So what's wrong with penicillin for strep throat?
So what's wrong with penicillin for strep throat?
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那么青霉素治疗链球菌性咽喉炎有什么问题呢？
作者：
S. Shulman;M. Gerber
“改变是一回事，进步是另一回事。伯特兰·罗素（1872-1970）
A组β-溶血性链球菌（GABHS）咽炎是儿童最常见的感染之一。50年来，青霉素一直是治疗这种感染的首选药物，目前美国儿科学会、1美国心脏协会、2世界卫生组织、3和美国传染病学会4都推荐使用青霉素。尽管细菌耐药性增加的问题是我们这个时代最重要的感染性疾病问题之一，但值得注意的是，GABHS从未对任何青霉素或头孢菌素产生耐药性，或在至少50年内显示青霉素最小抑制浓度的任何增加。定期重新考虑青霉素是否应该继续作为治疗的选择，或者是否可以提出令人信服的理由来改变对不同药物的推荐，头孢菌素。在《儿科学》4月号上，凯西和皮奇切罗7对1970年至1999年期间进行的35项临床试验进行了荟萃分析，其中头孢菌素与青霉素治疗GABHS咽炎进行了比较。7基于该分析，他们得出结论，头孢菌素应作为“GABHS扁桃体咽炎的治疗选择”。然而，他们的报告有几个重大缺陷，使人们无法接受他们的结论的有效性。
荟萃分析是“一种统计分析，它结合或整合了分析师认为是'可结合'的几个临床试验的结果。8随着时间的推移，荟萃分析研究被认为已经改善了临床试验的实施和报告，包括消除了主要的偏倚来源，例如，发生在研究中的偏倚。
地址通信斯坦福大学T。Shulman，医学博士，西北大学范伯格医学院儿童纪念医院传染病科，芝加哥，IL 60614。电子邮件：sshulman{at}nwu.edu
“Change is one thing, progress is another.” Bertrand Russell (1872–1970)
Group A β-hemolytic streptococcal (GABHS) pharyngitis is one of the most common infections of children. For 5 decades, penicillin has been the treatment of choice for this infection, and it is currently recommended by the American Academy of Pediatrics,1 the American Heart Association,2 the World Health Organization,3 and the Infectious Diseases Society of America.4 Amoxicillin is often utilized in young children in place of penicillin V because of taste considerations. Although the problem of increasing antimicrobial resistance among bacteria is one of the most important infectious disease issues of our time,5 GABHS remarkably have never developed resistance to any of the penicillins or cephalosporins or shown any increase in penicillin minimal inhibitory concentrations over at least 5 decades.6 However, it is appropriate to reconsider periodically whether penicillin should remain the treatment of choice or whether a compelling argument can be made to change the recommendation to a different agent such as a cephalosporin. In the April issue of Pediatrics , Casey and Pichichero7 presented a meta-analysis of 35 clinical trials performed between 1970 and 1999 in which a cephalosporin was compared with penicillin for the treatment of GABHS pharyngitis.7 Based on this analysis, they concluded that cephalosporins should be added as a “treatment of choice for GABHS tonsillopharyngitis.” However, their report has several major flaws that make it impossible to accept the validity of their conclusion.
Meta-analysis is “a statistical analysis which combines or integrates the results of several clinical trials considered by the analyst to be ‘combinable.’”8 Over time, meta-analysis research is thought to have led to improved conduct and reporting of clinical trials, including the removal of major sources of bias that, for example, occur in studies that are …
Address correspondence to Stanford T. Shulman, MD, Division of Infectious Diseases, Children’s Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL 60614. E-mail: sshulman{at}nwu.edu
血液学和肿瘤学的荟萃分析。
DOI：
10.1016/s0889-8588(05)70322-1
发表时间：
2000
期刊：
Hematology/oncology clinics of North America
影响因子：
--
作者：
Ioannidis,JP;Schmid,CH;Lau,J
通讯作者：
Lau,J