單純表皮膿腫切開引流術(shù)后抗生素使用指南兼容版

1、單純表皮膿腫切開引流術(shù)后抗生素使用指南,Antibiotics after incision and drainage for uncomplicated skin abscesses: a clinical practice guideline,發(fā)表時間：2018 年 2 月 6 日全名：英國醫(yī)學(xué)雜志（British medical journal）,四大頂級醫(yī)學(xué)期刊,1.新英格蘭醫(yī)學(xué)雜志（new England journal

2、of medicine）2.柳葉刀（lancet）3.美國醫(yī)學(xué)會雜志（journal of American medical association）4.英國醫(yī)學(xué)雜志（British medical journal）,IF（影響因子）72.40645.21735.28919.6967,表皮膿腫切開引流術(shù)后是否需要使用抗生素？,抗生素的選擇,復(fù)方新諾明 V.S. 克林霉素,指南適用范圍,該指南適用人群

3、為幾乎所有皮膚膿腫患者，包括：（1）既適用于成人，又適用于兒童；（2）病原菌尚未能明確，甚至不能查明者也適用；（3）無論是小的膿腫還是大的膿腫均適用；（4）可應(yīng)用于急診及社區(qū)基層醫(yī)療場合。,以下情況該指南并不適用：（1）有證據(jù)顯示存在系統(tǒng)性疾病（膿毒血癥）；（2）深層組織感染；（3）免疫功能低下狀態(tài)；（4）未行切除或引流治療的皮膚膿腫患者。,數(shù)據(jù)來源,,,1.Daum RS, Miller LG, Immergluck L

4、, et al. DMID 07-0051 Team. A placebo controlled trial of antibiotics for smaller skin abscesses. N Engl J Med 2017;376:2545-55. 2. Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim sulfamethoxazole versus placeb

5、o for uncomplicated skin abscess. N Engl J Med 2016;374:823-32. 3. Duong M, Markwell S, Peter J, Barenkamp S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pe

6、diatric patient. Ann Emerg Med 2010;55:401-7 4. Llera JL, Levy RC. Treatment of cutaneous abscess: a double-blind clinical study. Ann Emerg Med 1985;14:15-9. 5. Schmitz GR, Bruner D, Pitotti R, et al. Randomized cont

7、rolled trial of trimethoprim-sulfamethoxazole for uncomplicated skin abscesses in patients at risk for community-associated methicillin-resistant6.Staphylococcus aureus infection. Ann Emerg Med 2010;56:283-7. Macfie J,

8、 Harvey J. The treatment of acute superficial abscesses: aprospective clinical trial. Br J Surg 1977;64:264-6 7. Giordano PA, Elston D, Akinlade BK, et al. Cefdinir vs. cephalexin for mild to moderate uncomplicated skin

9、 and skin structure infections in adolescents and adults. Curr Med Res Opin 2006;22:2419-28. 8. Miller LG, Daum RS, Creech CB, et al. DMID 07-0051 Team. Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicate

10、d skin infections. N Engl J Med 2015;372:1093-103 9. Keiichi F, Eiichiro N, Hisashi T. Clinical evaluation of cefadroxil in the treatment of superficial suppurativve skin and soft tissue infections – a double-blind stu

11、dy comparing to L-cephalexin. Clin Eval 1982;10:175-200. 10. Rajendran PM, Young D, Maurer T, et al. Randomized, double-blind,placebo-controlled trial of cephalexin for treatment of uncomplicated skinabscesses in a pop

12、ulation at risk for community-acquired methicillinresistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2007;51:4044-8.,(Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT0073002

13、8.),(Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00729937.),(Funded by the National Institute of Allergy and Infectious Diseases and the National Center for Advancin

14、g Translational Sciences, National Institutes of Health; ClinicalTrials.gov number, NCT00730028.),結(jié)論,首先第一條推薦在皮膚膿腫切除 / 引流術(shù)后加用抗菌藥物是一條弱推薦。第二條，當(dāng)確定要加用抗菌藥物時，不推薦選用一二代頭孢菌素是一條強推薦。第三條講在復(fù)方新諾明與克林霉素之間，首先前者是弱推薦。據(jù)原文描述之所以優(yōu)選復(fù)方新諾明是因為其