預防性抗生素於再發性下肢蜂窩性組織炎的費用成效之評估

Evaluation of Cost-Effectiveness for Prophylactic Antibiotic in Recurrent Cellulitis of Lower Limb

楊清鎮(Ching-Cheng Yang) ； 潘忠煜(Chung-Yu Pan)

《內科學誌》 22卷5期 (2011/10) Pp. 352-362

https://doi.org/10.6314/JIMT.2011.22(5).07

摘要

下肢蜂窩性組織炎的反覆感染，通常為β 溶血性鏈球菌引起，病患需要多次就醫，不但病患肢體疼痛，而且影響到其日常工作及收入。本研究以回溯性評估下肢蜂窩性組織炎住院病患，其於五年內至少有一次同樣病史，在治癒後給予預防性抗生素benzathine penicillin肌肉注射，每四週一次，之後為期十八個月追蹤探討其預防成效及比較每次再發平均抗生素費用。收案的病患84人，分為研究組40人（研究組A 18人，為完成12次預防性抗生素療程；研究組B22人，為接受部分的療程）及對照組44人（未接受預防性抗生素療程）。本研究接受（完整或部分療程）預防性抗生素組及接受完整療程組的十八個月內再發率（37.5%及27.8%）明顯地比未接受組（61.4%）少（p = 0.029及0.016），其再發次數亦明顯地比未接受組少（p = 0.003及0.002）；而接受部分療程組與完整療程組的再發率（45.5% vs 27.8%）及再發次數比較或與未接受組的再發率（45.5% vs 61.4%）及再發次數比較，皆無統計上的明顯差異。所以接受完整12次每四週預防性抗生素，在預防反覆發作的下肢蜂窩性組織炎是有所幫助；但接受部分療程，在往後反覆發作的幫助則未能確立。就整體而言，十八個月內的再發追蹤，接受預防性抗生素組比未接受組每次平均再發抗生素費用支出並無明顯的差異。在再發、費用兩者相比取捨，建議符合本研究的患者，給予每四週一次的完整12次預防性抗生素療程。

關鍵字

下肢蜂窩性組織炎 ； 再發 ； 預防性抗生素 ； 抗生素費用

並列摘要

Recurrent cellulitis of lower limb is usually caused by β-hemolytic streptococcal infection. The patients probably need several visits for medication during period of the acute stage, which do not only make their affected limbs painful and limit activities, but also decrease their income. In this study, we retrospectively evaluate the effectiveness about the prophylactic antibiotic benzathine penicillin intramuscular injections every four weeks for these patients with presumed streptococcal recurrent cellulitis of lower limb and they ever had the same occurrence within recent five years. We also compare with average cost of prescribed antibiotics in recurrent events of each group in the backward 18-month follow-up. Forty-eight patients, enrolled in this study, are divided into two major groups, study groups, 40 cases (subgroup A, 18 cases, received complete course; subgroup B, 22 cases, only partially received) and control group, 44 cases (did not receive any one) based on the status of receiving prophylactic antibiotic. As a result, the recurrent rate of study group and its subgroup A is 37.5%, 27.8% respectively, whichever is statistically lower than one (61.4%) of control group (p = 0.029 and 0.016 respectively). Recurrent episodes of study group or of its subgroup A, whichever is also statistically lower than those of control group (p = 0.003 and 0.002 respectively). No significant differences in recurrent rates or in frequencies of recurrent episode present between study subgroups or between subgroup B and control group. Therefore, we concluded that receiving complete prophylactic course is probably beneficial for prophylaxis in recurrent cellulitis of lower limb. However, it is of no benefit for prophylaxis in the patients who only received partial course. During the period of 18-month follow-up, there is no significant difference in average cost in every episode between study and control groups. It is worthy to receive complete prophylactic course for the patients with recurrent cellulitis of lower limb within recent five years.

並列關鍵字

Cellulitis of lower limb ； Recurrent ； Prophylactic antibiotic ； Cost of antibiotic