社区获得性肺炎抗生素治疗的持续时间

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now Pub Date : 2025-07-30 DOI:10.1016/j.idnow.2025.105125

Aurélien Dinh , David Lebeaux

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引用次数: 0

摘要

先前的指南建议对48-72小时后出现临床改善的社区获得性肺炎（CAP）患者进行5天抗生素治疗，对其他简单形式的CAP患者进行7天抗生素治疗。三项荟萃分析和两项随机双盲试验证实，与长期治疗（7天）相比，短期（3-7天）的抗生素治疗无劣效性。一项涉及很少合并症的年轻患者的试验表明，在D3临床改善的情况下，用阿莫西林治疗3天是有效的。第二项试验，涉及有更多合并症的老年患者，验证了通过注射β -内酰胺对稳定在D3的患者进行为期三天的抗生素治疗。2025指南采用了一种以实现临床稳定性为前提的个性化方法：非严重或中度CAP稳定在D3时的3天抗生素治疗，稳定在D5时的5天抗生素治疗，其他非复杂形式的社区获得性肺炎的7天抗生素治疗。只有当出现并发症时才需要延长治疗时间。随后的建议旨在减少抗生素暴露，同时保持社区获得性肺炎的最佳治疗效果。

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Duration of antibiotic treatment for community-acquired pneumonia

Previous guidelines have recommended 5-day antibiotic treatment for community-acquired pneumonia (CAP) patients manifesting clinical improvement after 48–72 h, and seven-day treatment for other, uncomplicated forms of CAP.

Three meta-analyses and two randomized double-blind trials have confirmed the non-inferiority of short (3–7 days) as compared to long treatments (>7 days). A trial involving young patients with few comorbidities demonstrated the efficacy of 3-day treatment by amoxicillin in the event of clinical improvement at D3. A second trial, which involved older patients with more comorbidities, validated three-day antibiotic treatment by injectable beta-lactams for patients stabilized at D3.

The 2025 guidelines adopt a personalized approach premised on attainment of clinical stability: three days of antibiotic treatment for non-severe or moderate CAP stabilized at D3, five days when stability is achieved by D5, and seven days for other, uncomplicated forms of community-acquired pneumonia. Only when complications occur is prolonged duration indicated.

The ensuing recommendations are aimed at reducing antibiotic exposure while maintaining optimal efficacy of treatment for community-acquired pneumonia.

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