短期与长期抗生素治疗A组β溶血性链球菌扁桃体咽炎的有效性和安全性：一项随机试验的荟萃分析
Effectiveness and safety of short-course vs long-course antibiotic therapy for group a beta hemolytic streptococcal tonsillopharyngitis: a meta-analysis of randomized trials.
作者信息
Falagas Matthew E, Vouloumanou Evridiki K, Matthaiou Dimitrios K, Kapaskelis Anastasios M, Karageorgopoulos Drosos E
机构信息
Alfa Institute of Biomedical Sciences, 9 Neapoleos St, 151 23 Marousi, Athens, Greece.
出版信息
Mayo Clin Proc. 2008 Aug;83(8):880-9.
OBJECTIVE
To evaluate the effectiveness and safety of short-course antibiotic treatment of group A beta-hemolytic streptococcal (GAS) tonsillopharyngitis.
METHODS
We performed a meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed and the Cochrane Central Register of Controlled Trials using a structured search strategy. The last date either database was accessed was November 14, 2007. We included RCTs that involved patients of any age with GAS tonsillopharyngitis, comparing short-course (< or =7 days) vs long-course (at least 2 days longer than short-course) treatment with the same antibiotics. The primary analysis compared 5 to 7 days with 10 days of treatment, using a random effects model.
RESULTS
Eleven RCTs comparing short-course vs long-course treatment (5 with penicillin V, 4 with oral cephalosporins, 1 with intramuscular ceftriaxone, and 1 with clindamycin; 6 of the 11 were open label) were included. In the primary analysis, microbiological eradication rates of GAS were inferior for short-course vs long-course treatment (8 RCTs, 1607 patients; odds ratio [OR], 0.49; 95% confidence interval [CI], 0.32-0.74). This association was noted with penicillin V treatment (3 RCTs, 500 patients; OR, 0.36; 95% CI, 0.13-0.99) but was nonsignificant with cephalosporin treatment (4 RCTs, 1018 patients; OR, 0.62; 95% CI, 0.38-1.03). Microbiological eradication was less likely with short-course treatment in trials involving primarily children and adolescents (aged <18 years) (6 RCTs, 1258 patients; OR, 0.63; 95% CI, 0.40-0.98). Clinical success was inferior in patients who received short-course treatment (5 RCTs, 1217 patients; OR, 0.49; 95% CI, 0.25-0.96). Adverse events did not differ between compared groups. The above associations were consistent in the analyses involving all included RCTs.
CONCLUSION
Short-course treatment for GAS tonsillopharyngitis, particularly with penicillin V, is associated with inferior bacteriological eradication rates.
目的
评估短疗程抗生素治疗A组β溶血性链球菌（GAS）扁桃体咽炎的有效性和安全性。
方法
我们使用结构化检索策略，对从PubMed和Cochrane对照试验中央注册库中检索到的随机对照试验（RCT）进行了荟萃分析。两个数据库的最后访问日期均为2007年11月14日。我们纳入了涉及任何年龄GAS扁桃体咽炎患者的RCT，比较使用相同抗生素的短疗程（≤7天）与长疗程（比短疗程至少长2天）治疗。主要分析使用随机效应模型比较了5至7天与10天的治疗。
结果
纳入了11项比较短疗程与长疗程治疗的RCT（5项使用青霉素V，4项使用口服头孢菌素，1项使用肌内注射头孢曲松，1项使用克林霉素；11项中有6项为开放标签）。在主要分析中，短疗程治疗的GAS微生物清除率低于长疗程治疗（8项RCT，1607例患者；优势比[OR]，0.49；95%置信区间[CI]，0.32 - 0.74）。青霉素V治疗有此关联（3项RCT，500例患者；OR，0.36；95%CI，0.13 - 0.99），但头孢菌素治疗无显著差异（4项RCT，1018例患者；OR，0.62；95%CI，0.38 - 1.03）。在主要涉及儿童和青少年（年龄<18岁）的试验中，短疗程治疗微生物清除的可能性较小（6项RCT，1258例患者；OR，0.63；95%CI，0.40 - 0.98）。接受短疗程治疗的患者临床成功率较低（5项RCT，1217例患者；OR，0.49；95%CI，0.25 - 0.96）。比较组之间不良事件无差异。上述关联在涉及所有纳入RCT的分析中是一致的。
结论
GAS扁桃体咽炎的短疗程治疗，尤其是使用青霉素V，与较低的细菌清除率相关。
Zotero 插件