Abstract:
OBJECTIVES:To compare the effectiveness of an early switch to oral antibiotics with the standard 7 day course of intravenous antibiotics in severe community acquired pneumonia. DESIGN:Multicentre randomised controlled trial. SETTING:Five teaching hospitals and 2 university medical centres in the Netherlands. PARTICIPANTS:302 patients in non-intensive care wards with severe community acquired pneumonia. 265 patients fulfilled the study requirements. INTERVENTION:Three days of treatment with intravenous antibiotics followed, when clinically stable, by oral antibiotics or by 7 days of intravenous antibiotics. MAIN OUTCOME MEASURES:Clinical cure and length of hospital stay. RESULTS:302 patients were randomised (mean age 69.5 (standard deviation 14.0), mean pneumonia severity score 112.7 (26.0)). 37 patients were excluded from analysis because of early dropout before day 3, leaving 265 patients for intention to treat analysis. Mortality at day 28 was 4% in the intervention group and 6% in the control group (mean difference 2%, 95% confidence interval -3% to 8%). Clinical cure was 83% in the intervention group and 85% in the control group (2%, -7% to 10%). Duration of intravenous treatment and length of hospital stay were reduced in the intervention group, with mean differences of 3.4 days (3.6 (1.5) v 7.0 (2.0) days; 2.8 to 3.9) and 1.9 days (9.6 (5.0) v 11.5 (4.9) days; 0.6 to 3.2), respectively. CONCLUSIONS:Early switch from intravenous to oral antibiotics in patients with severe community acquired pneumonia is safe and decreases length of hospital stay by 2 days. TRIAL REGISTRATION:Clinical Trials NCT00273676 [ClinicalTrials.gov].
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Oosterheert JJ,Bonten MJ,Schneider MM,Buskens E,Lammers JW,Hustinx WM,Kramer MH,Prins JM,Slee PH,Kaasjager K,Hoepelman AIdoi
10.1136/bmj.38993.560984.BEsubject
Has Abstractpub_date
2006-12-09 00:00:00pages
1193issue
7580eissn
0959-8138issn
1756-1833pii
bmj.38993.560984.BEjournal_volume
333pub_type
杂志文章,多中心研究,随机对照试验abstract:OBJECTIVE:To evaluate the immunogenicity and reactogenicity of a new triple S recombinant hepatitis B vaccine in a cohort of healthy people in whom currently licensed hepatitis B vaccines had persistently not induced an immune response. DESIGN:Single centre, randomised, double blind, dose-response study. SETTING:Rese...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.314.7077.329
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVE:To assess the efficacy of a newly developed system for applying continuous or intermittent negative (subatmospheric) extrathoracic pressure in respiratory failure. DESIGN:Uncontrolled clinical trials in infants deteriorating or failing to improve despite standard medical treatment. SETTING:Paediatric and ne...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.299.6710.1253
更新日期:1989-11-18 00:00:00
abstract:OBJECTIVE:To describe the characteristics at birth of children conceived by in vitro fertilisation (IVF) or by gamete intrafallopian transfer (GIFT) and to assess whether they differ from those of children conceived naturally. DESIGN:Survey of children resulting from IVF or GIFT and comparison of their characteristics...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6734.1229
更新日期:1990-05-12 00:00:00
abstract:OBJECTIVE:To compare the prevalence of silent myocardial ischaemia associated with coronary artery disease in diabetic subjects with that in controls of similar age and sex. DESIGN:A controlled study in which subjects with positive findings on exercise electrocardiography, 24 hour electrocardiographic recording, or dy...
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pub_type: 杂志文章
doi:10.1136/bmj.301.6743.92
更新日期:1990-07-14 00:00:00
abstract:OBJECTIVES:To report the sensitivities of the faecal occult blood test, screening episode, and screening programme for colorectal cancer and the benefits of applying a randomised design at the implementation phase of a new public health policy. DESIGN:Experimental design incorporated in public health evaluation using ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.a2261
更新日期:2008-11-20 00:00:00
abstract:OBJECTIVE:To systematically review the accuracy of physicians' clinical predictions of survival in terminally ill cancer patients. DATA SOURCES:Cochrane Library, Medline (1996-2000), Embase, Current Contents, and Cancerlit databases as well as hand searching. STUDY SELECTION:Studies were included if a physician's tem...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.327.7408.195
更新日期:2003-07-26 00:00:00
abstract:OBJECTIVE:To investigate associations between maternal overweight and obesity and infant mortality outcomes, including cause-specific mortality. DESIGN:Population based cohort study. SETTING AND PARTICIPANTS:1,857,822 live single births in Sweden 1992-2010. MAIN OUTCOME MEASURES:Associations between maternal body ma...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.g6572
更新日期:2014-12-02 00:00:00
abstract::Accumulating data indicate that modifications in diet may reduce the risk of cancer by as much as one third and possibly by as much as two thirds. On the basis of the existing evidence, however, it is not possible to be certain which cancers are causally related to diet and what proportion of them are due to specific ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.308.6944.1610
更新日期:1994-06-18 00:00:00
abstract:OBJECTIVE:To characterise the complete case series of influenza A/H7N9 infections as of 27 May 2013, detected by China's national sentinel surveillance system for influenza-like illness. DESIGN:Case series. SETTING:Outpatient clinics and emergency departments of 554 sentinel hospitals across 31 provinces in mainland ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f3693
更新日期:2013-06-24 00:00:00
