抗生素英文课件精品ElectiveAntibiotics for Cystic .pptVIP

Elective Antibiotics for Cystic Fibrosis Esther Sim Summary of Case CW, a 15 year old girl with cystic fibrosis Multiple admissions (current is 64th) Pseudomonas Aeruginosa colonised Just started on regular 6/52 admissions for “tune ups” Clinical Question What is the evidence for “tune up” admissions? OR (in EBM language) Do elective admissions for antibiotics in CF patients result in an improved clinical status? PICO Format P = Cystic Fibrosis patients I = Elective admission for antibiotics C = Symptomatic admission for antibiotics O = Improvement in clinical status Lung function Hospitalisations Exacerbations Survival Searching for Evidence Cochrane Library Search string: “Cystic fibrosis AND antibiotic AND (elective OR prophylactic)” 3 hits PubMed Search string: “Cystic fibrosis AND antibiotic AND (elective OR prophylactic)” 41 hits Systematic Review Breen L, Aswani N. Elective versus symptomatic intravenous antibiotic therapy for cystic fibrosis. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD002767. DOI: 10.1002CD002767. JACKPOT! Or so I thought… Not all that glitters is gold… Comprehensive and thorough search strategy Cochrane Trials register, MEDLINE, EMBASE Yielded 4 studies 2 studies excluded as did not met inclusion criteria 1 compared inhaled Vs IV antibiotics 1 abstract compared single Vs combination antibiotics Hmm…. 2 studies included in final analysis (n = 79) Brett 1992 – looked at effect of value of serum IgG titres against P aeruginosa N = 19 Elborn 2000 – compared elective Vs symptomatic antibiotics N = 60 Study – Elborn 2000 Elborn J et al; Elective versus symptomatic antibiotic treatment in cystic fibrosis patients with chronic Pseudomonas infection of the lungs; 2000; Thorax 55(5):355-358. Was the assignment of patients to treatments randomised? Central coordinating centre Randomised to Elective antibiotics – every 3 months 10-14 days with antipseudomal antibiotics Symptomatic antibi