Smyth A R, Tan K H
Nottingham City Hospital, Department of Respiratory Medicine, Clinical Sciences Building, Hucknall Road, Nottingham, UK NG5 1PB.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD002009. doi: 10.1002/14651858.CD002009.pub2.
People with cystic fibrosis, who are chronically colonised with the organism Pseudomonas aeruginosa, often require multiple courses of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations. The properties of aminoglycosides suggest that they could be given in higher doses less often.
To assess the effectiveness and safety of once-daily versus multiple-daily dosing of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations in cystic fibrosis.
We searched the Cystic Fibrosis Specialist Register held at the Cochrane Cystic Fibrosis and Genetic Disorders Group's editorial base, comprising references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings.Date of the most recent search: August 2005.
All randomised controlled trials, whether published or unpublished, in which once-daily dosing of aminoglycosides has been compared with multiple-daily dosing in terms of efficacy and/or toxicity, in people with cystic fibrosis.
The two authors independently selected the studies to be included in the review and assessed methodological quality of each study. Data were independently extracted by each author. Authors of the included studies were contacted for further information. As yet unpublished data were obtained for one of the included studies.
Eleven studies were identified for possible inclusion in the review. Four studies reporting results from a total of 328 participants were included in this review. All studies compared once-daily dosing with thrice-daily dosing. There was no significant difference between treatment groups in: forced expiratory volume at one second, weighted mean difference (WMD) 0.33 (95% confidence interval (CI) -2.81 to 3.48); forced vital capacity, WMD 0.29 (95% CI -6.58 to 7.16); % weight for height, WMD -0.82 (95% CI -3.77 to 2.13); body mass index, WMD 0.00 (95% CI -0.42 to 0.42); or in the incidence of ototoxicity, relative risk 0.56 (95% CI 0.04 to 7.96). The percentage change in creatinine significantly favoured once-daily treatment in children, WMD -8.20 (95% CI -15.32 to -1.08), but showed no difference in adults, WMD 3.25 (95% CI -1.82 to 8.33).
AUTHORS' CONCLUSIONS: Once and three times daily aminoglycoside antibiotics appear to be equally effective in the treatment of pulmonary exacerbations of cystic fibrosis. There is evidence of less nephrotoxicity in children.
患有囊性纤维化的患者长期被铜绿假单胞菌定植，在治疗肺部病情加重时通常需要多次静脉注射氨基糖苷类抗生素。氨基糖苷类药物的特性表明可以减少给药频率并提高剂量。
评估静脉注射氨基糖苷类抗生素每日一次给药与多次给药治疗囊性纤维化肺部病情加重的有效性和安全性。
我们检索了Cochrane囊性纤维化和遗传疾病小组编辑基地保存的囊性纤维化专科登记册，其中包括通过全面电子数据库检索、手工检索相关期刊以及手工检索会议论文摘要集确定的参考文献。最近一次检索日期：2005年8月。
所有随机对照试验，无论是否发表，只要是将囊性纤维化患者中氨基糖苷类药物每日一次给药与多次给药在疗效和/或毒性方面进行比较的试验。
两位作者独立选择纳入综述的研究，并评估每项研究的方法学质量。每位作者独立提取数据。与纳入研究的作者联系以获取更多信息。其中一项纳入研究获取了尚未发表的数据。
确定了11项可能纳入综述的研究。本综述纳入了4项研究，共报告了328名参与者的结果。所有研究均比较了每日一次给药与每日三次给药。治疗组在以下方面无显著差异：一秒用力呼气量，加权平均差（WMD）0.33（95%置信区间（CI）-2.81至3.48）；用力肺活量，WMD 0.29（95%CI -6.58至7.16）；身高体重百分比，WMD -0.82（95%CI -3.77至2.13）；体重指数，WMD 0.00（95%CI -0.42至0.42）；或耳毒性发生率，相对风险0.56（95%CI 0.04至7.96）。肌酐的百分比变化在儿童中显著有利于每日一次治疗，WMD -8.20（95%CI -15.32至-1.08），但在成人中无差异，WMD 3.25（95%CI -1.82至8.33）。
每日一次和每日三次的氨基糖苷类抗生素在治疗囊性纤维化肺部病情加重方面似乎同样有效。有证据表明儿童的肾毒性较小。
