Impact of first-line vs second-line antibiotics for the treatment of acute uncomplicated sinusitis
Impact of first-line vs second-line antibiotics for the treatment of acute uncomplicated sinusitis
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DOI：
10.1001/jama.286.15.1849
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发表时间：
2001-10-17
影响因子：
120.7
通讯作者：
Goggin, A
中科院分区：
文献类型：
--
作者：
Piccirillo, JF;Mager, DE;Goggin, A
背景研究表明，使用较新和较昂贵的(二线)抗生素而不是较旧和较便宜的(一线)抗生素对缓解急性鼻窦炎症状几乎没有好处。目的比较一线和二线抗生素治疗成人急性非复杂性鼻窦炎的疗效和成本。设计、设置和患者回顾队列研究，使用包含人口统计、临床(国际疾病分类，第九次修订)、治疗和收费信息的药物数据库，从1996年7月1日至1997年6月30日期间，对29102名被诊断为急性鼻窦炎的成人患者进行初步抗生素治疗。主要结果指标在首次抗生素治疗后28天内没有额外声称使用抗生素，是否声称需要第二种抗生素，急性鼻窦炎的严重并发症及直接收费和使用。结果本次研究共开出17种抗生素。大多数患者(59.5%)接受了1种一线抗生素。总成功率为90.4%(95%可信区间为90.0%~90.8%)。接受一线抗生素治疗的17329例患者的治疗成功率为90.1%，而应用二线抗生素治疗的11773例患者的治疗成功率为90.8%，差异有0.7%(95%CI，0.01%~1.40%；P
Context Studies suggest little benefit in relief of acute sinusitis symptoms from the use of newer and more expensive (second-line) antibiotics instead of older and less expensive (first-line) antibiotics. However, researchers have failed to include development of complications and cost of care in their analyses.Objective To compare the effectiveness and cost of first-line with second-line antibiotics for the treatment of acute uncomplicated sinusitis in adults.Design, Setting, and Patients Retrospective cohort study using a pharmaceutical database containing demographic, clinical (International Classification of Diseases, Ninth Revision), treatment, and charge information for 29102 adults with a diagnosis of acute sinusitis receiving initial antibiotic treatment between July 1, 1996, and June 30, 1997.Main Outcome Measures Absence of additional claim for an antibiotic in the 28 days after the initial antibiotic, presence of a claim for a second antibiotic, serious complications of sinusitis, and direct charges and use for the acute sinusitis treatment.Results There were 17 different antibiotics prescribed in this study. The majority (59.5%) of patients received 1 of the first-line antibiotics. The overall success rate was 90.4% (95% confidence interval [CI], 90.0%-90.8%). The success rate for the 17 329 patients who received a first-line antibiotic was 90.1% and for the 11773 patients who received a second-line antibiotic was 90.8%, a difference of 0.7% (95% CI, 0.01%-1.40%; P