Villar J, Lydon-Rochelle M T, Gülmezoglu A M, Roganti A
Servicio de Obstetricia y Ginecología, Hospital Nacional Alejandro Posadas, Pte. Illia y Marconi, Buenos Aires, Argentina, 1424.
Cochrane Database Syst Rev. 2000(2):CD000491. doi: 10.1002/14651858.CD000491.
A Cochrane systematic review has shown that drug treatment of asymptomatic bacteriuria in pregnant women substantially decreases the risk of pyelonephritis and reduces the risk of preterm delivery. However, it is not clear whether single dose therapy is as effective as longer conventional antibiotic treatment.
The objective of this review was to assess the effects of different durations of treatment for asymptomatic bacteriuria in pregnancy.
We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and the reference lists of articles.
Randomised and quasi-randomised trials comparing antimicrobial therapeutic regimens that differed in duration (particularly comparing single dose with longer duration regimens) in pregnant women diagnosed with asymptomatic bacteriuria.
Trial quality was assessed and data were extracted independently by the reviewers.
Eight studies involving over 400 women were included. All were comparisons of single dose treatment with four to seven day treatments. The trials were generally of poor quality. No difference in 'no-cure' rate was detected between single dose and short course (4-7 day) treatment for asymptomatic bacteriuria in pregnant women (relative risk 1.13, 95% confidence interval 0.82 to 1.54) as well as in the recurrent asymptomtic bacteriuria (relative risk 1.08, 95% confidence interval 0.70 to 1.66). However these results showed significant heterogeneity. No differences were detected for preterm births and pyelonephritis although sample size of trials was small. Longer duration treatment was associated with an increase in reports of adverse effects (relative risk 0.53, 95% confidence interval 0.31 to 0.91).
REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate whether single dose or longer duration doses are more effective in treating asymptomatic bacteriuria in pregnant women. Because single dose has lower cost and increases compliance, this comparison should be explored in a properly sized randomized controlled trial.
一项Cochrane系统评价表明，药物治疗孕妇无症状菌尿可大幅降低肾盂肾炎风险并减少早产风险。然而，单剂量疗法是否与较长疗程的传统抗生素治疗同样有效尚不清楚。
本评价的目的是评估不同疗程治疗孕妇无症状菌尿的效果。
我们检索了Cochrane妊娠与分娩组试验注册库、Cochrane对照试验注册库以及文章的参考文献列表。
比较诊断为无症状菌尿的孕妇中不同疗程抗菌治疗方案（特别是比较单剂量与较长疗程方案）的随机和半随机试验。
由评价者独立评估试验质量并提取数据。
纳入了八项涉及400多名女性的研究。所有研究均为单剂量治疗与四至七天治疗的比较。这些试验质量普遍较差。对于孕妇无症状菌尿，单剂量治疗与短疗程（4 - 7天）治疗的“未治愈”率无差异（相对危险度1.13，95%置信区间0.82至1.54），复发性无症状菌尿亦是如此（相对危险度1.08，95%置信区间0.70至1.66）。然而，这些结果显示出显著的异质性。尽管试验样本量较小，但早产和肾盂肾炎方面未检测到差异。较长疗程治疗与不良反应报告增加相关（相对危险度0.53，95%置信区间0.31至0.91）。
没有足够证据评估单剂量或较长疗程剂量在治疗孕妇无症状菌尿方面哪种更有效。由于单剂量成本较低且依从性更高，应在规模适当的随机对照试验中探讨这种比较。
