Casey Janet R, Pichichero Michael E
Department of Pediatrics, Elmwood Pediatric Group, University of Rochester Medical Center, New York, USA.
Clin Infect Dis. 2005 Jun 15;40(12):1748-55. doi: 10.1086/430307. Epub 2005 May 13.
Azithromycin has become a frequent choice for the treatment of group A streptococcal (GAS) tonsillopharyngitis. In this study, our objective was to determine the optimal dose of azithromycin for treatment of GAS tonsillopharyngitis in children and adults by analyzing trials that used different dose regimens.
We performed a meta-analysis of randomized, controlled trials that involved bacteriological confirmation of GAS tonsillopharyngitis, random assignment to receive either azithromycin or a 10-day comparator antibiotic, and assessment of bacteriological eradication by throat culture after therapy. The primary outcomes of interest were bacteriological and clinical cure rates.
Nineteen trials involving 4626 patients were included in the analysis. One trial used 10-day course of 2 different comparator antibiotics, and 2 trials compared 2 dose regimens of azithromycin with a 10-day course of comparator antibiotic; all other trials compared 1 dose regimen of azithromycin with a single 10-day course of comparator antibiotic. In children, azithromycin administered at 60 mg/kg per course was superior to the 10-day courses of comparators (P < .00001), with bacterial failure occurring 5 times more often in patients receiving the 10-day courses of antibiotics. Azithromycin administered at 30 mg/kg per course was inferior to the 10-day courses of comparators (P = .02), with bacterial failure occurring 3 times more frequently in patients receiving azithromycin. Three-day regimens were inferior to 5-day regimens (P = .002). In adults, no studies compared dosages by weight. Three-day regimens of 500 mg/day showed a trend favoring azithromycin over the 10-day courses of comparators (P = .14); 5-day regimens were inferior to 3-day regimens (P = .006). Clinical cure rates were significantly different for the different azithromycin regimens, with differences that resembled those for bacterial cure rate.
This analysis suggests that azithromycin administered at a dosage of 60 mg/kg in children or administered for 3 days at a dosage of 500 mg/day in adults is more effective than other treatment regimens in producing eradication and clinical cure of GAS tonsillopharyngitis.
阿奇霉素已成为治疗A组链球菌（GAS）扁桃体咽炎的常用选择。在本研究中，我们的目的是通过分析使用不同剂量方案的试验，确定治疗儿童和成人GAS扁桃体咽炎的阿奇霉素最佳剂量。
我们对随机对照试验进行了荟萃分析，这些试验包括GAS扁桃体咽炎的细菌学确认、随机分配接受阿奇霉素或为期10天的对照抗生素，以及治疗后通过咽拭子培养评估细菌清除情况。主要关注的结果是细菌学和临床治愈率。
分析纳入了19项涉及4626例患者的试验。一项试验使用了2种不同对照抗生素的10天疗程，2项试验将阿奇霉素的2种剂量方案与对照抗生素的10天疗程进行了比较；所有其他试验将阿奇霉素的1种剂量方案与对照抗生素的单一10天疗程进行了比较。在儿童中，每疗程60mg/kg的阿奇霉素优于对照抗生素的10天疗程（P <.00001），接受抗生素10天疗程的患者细菌清除失败的发生率高出5倍。每疗程30mg/kg的阿奇霉素不如对照抗生素的10天疗程（P =.02），接受阿奇霉素治疗的患者细菌清除失败的发生率高出3倍。3天疗程不如5天疗程（P =.002）。在成人中，没有研究按体重比较剂量。每天500mg的3天疗程显示出阿奇霉素优于对照抗生素10天疗程的趋势（P =.14）；5天疗程不如3天疗程（P =.006）。不同阿奇霉素方案的临床治愈率有显著差异，差异与细菌治愈率相似。
该分析表明，儿童使用60mg/kg剂量的阿奇霉素或成人使用每天500mg剂量治疗3天，在根除GAS扁桃体咽炎和实现临床治愈方面比其他治疗方案更有效。
