経験的治療、経験的療法

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the management of someone or something; "the handling of prisoners"; "the treatment of water sewage"; "the right to equal treatment in the criminal justice system" (同)handling
care provided to improve a situation (especially medical procedures or applications that are intended to relieve illness or injury) (同)intervention
a manner of dealing with something artistically; "his treatment of space borrows from Italian architecture"
relying on medical quackery; "empiric treatment" (同)empirical

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〈U〉(人・物の)『取り扱い』,扱い方《+of+名》 / 〈U〉治療;〈C〉(…に対する)治療法《+for+名》

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/09/28 16:09:22」(JST)

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Empiric therapy or empirical therapy is therapy based on experience^[1] and, more specifically, therapy begun on the basis of a clinical educated guess in the absence of complete or perfect information. Thus it is applied before the confirmation of a definitive diagnosis or in the absence of complete understanding of mechanism, whether the biological mechanism of pathogenesis or the therapeutic mechanism of action. The name shares the same stem with empirical evidence, involving an idea of practical experience. Empiric therapy is most often used when antibiotics are given to a person before the specific bacterium causing an infection is known. Fighting an infection sooner rather than later is important to minimize morbidity, risk, and complications, so there is value in getting started with good information rather than waiting around for better information. Examples of this include antibiotics given for pneumonia, urinary tract infections, and suspected bacterial meningitis in newborns aged 0 to 6 months. Empiric antibiotic therapy thus may be thought of as taking the initiative against an anticipated and likely cause of infectious disease.

Empiric antibiotic therapy

Empiric antibiotics are typically broad-spectrum, in that they treat both a multitude of either Gram-positive and/or Gram-negative bacteria. When more information is known (as from a blood culture), treatment may be changed to a narrow-spectrum antibiotic which more specifically targets the bacterium known to be causing disease.

The advantage of indicating antibiotics empirically exists where a causative pathogen is likely albeit unknown and where diagnostic tests will not be influential to treatment. In this case, there may be little if any perceived benefit of using what may be costly and inconclusive tests that will only delay treatment of the same antibiotics. The empirical use of broad-spectrum antibiotics increases, by selection, the prevalence of bacteria resistant to several antibiotics. However, the delay and expense that would be required to perform definitive species identification in every single clinical case are not affordable, so some degree of trade-off is accepted on the principle of the benefits outweighing the risk.

Other than antibiotics

Another sense of the term empiric therapy involves quackery, and empiric as a noun has been used as a synonym of quack.^[2] This sense applies when the amount of guessing involved by the clinician transcends so far beyond science that the standard of care is not upheld. Whereas prescribing a broad-spectrum antibiotic to fight a clinically apparent infection as early as possible is entirely prudent and scientific despite the absence of confirmatory cultures, prescribing magic rituals or pseudoscientific schemes is not.

The fact that "acting on practical experience in the absence of theory or complete knowledge" can have both legitimate and illegitimate forms stretches back to long before science existed. For example, in the era of ancient Greece, when medical science as we now know it did not yet exist, all medicine was unscientific and traditional; theories of etiology, pathogenetic mechanism, and therapeutic mechanism of action were based on religious, mythologic, or cosmologic ideas. For example, humorism could dictate that bloodletting was indicated for a certain disorder because a supposed excess of water could be rebalanced. However, because such theories involved a great deal of fanciful notions, their safety and efficacy could be slim to negative. In the example of bloodletting to correct excess water, the fact that fluid balance is a legitimate physiologic concern didn't mean that the then-state-of-the-art "understanding" of causation was well founded overall. In this environment where mainstream medicine was unscientific, a school of thought arose in which theory would be ignored and only practical results would be considered. This was the original introduction of empiricism into medicine, long before medical science would greatly extend it.

However, by the late 19th and early 20th centuries, as biological and medical science developed, the situation had reversed: because the state of the art in medicine was now scientific medicine, those physicians who ignored all etiologic theory in favor of only their own experience were now increasingly quackish, even though in the era of religion-based or mythology-based medicine (the era of medicine men) they might have been, as viewed through today's hindsight, admirably rational and in fact protoscientific. Thus as science became the norm, unscientific and pseudoscientific approaches qualified as quackery.

