WANG Yingqiang , LI Honghao , LI Youping , LI Cuicui , YANG Zongxia , SHEN Jiantong , LI Xiao , YANG Xiaoyan , WANG Li , LI Xianglian
  • Chinese Evidence-Based Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China;
LI Youping, Email: yzmylab@hotmail.com
Township health center; Essential medicine; Evidence-based evaluation and selection; Community-acquired pneumonia
10.7507/1672-2531.20120145
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Objective 　To evaluate and select essential medicine for community-acquired pneumonia (CAP) using evidence-based methods based on the burden of disease.
Methods 　By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence.
Results 　(1) Eleven guidelines were included (nine foreign guidelines, two domestic guidelines; nine based on evidence, two based on expert consensus). For CAP, amoxicillin  amp; clavulanate potassium had efficiencies of 77.1% and an incidence of 18.8% as to adverse reaction that mainly included gastrointestinal reaction, skin rashes, etc. Piperacillin/tazobactam had an efficiency of 92.1% and a bacterial clearance rate of 88.9%. Cefuroxime had an efficiency of 89% and a bacterial clearance rate of 85.5%. There was no statistical significance between azithromycin and cefuroxime for CAP (RR=0.98, 95%CI 0.9 to 1.06); however, azithromycin was superior to cefuroxime in shortening fever-relief time (MD=–0.98, 95%CI –1.24 to –0.55) and cough-relief time (MD=–1.36, 95%CI –1.94 to –0.78). Efficiencies of ceftriaxone, cefotaxime, moxifloxacin and lavofloxacin were all more than 80% and among the three, moxifloxacin was the most efficient (RR=1.08, 95%CI 1.02 to 1.13, P=0.004). Meropenem had an efficiency of 90%, a bacterial clearance rate of 83.3% and an incidence of 3.33% as to adverse reaction that mainly included diarrhea.
Conclusion 　(1) We offer a b recommendation for antibiotics such as amoxicillin, amoxicillin  amp; clavulanate potassium, ampicillin/sulbactam, piperacillin/tazobactam, doxycycline, azithromycin, clarithromycin, cefuroxim, ceftriaxone, cefotaxime, lavofloxacin, moxifloxacin, ertapenem, meropenem, imipenem and vancocin. (2) We offer a weak recommendation for penicillin G, ciprofloxacin and erythromycin. (3) We propose that doctor should choose optimal antibiotics based on commonly-seen pathogenic bacteria that cause CAP, local criteria of antibiotic susceptibility, severity of CAP, and risk factors of patients.

Citation： WANG Yingqiang,LI Honghao,LI Youping,LI Cuicui,YANG Zongxia,SHEN Jiantong,LI Xiao,YANG Xiaoyan,WANG Li,LI Xianglian. Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 6. Community-Acquired Pneumonia. Chinese Journal of Evidence-Based Medicine, 2012, 12(8): 895-906. doi: 10.7507/1672-2531.20120145 Copy

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