Li Jonathan Z, Winston Lisa G, Moore Dan H, Bent Stephen
Department of Medicine, San Francisco VA Medical Center, University of California, San Francisco, CA 94143-0862, USA.
Am J Med. 2007 Sep;120(9):783-90. doi: 10.1016/j.amjmed.2007.04.023.
There is little consensus on the most appropriate duration of antibiotic treatment for community-acquired pneumonia. The goal of this study is to systematically review randomized controlled trials comparing short-course and extended-course antibiotic regimens for community-acquired pneumonia.
We searched MEDLINE, Embase, and CENTRAL, and reviewed reference lists from 1980 through June 2006. Studies were included if they were randomized controlled trials that compared short-course (7 days or less) versus extended-course (>7 days) antibiotic monotherapy for community-acquired pneumonia in adults. The primary outcome measure was failure to achieve clinical improvement.
We found 15 randomized controlled trials matching our inclusion and exclusion criteria comprising 2796 total subjects. Short-course regimens primarily studied the use of azithromycin (n=10), but trials examining beta-lactams (n=2), fluoroquinolones (n=2), and ketolides (n=1) were found as well. Of the extended-course regimens, 3 studies utilized the same antibiotic, whereas 9 involved an antibiotic of the same class. Overall, there was no difference in the risk of clinical failure between the short-course and extended-course regimens (0.89, 95% confidence interval [CI], 0.78-1.02). In addition, there were no differences in the risk of mortality (0.81, 95% CI, 0.46-1.43) or bacteriologic eradication (1.11, 95% CI, 0.76-1.62). In subgroup analyses, there was a trend toward favorable clinical efficacy for the short-course regimens in all antibiotic classes (range of relative risk, 0.88-0.94).
The available studies suggest that adults with mild to moderate community-acquired pneumonia can be safely and effectively treated with an antibiotic regimen of 7 days or less. Reduction in patient exposure to antibiotics may limit the increasing rates of antimicrobial drug resistance, decrease cost, and improve patient adherence and tolerability.
对于社区获得性肺炎最适宜的抗生素治疗疗程，目前几乎没有共识。本研究的目的是系统评价比较社区获得性肺炎短疗程和长疗程抗生素治疗方案的随机对照试验。
我们检索了MEDLINE、Embase和CENTRAL数据库，并查阅了1980年至2006年6月的参考文献列表。纳入的研究需为随机对照试验，比较成人社区获得性肺炎短疗程（7天或更短）与长疗程（>7天）抗生素单药治疗。主要结局指标为未实现临床改善。
我们发现15项符合纳入和排除标准的随机对照试验，共2796名受试者。短疗程方案主要研究了阿奇霉素的使用（n = 10），但也发现了研究β-内酰胺类（n = 2）、氟喹诺酮类（n = 2）和酮内酯类（n = 1）的试验。在长疗程方案中，3项研究使用了相同的抗生素，而9项研究涉及同一类抗生素。总体而言，短疗程和长疗程方案在临床失败风险方面没有差异（0.89，95%置信区间[CI]，0.78 - 1.02）。此外，在死亡率风险（0.81，95%CI，0.46 - 1.43）或细菌清除率（1.11，95%CI，0.76 - 1.62）方面也没有差异。在亚组分析中，所有抗生素类别中短疗程方案在临床疗效方面均有向好趋势（相对风险范围，0.88 - 0.94）。
现有研究表明，轻度至中度社区获得性肺炎成人患者可使用7天或更短疗程的抗生素方案进行安全有效的治疗。减少患者对抗生素的暴露可能会限制抗菌药物耐药性的上升率，降低成本，并提高患者的依从性和耐受性。