In the 21st century, the next phase of differentiation on this topic is underway. Today, all clinical practice based on medical science is therefore based on empirical evidence to a large degree, but now efforts are underway to make sure that all of the science on any given medical topic is consistently applied in the clinic, with the best portions of it graded and weighted more heavily. This is the latest cycle in which personal experience (even expert opinion with scientific basis) is not considered good enough by itself. Thus, in evidence-based medicine, the goal is that every clinician will make decisions for every patient with total mastery and critical analysis of the entire scientific literature at their fingertips. This is a formidably vast goal to implement operationally (because it is not even possible for one person to master all extant biomedical knowledge on the basis of individual education^[3]), but development of health information technology such as expert systems and other artificial intelligence in medicine is underway in pursuit of it.^[3] In the meantime, until the day when the reality begins to approximate the ideal, it is duly recognized that expert opinion and clinical judgment are still necessary in clinical practice,^[4] because their premature banishment, before their eventual replacement has been fully prepared, amounts to scientism.

References

^ Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.
^ Merriam-Webster, Merriam-Webster's Collegiate Dictionary, Merriam-Webster.
^ ^a ^b Khosla, Vinod (2012-12-04), "Technology will replace 80% of what doctors do", Fortune magazine, Most doctors couldn’t possibly read and digest all of the latest 5,000 research articles on heart disease. And, most of the average doctor’s medical knowledge is from when they were in medical school, while cognitive limitations prevent them from remembering the 10,000+ diseases humans can get.
^ Koppenheffer, Michael (January 29, 2015), Guidelines are not gospel

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2. 成人における黄色ブドウ球菌菌血症に対する臨床的アプローチ clinical approach to staphylococcus aureus bacteremia in adults
3. Intracranial epidural abscess
4. Antimicrobial stewardship
5. 資源の豊富な国の成人における急性下痢に対するアプローチ approach to the adult with acute diarrhea in resource rich countries

English Journal

Fourteen-day optimized levofloxacin-based therapy versus classical quadruple therapy for Helicobacter pylori treatment failures: a randomized clinical trial.

Cao Z1, Chen Q, Zhang W, Liang X, Liao J, Liu W, Xiao S, Lu H.
Scandinavian journal of gastroenterology.Scand J Gastroenterol.2015 Oct;50(10):1185-90. doi: 10.3109/00365521.2015.1037345. Epub 2015 Apr 16.
OBJECTIVE: To test the efficacy of lansoprazole, bismuth, levofloxacin, and amoxicillin therapy compared to bismuth metronidazole tetracycline (BMT) quadruple therapy for second-line treatment of Helicobacter pylori infection.METHODS: A total of 284 patients who failed prior H. pylori eradication we
PMID 25881966

Clinical utility of bronchoalveolar lavage and respiratory tract biopsies in diagnosis and management of suspected invasive respiratory fungal infections in children.

Batra S1,2, Li B1, Underhill N1, Maloney R1, Katz BZ2,3, Hijiya N1,2.
Pediatric blood & cancer.Pediatr Blood Cancer.2015 Sep;62(9):1579-86. doi: 10.1002/pbc.25570. Epub 2015 May 4.
BACKGROUND: Bronchoscopy with bronchoalveolar lavage (BAL) and respiratory tract biopsies are important tools for diagnosing fungal infections in children with cancer and hematopoietic stem cell transplant (HSCT) recipients. Our objective was to evaluate the impact of BAL and respiratory tract biops
PMID 25940202

Primary Capreomycin Resistance Is Common and Associated With Early Mortality in Patients With Extensively Drug-Resistant Tuberculosis in KwaZulu-Natal, South Africa.

