参考文献 1 は感冒症状に対する NSAIDsの効果を検討した論文 全体的な効果は統計の処理の仕方によって変わるようだが 効果があるか差が無いのか微妙なライン 少なくとも大幅に増悪することは無さそう 咽頭症状に対する効果ははっきりしないが 頭痛や耳痛 筋肉痛 関節痛 くしゃみなどには効果を認める I

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1 感冒に対して PL 配合顆粒は効果があるか (110922) 研修中にはいろいろな疑問が出てくる 誰かの真似をするというのはとても健全な学習のプロセスだと思うが 純粋な彼らだからこそ素朴な疑問も出てくる 全ての疑問を解決しながら実際の臨床を行うなんて無理で まず体が動くというのは大切なことだけれど その場で重要と感じたら いつか調べてみようと思えることがより健全な学習のプロセスだと信じたい 感冒時に PL 配合顆粒は効果があるんですか? という研修医の疑問からその効果を検討してみた PL 顆粒はプラセボ顆粒などという医師もいるようだが 少なくともプラセボ以上の効果は期待できると感じている PL 配合顆粒 PubMed で調べてもあまりヒットせず 合剤なのでなかなか判断が難しいが 有効成分の効果を調べてみることにした PL 配合顆粒の成分は以下の通り サリチルアミドは NSAIDs の一種 確かに構造式はアスピリ ンと似ている プロメタジンは抗ヒスタミン薬 顆粒 :1g 中サリチルアミド 270mg アセトアミノフェン 150mg 無水カフェイン 60mg メチレンジサリチル酸プロメタジン 13.5mg サリチルアミドの構造式 アスピリンの構造式

2 参考文献 1 は感冒症状に対する NSAIDsの効果を検討した論文 全体的な効果は統計の処理の仕方によって変わるようだが 効果があるか差が無いのか微妙なライン 少なくとも大幅に増悪することは無さそう 咽頭症状に対する効果ははっきりしないが 頭痛や耳痛 筋肉痛 関節痛 くしゃみなどには効果を認める In a pooled analysis, NSAIDs did not significantly reduce the total symptom score, or duration of colds.however, for outcomes related to the analgesic effects of NSAIDs (headache, ear pain, and muscle and joint pain) NSAIDs produced significant benefits, and malaise showed a borderline benefit, although throat irritation was not improved. Chills showed mixed results. For respiratory symptoms, cough and nasal discharge scores were not improved, but the sneezing score significantly improved. We found no evidence of increased frequency of adverse effects in the NSAID treatment groups. ( 参考文献 1 より引用 )

3 ( 参考文献 1 より引用 ) ( 参考文献 1 より引用 ) アセトアミノフェンの効果は以前にも勉強したが この時には短期的な解熱は認め QOL を改善 するということだった 小児の熱に解熱薬を投与する意義 参考文献 2 では 一貫した効果は証明されていないようだが 少なくとも熱を増悪させるデータ

4 は無いようだし 2 時間後の発熱についてはクーリングより優れているというデータもある In a meta-analysis of two trials (n = 120), the proportion of children without fever by the second hour after treatment did not differ significantly between those given paracetamol and those sponged (Relative Risk 1.84; confidence interval 0.94 to 3.61, random effects model). ( 参考文献 2 より引用 ) 参考文献 3 は抗ヒスタミン薬の効果を検討している 単独ではあまり効果を認めないようだが う っ血除去薬との併用は効果があるようだ 以下の試験に用いられているうっ血除去薬はプソイド エフェドリンという薬剤 There was no evidence of any clinically significant effect - in children or in adults - on general recovery of antihistamines in monotherapy. First generation - but not non-sedating - antihistamines have a small effect on rhinorrhea and sneezing. In trials with first generation antihistamines the incidence of side effects (especially sedation) is significantly higher with active treatment. Two trials, studying a combination of antihistamines with decongestives in small children, both failed to show any effect. Of the eleven trials on older children and adults, the majority show an effect on general recovery and on nasal symptom severity.

5 ( 参考文献 3 より引用 ) ( 参考文献 3 より引用 ) プソイドエフェドリンは 医師が処方することは無いと思うが 市販薬には広く用いられている 多 くの鼻炎の市販薬に含まれているが 感冒薬だとベンザブロック L にこの成分が含まれている こ れ以外の感冒の市販薬には含まれていない ( 探せないだけかもしれないが )

6 6 錠中 成分イブプロフェン塩酸プソイドエフェドリンクロルフェニラミンマレイン酸塩ジヒドロコデインリン酸塩無水カフェイン 分量 450mg 135mg 7.5mg 24mg 75mg ( ベンザブロック L 添付文書より ) ちなみに ベンザブロック IP やベンザブロック S にはプソイドエフェドリンは含まれていない エ ビデンスが豊富なのはベンザブロック IP や S よりベンザブロック L です という説明もどこかで役 に立つかもしれない 少し脱線したが PL 顆粒自体の効果は検討できないし 各論文の結果を PL 顆粒の効果として 一般化できる保証はないが やはりエビデンスとしては有効と考えるのが無難と思う 薬が有効か どうかというより むしろ 有効な使い方というものの方が重要と言えるのかもしれない 参考文献 1. Kim SY, Chang YJ, Cho HM, Hwang YW, Moon YS. Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database Syst Rev Jul 8;(3):CD Meremikwu M, Oyo-Ita A. Paracetamol for treating fever in children. Cochrane Database Syst Rev. 2002;(2):CD Sutter AI, Lemiengre M, Campbell H, Mackinnon HF. Antihistamines for the common cold. Cochrane Database Syst Rev. 2003;(3):CD

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