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BMJ:儿童应慎用达菲和乐感清

来源:新华网 2009-08-20 09:56

英国一项最新研究说,儿童如果感染甲型H1N1流感病毒,应该慎用达菲以及乐感清治疗,因为从总体来看,这类抗病毒药物对儿童弊大于利。

英国牛津大学研究人员8月10日在《英国医学杂志》(BMJ)上报告说,他们在普通流感季节中调查了2629名儿童服用达菲和乐感清治疗或预防流感的情况。这些儿童年龄不超过12岁。

结果发现,达菲或乐感清可以帮助减少儿童流感症状持续的时间,但最多也只能减少一天半时间。对于哮喘、耳部感染等并发症,这些药物则基本没有效果,也不会减少患病儿童对使用抗生素的需要。而且,儿童服用达菲后出现呕吐的风险升高,这会引发脱水等对儿童来说非常危险的并发症。

研究人员因此认为达菲和乐感清对儿童来说弊大于利,应该慎用,而且他们认为,这一结论同样适用于目前正在流行的甲型H1N1流感。

目前在英国以及其他许多国家,医生一般都使用达菲和乐感清治疗甲型H1N1流感患者。英国甚至广泛散发达菲等抗流感药物,用以治疗甲型H1N1流感和控制其传播。

领导这项研究的牛津大学马修·汤普森教授说,英国政府应重新审视对所有出现甲型H1N1流感症状患者普遍使用达菲的做法,采取一种“更保守谨慎”的防控策略。研究小组指出,目前多数甲型H1N1流感患者症状都较轻微,大范围使用抗病毒药物可能会导致甲型H1N1流感病毒出现广泛抗药性。(生物谷Bioon.com)

生物谷推荐原始出处:

BMJ 2009;339:b3172, doi: 10.1136/bmj.b3172

Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials

Matthew Shun-Shin, academic foundation year 2 doctor1, Matthew Thompson, senior clinical scientist2, Carl Heneghan, clinical lecturer2, Rafael Perera, university lecturer in medical statistics2, Anthony Harnden, university lecturer in general practice2, David Mant, professor of general practice2

1 Kadoorie Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU, 2 Oxford University Department of Primary Health Care, Rosemary Rue Building, Headington, Oxford OX3 7LF

Objective To assess the effects of the neuraminidase inhibitors oseltamivir and zanamivir in treatment of children with seasonal influenza and prevention of transmission to children in households.

Design Systematic review and meta-analysis of data from published and unpublished randomised controlled trials.

Data sources Medline and Embase to June 2009, trial registries, and manufacturers and authors of relevant studies.

Review methods Eligible studies were randomised controlled trials of neuraminidase inhibitors in children aged 12 in the community (that is, not admitted to hospital) with confirmed or clinically suspected influenza. Primary outcome measures were time to resolution of illness and incidence of influenza in children living in households with index cases of influenza.

Results We identified four randomised trials of treatment of influenza (two with oseltamivir, two with zanamivir) involving 1766 children (1243 with confirmed influenza, of whom 55-69% had influenza A), and three randomised trials for postexposure prophylaxis (one with oseltamivir, two with zanamivir) involving 863 children; none of these trials tested efficacy with the current pandemic strain. Treatment trials showed reductions in median time to resolution of symptoms or return to normal activities, or both, of 0.5-1.5 days, which were significant in only two trials. A 10 day course of postexposure prophylaxis with zanamivir or oseltamivir resulted in an 8% (95% confidence interval 5% to 12%) decrease in the incidence of symptomatic influenza. Based on only one trial, oseltamivir did not reduce asthma exacerbations or improve peak flow in children with asthma. Treatment was not associated with reduction in overall use of antibiotics (risk difference –0.30, –0.13 to 0.01). Zanamivir was well tolerated, but oseltamivir was associated with an increased risk of vomiting (0.05, 0.02 to 0.09, number needed to harm=20).

Conclusions Neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics. Their effects on the incidence of serious complications, and on the current A/H1N1 influenza strain remain to be determined.

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