西药治疗鼻窦炎无效
From 自明知识
鼻窦炎目前常用治疗措施无效
美国医疗协会杂志12月第5期发表的一篇文章提示,目前采用的治疗鼻窦炎的治疗措施是无效的.
目前,鼻窦炎的诊断与治疗往往没有充分的临床信息保障,因为来自对临床患者进行的微生物病因学研究非常有限.在致病菌不清的情况下,英国与美国约9成的鼻窦炎患者应用抗生素治疗,这种过度治疗导致抗生素的大量使用,并对抗生素耐受产生了深远的影响.类固醇类药物也应用于急性鼻窦炎的治疗,但针对其有效性的研究同样非常有限.
针对此, 英国南安普顿大学的Ian G. Williamson博士及其课题组进行了一项双盲,随机,安慰剂对照试验,以确定阿莫西林与布的奈德对于急性上颌窦炎的疗效.240名非复发性鼻窦炎患者入选了该试验,并在2001.11-2005.11的试验期间接受58全科治疗.患者被随机分配入以下4组之一:
1. 抗生素与鼻类固醇组(阿莫西林500 mg,每日3次,疗程7天; 布的奈德,每个鼻孔200μg,,每日1次.疗程10天)
2. 抗生素安慰剂与鼻类固醇组;
3. 抗生素与鼻类固醇安慰剂组;
4. 抗生素安慰剂与类固醇安慰剂组.
研究结果如下:
--29%接受阿莫西林治疗的患者症状持续超过10天;
--36%未接受阿莫西林治疗的患者症状持续超过10天;
--31.4%接受布的奈德治疗的患者症状持续超过10天;
--31.4%未接受布的奈德治疗的患者症状持续超过10天.
最终的研究结果表明, 对于伴有急性细菌性鼻窦炎典型特征的患者,目前的常用治疗措施(抗生素与类固醇药物单独或联合应用)对鼻窦炎症状的严重程度,持续时间以及病情的自然过程均无明显影响.类固醇药物对于症状较轻的患者可能有效.
Placebo As Good As Common Treatments For Sinus Infections
A placebo is likely to be just as effective as common acute sinusitis treatments involving a topical steroid and an antibiotic, according to an article published in the Journal of the American Medical Association (JAMA), 5th December issue.
Sinus infection (acute sinusitis) is often diagnosed and treated without clinical information, even though it is a common clinical problem which has symptoms similar to those found in other illnesses, the authors explain.
92% of patients in the UK and 85-98% of those in the USA are prescribed antibiotics, even though a bacterial cause is uncertain. The writers say "Because there are no satisfactory studies of microbiological etiology from typical primary care patient practices, wide-scale overtreatment is likely occurring."
The widespread use of antibiotics may be having an impact on raised antibiotic resistance rates in the community. While topical steroids are commonly used to treat acute sinusitis, research on their effectiveness has been limited.
Ian G. Williamson, M.D., of the University of Southampton, England, and team carried out a double-blind randomized placebo-controlled trial to find out how effective amoxicillin (an antibiotic) and budesonide (a topical steroid) were for the treatment of acute maxillary sinusitis (rhinosinusitis - inflammation of the nasal cavity and sinuses).
240 adult patients were included in the trial. They all had non-recurrent sinusitis and were being treated at 58 GP (General Practitioner) practices, during the period Nov 2001 - Nov 2005.
They were randomly selected into one of four groups:
1. antibiotic and nasal steroid (500 mg of amoxicillin 3 times per day for 7 days and 200 μg of budesonide in each nostril once per day for 10 days) 2. placebo antibiotic and nasal steroid 3. antibiotic and placebo nasal steroid 4. placebo antibiotic and placebo nasal steroid
The researchers found that:
-- 29% of those receiving amoxicillin had symptoms lasting more than ten days -- 36% of patients not receiving amoxicillin had symptoms lasting for more than ten days -- 31.4% of those receiving topical budesonide had symptoms lasting for more than ten days -- 31.4% of those not receiving budesonide had symptoms lasting for more than ten days
Further analysis found that nasal steroids were much more effective for those whose symptoms were less severe at baseline.
The researchers wrote "Our main conclusions are that among patients with the typical features of acute bacterial sinusitis, neither an antibiotic nor a topical steroid alone or in combination are effective in altering the symptom severity, the duration, or the natural history of the condition. Topical steroids are likely to be effective in those with such features but who have less severe symptoms at presentation to the physician," the authors write.