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毎日やろう、感染対策者のための英語講座74

岩田健太郎(神戸大学感染症内科診療科長・国際診療部長)
岩田健太郎(神戸大学感染症内科診療科長・国際診療部長)

I「さて、推奨だけ読むのもちと素人っぽいので、その根拠を読んでみましょう。summary of the evidenceが載っています」

Summary of the evidence. Repeat courses of antibiotics, usually metronidazole or vancomycin are necessary to treat RCDI; both have similar recurrence rates. Re-treatment with a 10-14-day regimen is common. The IDSA/SHEA guidelines recommend treatment of the first recurrence using the same antibiotic that was used for the initial episode; use of vancomycin is recommended for repeated recurrences because of the risk of neuropathy with repeated administration of metronidazole (3). The use of vancomycin, 125 mg four times daily for 10 days, is preferred for any recurrence if it is severe, even if the initial episode had been treated with metronidazole. If the initial episode was treated with vancomycin, a tapered and pulsed regimen or just a pulsed regimen of vancomycin may be considered; none of these recommendations for extended vancomycin regimens have been studied in RCTs. Evidence that longer, tapered, pulsed-dosing is more effective than conventional regimens comes from evaluation of placebo-treated patients in a trial of a probiotic adjunct to antibiotic therapy in patients who already had one or more recurrences. Patients who had a standard 10-14-day course had recurrence rates of up to 54%, compared with 31% in those who had tapering regimens (gradually lowered doses) and 14% in those who had pulsed (every 2?3 day) regimens (80). There are no controlled data to support specific tapering or pulse regimens (86). We here propose a simple cost-effective regimen: a standard 10-day course of vancomycin at a dose of 125 mg given four times daily, followed by 125 mg daily pulsed every 3 days for ten doses (Scott Curry, personal communication). There is no convincing evidence of efficacy of other antibiotics, such as rifampin or rifaximin. In one study, six of seven patients responded to treatment with vancomycin and rifampin (87). In three small series, a total of 16 of 20 patients had no further recurrences when treated with 2 weeks of rifaximin after a 2-week course of vancomycin (88,89,90); a recently published RCT of this regimen did not find a decrease in documented CDI recurrences with rifaximin (91). Moreover, high-level resistance to rifampin is a concern and should limit its use (92).

M「うう、もうだめ。物量で負けた、、、」
I「大丈夫、これって全部パルスの話をしてるわけじゃないですから。てれてれーって読み飛ばして、必要なとこだけ拾い読み、も必要なスキルです。関連した文章は、ここだけ!」

If the initial episode was treated with vancomycin, a tapered and pulsed regimen or just a pulsed regimen of vancomycin may be considered; none of these recommendations for extended vancomycin regimens have been studied in RCTs. Evidence that longer, tapered, pulsed-dosing is more effective than conventional regimens comes from evaluation of placebo-treated patients in a trial of a probiotic adjunct to antibiotic therapy in patients who already had one or more recurrences. Patients who had a standard 10-14-day course had recurrence rates of up to 54%, compared with 31% in those who had tapering regimens (gradually lowered doses) and 14% in those who had pulsed (every 2-3 day) regimens (80). There are no controlled data to support specific tapering or pulse regimens (86). We here propose a simple cost-effective regimen: a standard 10-day course of vancomycin at a dose of 125 mg given four times daily, followed by 125 mg daily pulsed every 3 days for ten doses (Scott Curry, personal communication).

M「うう、まだ長い?」
I「はいはい、分割、分割。

If the initial episode was treated with vancomycin, a tapered and pulsed regimen or just a pulsed regimen of vancomycin may be considered;

最初の治療をバンコマイシンで治療したら、テイパーして、かつパルスする治療法(a tapered and pulsed regimen)か、パルスするだけ(just a pulsed regimen)を考慮する。

I「セミコロン;は文章をつなぐ技法として使えます。論文執筆のときなど活用してみましょう。ちとかっこいいです」

none of these recommendations for extended vancomycin regimens have been studied in RCTs.

こうした推奨についてはRCT(ランダム化比較試験)で研究されていない。

Evidence that longer, tapered, pulsed-dosing is more effective than conventional regimens comes from evaluation of placebo-treated patients in a trial of a probiotic adjunct to antibiotic therapy in patients who already had one or more recurrences.

長期のテイパー、パルス療法が通常の治療よりもよいというエビデンスは、プラセボで治療した患者の評価から得られた(comes from)。それはプロバイオティクを抗菌薬にかませた研究で(a trial of a probitic adjunct to antibiotic therapy)で、患者は1回かそれ以上、再発していた。

Patients who had a standard 10-14-day course had recurrence rates of up to 54%, compared with 31% in those who had tapering regimens (gradually lowered doses) and 14% in those who had pulsed (every 2-3 day) regimens (80).

標準的10-14日治療では再発率は最大(up to)54%、それに対してテイパー(徐々に量を減らしていく、gradually lowered doses)では31%、パルス(2,3日毎、every 2-3 days)では14%だった。

There are no controlled data to support specific tapering or pulse regimens (86).

テイパーやパルスの特定のやり方(specific)を支持する比較試験のデータはない。

We here propose a simple cost-effective regimen: a standard 10-day course of vancomycin at a dose of 125 mg given four times daily, followed by 125 mg daily pulsed every 3 days for ten doses (Scott Curry, personal communication).

我々は提唱する(propose)。シンプルでコスト効果の高い方法を(a simple cost-effective regimen)。つまり(ここの:は「すなわち」くらいの意味)。125mg1日4回10日間のバンコマイシン、その後、125mgを1日1回のパルスを3日おきで、10回。

I「personal communicationは専門家との個人的な対話ってことです」
M「エキスパートオピニオンですね」
I「そのとおり」
M「要するに、英語を読むときは1文1文辛抱強くやってれば、いつかは読み終わるってことですね」
I「マラソンと一緒です。つらいかもしれませんが、いつかは必ずゴールが来ます」

英語は難しくありません。少しずつ学んでいきましょう。

今日のポイント
・長文にひるまない
・セミコロン、コロンの使い方を学ぼう。

今日学んだ単語:come from, gradually lowered dose (tapered), personal communication

[楽園はこちら側 2016年9月29日より転載]

楽園はこちら側
http://georgebest1969.typepad.jp/blog/

この記事の監修・執筆医師

注目情報

有益で確かな情報をお届けするという編集方針です。

脱衣所やトイレなどとの温度差にも注意が必要です。

スポーツの秋です。スポーツ関連クイズ特集です。

11月11日現在、50名の医師や専門家が「Aging Style」に参加しています!

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