评价保妇康治疗细菌性阴道病的疗效

目的评价保妇康栓治疗细菌性阴道病的疗效.方法门诊100例细菌性阴道病(BV)患者随机分成两组,A组(50例)使用保妇康栓治疗,B组(50例)使用甲硝唑栓治疗,用药10天,停药1周后复查.结果保妇康栓治疗BV有效率88.0%,甲硝唑栓治疗BV有效率92.0%,二者差异无显著性(P＞0.05).结论保妇康栓是治疗BV的安全有效药物,痊愈率及总有效率与甲哨唑无明显差异,值得临床推广.     

Antibiotic treatment of bacterial vaginosis to prevent preterm delivery: Systematic review and individual participant data meta-analysis

Background

Bacterial vaginosis (BV) increases preterm delivery (PTD) risk, but treatment trials showed mixed results in preventing PTD.

Objectives

Determine, using individual participant data (IPD), whether BV treatment during pregnancy reduced PTD or prolonged time-to-delivery.

Data Sources

Cochrane Systematic Review (2013), MEDLINE, EMBASE, journal searches, and searches (January 2013–September 2022) (“bacterial vaginosis AND pregnancy”) of (i) clinicaltrials.gov ; (ii) Cochrane Central Register of Controlled Trials; (iii) World Health Organization International Clinical Trials Registry Platform Portal; and (iv) Web of Science (“bacterial vaginosis”).

Study Selection and Data Extraction

Studies randomising asymptomatic pregnant individuals with BV to antibiotics or control, measuring delivery gestation. Extraction was from original data files. Bias risk was assessed using the Cochrane tool. Analysis used “one-step” logistic and Cox random effect models, adjusting gestation at randomisation and PTD history; heterogeneity by I². Subgroup analysis tested interactions with treatment. In sensitivity analyses, studies not providing IPD were incorporated by “multiple random-donor hot-deck” imputation, using IPD studies as donors.

Results

There were 121 references (96 studies) with 23 eligible trials (11,979 participants); 13 studies (6915 participants) provided IPD; 12 (6115) were incorporated. Results from 9 (4887 participants) not providing IPD were imputed. Odds ratios for PTD for metronidazole and clindamycin versus placebo were 1.00 (95% CI 0.84, 1.17), I² = 62%, and 0.59 (95% CI 0.42, 0.82), I² = 0 before; and 0.95 (95% CI 0.81, 1.11), I² = 59%, and 0.90 (95% CI: 0.72, 1.12), I² = 0, after imputation. Time-to-delivery did not differ from null with either treatment. Including imputed IPD, there was no evidence that either drug was more effective when administered earlier, or among those with a PTD history.

Conclusions

Clindamycin, but not metronidazole, was beneficial in studies providing IPD, but after imputing data from missing IPD studies, treatment of BV during pregnancy did not reduce PTD, nor prolong pregnancy, in any subgroup or when started earlier in gestation.     

Duration of antimicrobial therapy after video-assisted thoracoscopic surgery for thoracic empyema and complicated parapneumonic effusion: A single-center study

BackgroundThere are no evidence-based reports on the proper duration of antimicrobial therapy following video-assisted thoracoscopic surgery debridement (VATS-D) in thoracic empyema (TE) or complicated parapneumonic effusion (PPE). This study aimed to investigate the optimal duration of antimicrobial therapy after VATS-D.MethodsBetween January 2011 and December 2019, 33 patients corresponding to American College of Chest Physicians (ACCP) category 3 or 4 undergoing VATS-D were included. The times until the body temperature (BT) was confirmed to be less than 37.5 °C and 37.0 °C, white blood cell count (WBC) less than 10,000/μl, segmented neutrophils (seg) less than 80%, and C-reactive protein (CRP) level less than 25% of the preoperative value were retrospectively analyzed.ResultsThe median time from the onset of TE/PPE to surgery was 13 days. The median durations of preoperative and postoperative antibiotic use were five and seven days, respectively. Major complications occurred in four cases (three and one cases of respiratory failure and cerebral infarction, respectively). The median postoperative hospital stay was 14 days. Recurrence or progression to chronic empyema was seen in four cases. The median numbers of days until the conditions were met were three days for BT < 37.5 °C, six days for BT < 37.0 °C, four days for WBC<10,000, seven days for seg<80% and seven days for CRP<25%.ConclusionsThe proper duration of antimicrobial therapy after VATS-D for TE/PPE is approximately three to seven days. Urgent VATS-D may shorten the total antibiotic usage.