抗生素按照化学结构可以分为：喹诺酮类抗生素、β-内酰胺类抗生素、大环内酯类、氨基糖苷类抗生素等；按照用途可以分为抗细菌抗生素、抗真菌抗生素、抗肿瘤抗生素、抗病毒抗生素及其他微生物药物（如麦角菌产生的具有药理活性的麦角碱类，有收缩子宫的作用）等。
有的抗生素抗菌范围很广，称广谱抗生素；相反，则称窄谱抗生素。比如氯霉素、四环素对于革兰阳性菌、阴性菌、立克次体、衣原体、支原体、螺旋体等都有不同程度的抑制作用，所以被称为广谱抗生素。而青霉素只对革兰阳性菌有抗菌作用，而对革兰阴性菌、立克次体、结核杆 菌等无效，故属于窄谱抗生素。
下面来看一则最新的关于广谱VS窄谱抗生素用于儿童呼吸道感染的研究报道：
广域与窄谱抗生素联合治疗急性呼吸道感染患儿的失效率、不良事件和生活质量分析
背景
急性呼吸道感染在儿童疾病发病率中占很大比例，而广谱抗生素用于儿童急性呼吸道感染的治疗也在增加。目前，业界对于广谱治疗相比窄谱治疗是否可以改善疗效，尚无定论。
实验目的
比较广谱和窄谱抗生素治疗小儿急性呼吸道感染的疗效。
实验设计与受试者
一个回顾性队列研究以评估临床结果；一个前瞻性队列研究，以评估患儿主导的结果。
受试者为年龄在6个月至12岁之间诊断为急性呼吸道感染的患儿,他们来自宾夕法尼亚州和新泽西州的初级儿童护理中心，这些患儿在2015年1月至2016年4月期间，按规定口服抗生素。对两组患者分别进行分层和倾向分析，以解释临床医师和病人级特征的混淆。
主要结果和措施
在回顾性队列中，主要结果为诊断后14天出现治疗失败和不良反应。在前瞻性队列中，主要的结果是生活质量，其他患儿主导的结果，以及患儿自述的不良反应。
实验结果
30159名儿童在回顾性队列（19179例发生急性中耳炎;6746例发生A组链球菌性咽炎;4234例发生急性鼻窦炎），其中4307例(14%)使用广谱抗生素，其中包括阿莫西林-克拉维酸，头孢菌素，和大环内脂类。广谱治疗与较低的治疗失败率没有明显关系(广谱抗生素的治疗失败率为3.4%，窄谱抗生素为3.1%);风险差异完全匹配分析,0.3%(95% CI,0.4%-0.9%))。有2472名儿童分配到了前瞻性队列研究（1100例发生急性中耳炎；705例发生A组链球菌性咽炎；667例发生急性鼻窦炎），其中868例(35%)使用广谱抗生素。广谱抗生素与稍差的儿童生活质量相关(广谱抗生素90.2分，窄谱抗生素91.5分);得分差异完全匹配分析,1.4%(95% CI,−−0.4%- 2.4%))但与其他患儿主导的结果无关。广谱治疗与临床医生记录的不良事件风险较高有关(广谱抗生素3.7%，窄谱抗生素2.7%;完全匹配分析的风险差异，1.1%[95% CI,0.4% - 1.8%])和患儿自述的不良反应同样相关(广谱抗生素的35.6%,窄谱抗生素的25.1%;完全匹配分析的风险差异，12.2%[95% CI,7.3%-17.2%]。
结论
在患有急性呼吸道感染的儿童中，广谱抗生素与较窄谱抗生素相比，与较好的临床结果或患儿主导的结果没有明显相关性，但与较高的不良事件发生率相关。这些数据支持对大多数急性呼吸道感染儿童应使用窄谱抗生素。
Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections
Importance
Acute respiratory tract infections account for the majority of antibiotic exposure in children, and broad-spectrum antibiotic prescribing for acute respiratory tract infections is increasing. It is not clear whether broad-spectrum treatment is associated with improved outcomes compared with narrow-spectrum treatment.
Objective
To compare the effectiveness of broad-spectrum and narrow-spectrum antibiotic treatment for acute respiratory tract infections in children.
Design, Setting, and Participants
A retrospective cohort study assessing clinical outcomes and a prospective cohort study assessing patient-centered outcomes of children between the ages of 6 months and 12 years diagnosed with an acute respiratory tract infection and prescribed an oral antibiotic between January 2015 and April 2016 in a network of 31 pediatric primary care practices in Pennsylvania and New Jersey. Stratified and propensity score–matched analyses to account for confounding by clinician and by patient-level characteristics, respectively, were implemented for both cohorts.
Main Outcomes and Measures
In the retrospective cohort, the primary outcomes were treatment failure and adverse events 14 days after diagnosis. In the prospective cohort, the primary outcomes were quality of life, other patient-centered outcomes, and patient-reported adverse events.
Results
Of 30 159 children in the retrospective cohort (19 179 with acute otitis media; 6746, group A streptococcal pharyngitis; and 4234, acute sinusitis), 4307 (14%) were prescribed broad-spectrum antibiotics including amoxicillin-clavulanate, cephalosporins, and macrolides. Broad-spectrum treatment was not associated with a lower rate of treatment failure (3.4% for broad-spectrum antibiotics vs 3.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 0.3% [95% CI, −0.4% to 0.9%]). Of 2472 children enrolled in the prospective cohort (1100 with acute otitis media; 705, group A streptococcal pharyngitis; and 667, acute sinusitis), 868 (35%) were prescribed broad-spectrum antibiotics. Broad-spectrum antibiotics were associated with a slightly worse child quality of life (score of 90.2 for broad-spectrum antibiotics vs 91.5 for narrow-spectrum antibiotics; score difference for full matched analysis, −1.4% [95% CI, −2.4% to −0.4%]) but not with other patient-centered outcomes. Broad-spectrum treatment was associated with a higher risk of adverse events documented by the clinician (3.7% for broad-spectrum antibiotics vs 2.7% for narrow-spectrum antibiotics; risk difference for full matched analysis, 1.1% [95% CI, 0.4% to 1.8%]) and reported by the patient (35.6% for broad-spectrum antibiotics vs 25.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 12.2% [95% CI, 7.3% to 17.2%]).
Conclusions and Relevance
Among children with acute respiratory tract infections, broad-spectrum antibiotics were not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, and were associated with higher rates of adverse events. These data support the use of narrow-spectrum antibiotics for most children with acute respiratory tract infections.
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