阿奇霉素用于学龄前儿童喘息？不推荐
本文评述一项多中心随机试验，对象为因中重度喘息发作就诊于急诊科的18–59月龄学龄前儿童。研究比较阿奇霉素治疗与对照，评估对喘息发作的治疗价值。结论不支持在该类患儿中使用阿奇霉素。
要点
- 学龄前儿童喘息发作中常检出肺炎链球菌、卡他莫拉菌、流感嗜血杆菌。
- AZ-SWED试验纳入18–59月龄因中重度喘息就诊急诊的儿童。
- 现有证据不支持常规使用阿奇霉素治疗学龄前儿童喘息发作。
核心结论
- 对于因中重度喘息发作就诊于急诊科的18–59月龄学龄前儿童，不推荐使用阿奇霉素治疗。
研究设计与样本
- 本文为对AZ-SWED试验的评述，该试验由PECARN试验研究组开展，为多中心随机试验。
- AZ-SWED试验随机纳入因中重度喘息发作就诊于急诊科的18–59月龄学龄前儿童。
主要发现
- 观察性研究在喘息发作患儿的鼻咽或咽拭子中常同时检出病毒和细菌。
- 喘息发作中常检出的细菌包括肺炎链球菌、卡他莫拉菌和流感嗜血杆菌。
- 病毒一直被认为是喘息发作的主要病因，但细菌检出的临床意义尚不明确。
- AZ-SWED试验结果不支持在学龄前儿童中重度喘息发作时使用阿奇霉素。
关键数值与推荐
- AZ-SWED试验纳入标准为18–59月龄、因中重度喘息发作就诊于急诊科的学龄前儿童。
临床怎么用
- 临床面对学龄前儿童中重度喘息发作时，不建议常规使用阿奇霉素。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
There are several observational studies in pre-school children with wheezing that have identified the presence of virus and bacterial on nasopharyngeal/throat swabs during wheezy episodes. The virus has always been considered the primary culprit. But what about Streptococcus pneumoniae , Moraxella catarrhalis or Haemophilus influenzae , which are often identified? Is there any role in treating them during a flare up of the wheezing? The evidence remains unclear. A consortium of emergency and pulmonology physicians has made a great effort to power a study sufficiently to answer this question. The Pediatric Emergency Care Applied Research Network (PECARN) Azithromycin Therapy in Preschoolers with a Severe Wheezing Episode Diagnosed at the Emergency Department (AZ-SWED) Trial Study Group (KR Denninghoff, et al. N Engl J Med 2026;395:753-64. DOI: 10.1056/NEJMoa2516505) published data from a large multicentre trial, where they randomly assigned patients aged 18–59 months who presented to an emergency department with a moderate-to-severe episode of...
引用
- Archives of Disease in Childhood：Azithromycin for preschool wheezing? No
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。