Kyriakidou Kleoniki G, Rafailidis Petros, Matthaiou Dimitris K, Athanasiou Stavros, Falagas Matthew E
Alfa Institute of Biomedical Sciences, Marousi, Greece.
Clin Ther. 2008 Oct;30(10):1859-68. doi: 10.1016/j.clinthera.2008.10.007.
Despite the high incidence of acute pyelonephritis in the community setting, there is no consensus on the optimal duration of treatment. A potential reduction in the duration of the administered antibiotic regimens could contribute to avoiding further development of antimicrobial resistance.
The aim of this meta-analysis was to compare short-course (7- to 14-day) with long-course (14- to 42-day) treatment with the same antibiotic regimens, in terms of the effectiveness and tolerability, in acute pyelonephritis.
We searched PubMed, Cochrane Central Register of Controlled Trials, and SCOPUS (January 1966-March 2008) to identify and extract data from randomized controlled trials (RCTs) comparing the effectiveness and toxicity of short- versus long-course regimens. Additionally, references of studies were searched. A publication was included if: it was an RCT; involved adult and/or adolescent patients with acute pyelonephritis; compared regimens with the same antibiotic, at the same daily dosage, that were administered for differing durations (a short course and a long course lie, no absolute time cutoff (in days) was employed; rather, the duration of one regimen compared with another defined short- vs long-course]); and reported data regarding clinical success, bacteriologic efficacy, relapses, recurrences, and adverse events and/or patient withdrawals due to adverse events. Trials with a mixed population, including patients with acute pyelonephritis as a subset, were also included in the meta-analysis. Efficacy was assessed by evaluating clinical success, defined as resolution of symptoms and signs at the test-of-cure visit, and bacteriologic efficacy, defined as yielding sterile urine cultures or positive cultures with <10(3) colony-forming units per milliliter of urine at the test-of-cure visit. Tolerability was assessed by extracting data for adverse events.
According to our initial search, 205, 136, 179, and 73 potentially relevant articles were retrieved from PubMed, Cochrane Central Register of Controlled Trials, SCOPUS, and references of evaluable trials, respectively. Four RCTs were eligible for inclusion in the meta-analysis. Significant differences were not found between the short- and long-course treatment of acute pyclonephritis in terms of clinical success (odds ratio [OR], 1.27; 95% CI, 0.59-2.70), bacteriologic efficacy (OR, 0.80; 95% CI, 0.13-4.95), and relapse (OR, 0.65; 95% CI, 0.08-5.39). Also, significant differences were not found between the short- and long-course treatments regarding adverse events (OR, 0.64; 95% CI, 0.33-1.25), withdrawals due to adverse events (OR, 0.65; 95% CI, 0.28-1.55), and recurrences (OR, 1.39; 95% CI, 0.63-3.06).
This meta-analysis failed to identify any significant differences, with regard to effectiveness and tolerability, between short- and long-course treatment with the same antibiotic.
尽管社区环境中急性肾盂肾炎的发病率很高，但对于最佳治疗疗程尚无共识。缩短抗生素治疗方案的疗程可能有助于避免抗菌药物耐药性的进一步发展。
本荟萃分析的目的是比较相同抗生素方案的短疗程（7至14天）与长疗程（14至42天）治疗急性肾盂肾炎的有效性和耐受性。
我们检索了PubMed、Cochrane对照试验中央注册库和SCOPUS（1966年1月至2008年3月），以识别和提取比较短疗程与长疗程方案有效性和毒性的随机对照试验（RCT）的数据。此外，还检索了研究的参考文献。纳入的出版物需满足以下条件：是RCT；涉及成人和/或青少年急性肾盂肾炎患者；比较相同抗生素、相同每日剂量、不同疗程的方案（短疗程和长疗程，未采用绝对天数截止；相反，一个疗程与另一个疗程的持续时间比较定义短疗程与长疗程）；并报告有关临床成功、细菌学疗效、复发、再发以及不良事件和/或因不良事件导致的患者退出的数据。混合人群的试验，包括以急性肾盂肾炎患者为子集的试验，也纳入荟萃分析。通过评估临床成功来评估疗效，临床成功定义为治愈检查时症状和体征消失；通过评估细菌学疗效来评估疗效，细菌学疗效定义为治愈检查时尿培养无菌或每毫升尿中菌落形成单位<10³的阳性培养。通过提取不良事件数据来评估耐受性。
根据我们的初步检索，分别从PubMed、Cochrane对照试验中央注册库、SCOPUS和可评估试验的参考文献中检索到205篇、136篇、179篇和73篇潜在相关文章。四项RCT符合纳入荟萃分析的条件。急性肾盂肾炎短疗程和长疗程治疗在临床成功（比值比[OR]，1.27；95%可信区间[CI]，0.59 - 2.70）、细菌学疗效（OR，0.80；95% CI，0.13 - 4.95）和复发（OR，0.65；95% CI，0.08 - 5.39）方面未发现显著差异。短疗程和长疗程治疗在不良事件（OR，0.64；95% CI，0.33 - 1.25）、因不良事件导致的退出（OR，0.65；95% CI，0.28 - 1.55）和再发（OR，1.39；95% CI，0.63 - 3.06）方面也未发现显著差异。
本荟萃分析未能发现相同抗生素短疗程和长疗程治疗在有效性和耐受性方面存在任何显著差异。