abstract:OBJECTIVE:To assess the associations between different antidepressant treatments and the rates of suicide and attempted suicide or self harm in people with depression. DESIGN:Cohort study. SETTING:Patients registered with UK general practices contributing data to the QResearch database. PARTICIPANTS:238,963 patients...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.h517
更新日期:2015-02-18 00:00:00
abstract::The author is one of the medical advisers to the judge who led a government inquiry into allegations that an experimental research program at the National Women's Hospital in Auckland, New Zealand, to study the natural course of cervical carcinoma in situ had withheld conventional treatment from some patients. She ar...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6647.533
更新日期:1988-08-20 00:00:00
abstract::An investigation was conducted to determine the vehicle of infection of an outbreak of food poisoning in a large metropolitan building early in 1988. A questionnaire was distributed to 700 people who had eaten in the building during the week of the outbreak, and attack rates for specific food were calculated. Food and...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.298.6666.99
更新日期:1989-01-14 00:00:00
abstract::The results of the work of the Edinburgh Rehabilitation Medicine Service in one year were evaluated. Over 1400 new patients were seen, of whom 525 were in hospital at the time. Patients most often referred were those who had had cardiovascular accidents, back pain, lower limb amputations, and head injuries and those c...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6648.601
更新日期:1988-09-03 00:00:00
abstract::National allocation of resources to regional health authorities and by them to districts is now determined by a weighted capitation formula. The national formula was derived from regression analysis, with hospital utilisation as an index of need for health care--a method which has fundamental limitations. This paper a...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6881.835
更新日期:1993-03-27 00:00:00
abstract:OBJECTIVE:To determine whether the use of the UK clinical aptitude test (UKCAT) in the medical schools admissions process reduces the relative disadvantage encountered by certain sociodemographic groups. DESIGN:Prospective cohort study. SETTING:Applicants to 22 UK medical schools in 2009 that were members of the cons...
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doi:10.1136/bmj.e1805
更新日期:2012-04-17 00:00:00
abstract:OBJECTIVE:To review the evidence for ethnic differences in susceptibility to adverse drug reactions (ADRs) to cardiovascular drugs. DESIGN:Systematic review and meta-analysis. DATA SOURCES:We searched Medline and Embase to March 2005. Reference lists of identified articles were hand searched for further relevant arti...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.38803.528113.55
更新日期:2006-05-20 00:00:00
abstract:OBJECTIVE:To assess the effects of social deprivation on survival after cardiac surgery and to examine the influence of potentially modifiable risk factors. DESIGN:Analysis of prospectively collected data. Prognostic models used to examine the additional effect of social deprivation on the end points. SETTING:Birming...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b902
更新日期:2009-04-02 00:00:00
abstract::A brief note on the status of the AIDS pandemic, from the Amsterdam VIIIth International Conference on AIDS, warns that the course of the epidemic is not being altered by prevention efforts. AIDS occurs in every country, usually spread by heterosexual contact, so that women are equally affected with men. WHO estimat...
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pub_type: 新闻
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abstract:OBJECTIVE:To investigate the association between long term intake of dietary and supplemental calcium and death from all causes and cardiovascular disease. DESIGN:Prospective longitudinal cohort study. SETTING:Swedish mammography cohort, a population based cohort established in 1987-90. PARTICIPANTS:61 433 women (bo...
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更新日期:2013-02-12 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1989-09-09 00:00:00
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更新日期:2003-10-25 00:00:00
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更新日期:2003-12-13 00:00:00
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更新日期:2001-11-24 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7016.1325
更新日期:1995-11-18 00:00:00
abstract:OBJECTIVE:To estimate the risk of breast cancer associated with diagnostic radiation in carriers of BRCA1/2 mutations. DESIGN:Retrospective cohort study (GENE-RAD-RISK). SETTING:Three nationwide studies (GENEPSO, EMBRACE, HEBON) in France, United Kingdom, and the Netherlands, PARTICIPANTS:1993 female carriers of BRC...
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pub_type: 杂志文章
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更新日期:2012-09-06 00:00:00
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abstract:OBJECTIVES:To quantify the relative contribution of premorbid and episode specific factors in determining the long term persistence of disabling symptoms of low back pain. DESIGN:Prospective cohort study. SETTING:Two general practices in the south Manchester area. PARTICIPANTS:180 patients, who previously participat...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
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更新日期:1999-06-19 00:00:00
abstract:OBJECTIVE:To determine whether failure to adequately adjust for a reported 40% misclassification of use of in vitro fertilisation (IVF) as reported in a Swedish study could have led to a false finding that folic acid increases dizygotic twinning. DESIGN:Modelling with population based data. SETTING:Swedish vital reco...
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pub_type: 杂志文章
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更新日期:2005-04-09 00:00:00
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更新日期:2011-10-11 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:
更新日期:2000-01-29 00:00:00