Iyer Srikant, DeFoor William, Grocela Joseph, Kamholz Karen, Varughese Anna, Kenna Margaret
Department of Otolaryngology and Communication Disorders, Children's Hospital Boston, Harvard School of Public Health, 300 Longwood Avenue, Boston, MA 02115, USA.
Int J Pediatr Otorhinolaryngol. 2006 May;70(5):853-61. doi: 10.1016/j.ijporl.2005.09.021. Epub 2005 Dec 15.
To assess the efficacy of perioperative antibiotics in decreasing post-operative morbidity among patients undergoing tonsillectomy or adenotonsillectomy.
Meta-analysis based on a structured search of the literature, using MEDLINE and the Cochrane database.
Only articles, which included both treatment and control groups, were included in the final analysis. Studies were limited to ones that involved human subjects, including both children and adults. Studies using steroids and topical antibiotics were excluded.
Articles were abstracted for patient factors, elements of study design, methods of patient assignment to treatment and control groups, and clinical outcomes. The primary outcome, time required for return to normal oral intake, was analyzed in the final meta-analysis.
Four hundred and twenty-eight articles were initially identified. There were 23 potentially appropriate articles. Of these, 18 were able to be located in full text form and in English. Seven of these studies directly studied the efficacy of perioperative antibiotics (versus no antibiotics) in decreasing post-operative morbidity. Four studies had sufficient information to calculate effects estimates (xi) and standard deviations (Si) for the primary outcome. Three studies either did not report the outcome of interest or did not report a measure of stability (e.g. p-value or confidence interval). The data available from the first four studies were combined in a quantitative meta-analysis. Statistical analyses were performed using STATA for Windows software.
The pooled estimate indicated that the antibiotic group returned to normal oral intake, on average, 1 day sooner than the controls. This difference was found to be statistically significant with a 95% confidence interval of 0.5-1.6 days. An additional assessment of three qualitative reports also suggested the use of perioperative antibiotics for adenotonsillectomy was associated with less post-operative pain. However, studies varied in terms of study quality, sample size, outcome examined, measure used and antibiotic administered. Definitive conclusions regarding the effect of perioperative antibiotics on other outcomes including bleeding, halitosis, fever, activity level and nausea and vomiting could not be drawn due to the small numbers of studies.
In this meta-analysis, the use of perioperative antibiotics in patients who have had tonsillectomy or adenotonsillectomy appears to be associated with a 1-day reduction in the time required for return to normal oral intake. For other potentially important outcomes, such as post operative pain or bleeding, sufficient data were not available to make any definitive conclusions regarding the effect of perioperative antibiotics.
评估围手术期使用抗生素对扁桃体切除术或腺样体扁桃体切除术患者术后发病率的降低效果。
基于对文献的结构化检索进行荟萃分析，使用MEDLINE和Cochrane数据库。
最终分析仅纳入包含治疗组和对照组的文章。研究限于涉及人类受试者的研究，包括儿童和成人。排除使用类固醇和局部抗生素的研究。
提取文章中的患者因素、研究设计要素、患者分配至治疗组和对照组的方法以及临床结果。在最终的荟萃分析中分析主要结果，即恢复正常经口进食所需时间。
最初识别出428篇文章。有23篇可能合适的文章。其中，18篇能够找到全文且为英文。这些研究中有7项直接研究了围手术期使用抗生素（与不使用抗生素相比）对降低术后发病率的效果。4项研究有足够信息计算主要结果的效应估计值（xi）和标准差（Si）。3项研究要么未报告感兴趣的结果，要么未报告稳定性测量值（如p值或置信区间）。将前4项研究可得的数据进行定量荟萃分析。使用Windows版STATA软件进行统计分析。
汇总估计表明，抗生素组恢复正常经口进食的时间平均比对照组早1天。发现这一差异具有统计学意义，95%置信区间为0.5 - 1.6天。对3篇定性报告的额外评估也表明，腺样体扁桃体切除术围手术期使用抗生素与术后疼痛减轻有关。然而，研究在研究质量、样本量、检查的结果、使用的测量方法和给予的抗生素方面存在差异。由于研究数量较少，无法就围手术期抗生素对包括出血、口臭、发热、活动水平以及恶心和呕吐等其他结果的影响得出明确结论。
在这项荟萃分析中，扁桃体切除术或腺样体扁桃体切除术患者围手术期使用抗生素似乎可使恢复正常经口进食所需时间缩短1天。对于其他潜在重要结果，如术后疼痛或出血，没有足够数据就围手术期抗生素的效果得出任何明确结论。
