉素可能导致的直接不良反应包括胃肠道副作用、特发性肥厚性幽门狭窄、心血管副作用以及哮喘和肥胖等慢性病的增加。抗生素耐药性也是与丙二醛-阿奇霉素相关的风险，已有报告显示革兰氏阳性菌和肠道细菌都存在耐药性。此外，存在与其他抗菌药，特别是克林霉素交叉耐药的风险。有证据表明，在某些资源不足的情况下，丙二醛-阿奇霉素方案可能有利于减少沙眼、雅司病和5岁 <； 儿童的死亡率。然而，在决定如何、何时以及在哪里实施这些计划时，需要考虑重大的潜在风险。在实施了丙二醛-阿奇霉素计划的社区中，需要强大的系统来监测益处以及不良反应和抗菌素耐药性。
Mass drug administration (MDA) is a strategy to improve health at the population level through widespread delivery of medicine in a community. We surveyed the literature to summarize the benefits and potential risks associated with MDA of antibacterials, focusing predominantly on azithromycin as it has the greatest evidence base. High-quality evidence from randomized controlled trials (RCTs) indicate that MDA-azithromycin is effective in reducing the prevalence of infection due to yaws and trachoma. In addition, RCTs suggest that MDA-azithromycin reduces under-five mortality in certain low-resource settings that have high childhood mortality rates at baseline. This reduction in mortality appears to be sustained over time with twice-yearly MDA-azithromycin, with the greatest effect observed in children < 1 year of age. In addition, observational data suggest that infections such as skin and soft tissue infections, rheumatic heart disease, acute respiratory illness, diarrheal illness, and malaria may all be treated by azithromycin and thus incidentally impacted by MDA-azithromycin. However, the mechanism by which MDA-azithromycin reduces childhood mortality remains unclear. Verbal autopsies performed in MDA-azithromycin childhood mortality studies have produced conflicting data and are underpowered to answer this question. In addition to benefits, there are several important risks associated with MDA-azithromycin. Direct adverse effects potentially resulting from MDA-azithromycin include gastrointestinal side effects, idiopathic hypertrophic pyloric stenosis, cardiovascular side effects, and increase in chronic diseases such as asthma and obesity. Antibacterial resistance is also a risk associated with MDA-azithromycin and has been reported for both gram-positive and enteric organisms. Further, there is the risk for cross-resistance with other antibacterial agents, especially clindamycin. Evidence shows that MDA-azithromycin programs may be beneficial for reducing trachoma, yaws, and mortality in children < 5 years of age in certain under-resourced settings. However, there are significant potential risks that need to be considered when deciding how, when, and where to implement these programs. Robust systems to monitor benefits as well as adverse effects and antibacterial resistance are warranted in communities where MDA-azithromycin programs are implemented.
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影响因子：
3.3
作者：
Bloch, Evan M.;Coles, Christian L.;West, Sheila K.
通讯作者：
West, Sheila K.
DOI：
10.4269/ajtmh.2011.11-0046
发表时间：
2011-10-01
影响因子：
3.3
作者：
Coles, Christian L.;Seidman, Jessica C.;West, Sheila
通讯作者：
West, Sheila
影响因子：
8
作者：
Eberly, Matthew D.;Eide, Matilda B.;Nylund, Cade M.
通讯作者：
Nylund, Cade M.
DOI：
10.4103/ajps.ajps_51_16
发表时间：
2018-01-01
期刊：
African journal of paediatric surgery : AJPS
影响因子：
--
作者：
Ezomike, Uchechukwu Obiora;Ekenze, Sebastian Okwuchukwu;Obianyo, Nene Elsie
通讯作者：
Obianyo, Nene Elsie
影响因子：
5.5
作者：
Chorin, Ehud;Wadhwani, Lalit;Jankelson, Lior
通讯作者：
Jankelson, Lior