OʼDonnell MR1, Pillay M, Pillay M, Werner L, Master I, Wolf A, Mathema B, Coovadia YM, Mlisana K, Horsburgh CR, Padayatchi N.
Journal of acquired immune deficiency syndromes (1999).J Acquir Immune Defic Syndr.2015 Aug 15;69(5):536-43. doi: 10.1097/QAI.0000000000000650.
BACKGROUND: Capreomycin is a key antimycobacterial drug in treatment of extensively drug-resistant tuberculosis (XDR-TB). Drug-susceptibility testing (DST) for capreomycin is not routinely performed in newly diagnosed XDR-TB in South Africa. We performed this study to assess the prevalence, clinical
PMID 25886924

Japanese Journal

Clinical Utility of Procalcitonin as a Marker of Sepsis: A Potential Predictor of Causative Pathogens

Nakajima Atsuko,Yazawa Junko,Sugiki Daisuke,Mizuguchi Mari,Sagara Hironori,Fujisiro Masahiro,Shibazaki Mitsuei,Hitani Akihiko,To Masako,Haruki Kosuke
Internal Medicine 53(14), 1497-1503, 2014
… Objective Sepsis is one of the leading causes of mortality in critically ill patients, and providing a timely diagnosis and early intervention is necessary for successful treatment. … Conclusion The PCT level is a potentially useful marker of the type of causative pathogen in patients with sepsis whose measurement may facilitate the selection of appropriate empiric antibiotic treatment. …
NAID 130004466394

重症化を防げたPVL陽性CA-MRSAによる軟部組織感染症の1例

島田和樹,権東容秀,松村一,渡辺克益
日形会誌 : 日本形成外科学会会誌 = Journal of Japan Society of Plastic and Reconstructive Surgery 33(7), 529-533, 2013-07-20
NAID 10031189550

Prospective randomized comparison study of piperacillin/tazobactam and meropenem for healthcare-associated pneumonia in Japan

Yamamoto Yoshihiro,Izumikawa Koichi,Morinaga Yoshitomo,Nakamura Shigeki,Kurihara Shintaro,Imamura Yoshifumi,Miyazaki Taiga,Tsukamoto Misuzu,Kakeya Hiroshi,Yanagihara Katsunori,Yasuoka Akira,Kohno Shigeru
Journal of Infection and Chemotherapy 19(2), 291-298, 2013-04
… We compared the efficacy and safety of initial empiric therapy with piperacillin/tazobactam (PIPC/TAZ, 13.5 g/day) with that of meropenem (MEPM, 1.5 g/day) as single broad-spectrum regimens with gram-negative and anaerobic coverage in patients with HCAP in Japan. … Both treatment regimens are tolerable and might be appropriate to use as initial empiric therapy for HCAP in Japan. …
NAID 120005323724

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リンク元	「経験的治療」「経験的療法」
関連記事	「treatment」「empiric」

「経験的治療」

　　[★]

英: empiric treatment, empiric therapy
同: エンピリック治療

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経験的治療 : 約 209,000 件
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「経験的療法」

　　[★]

英: empiric treatment
関: 経験的治療

「treatment」

　　[★]

n.

取り扱い、待遇
治療。(～の)治療法。対症療法
(問題の)論じ方。(芸術・文芸における)(題材・人物などの)配置、性格付け
(映画)(脚本の)流れ、場面構成
(化学薬品による)処理

関: application, care, clinical practice, cure, curing, handle, intervention, manipulate, manipulation, measure, medical care, practice, processing, remediation, remedy, therapeutic, therapeutics, therapy, transaction, treat

「empiric」

　　[★]

adj.

経験的な

関: a priori、empirical、empirically、experimental

[Dorlands-1] Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.

[MW-2] Merriam-Webster, Merriam-Webster's Collegiate Dictionary, Merriam-Webster.

[Khosla_2012-12-04-3] Khosla, Vinod (2012-12-04), "Technology will replace 80% of what doctors do", Fortune magazine, Most doctors couldn’t possibly read and digest all of the latest 5,000 research articles on heart disease. And, most of the average doctor’s medical knowledge is from when they were in medical school, while cognitive limitations prevent them from remembering the 10,000+ diseases humans can get.

[4] Koppenheffer, Michael (January 29, 2015), Guidelines are not gospel

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empiric treatment