Altamimi Saleh, Khalil Adli, Khalaiwi Khalid A, Milner Ruth, Pusic Martin V, Al Othman Mohammed A
Department of Emergency Medicine and Pediatrics, King Fahd Medical City, Riyadh, Saudi Arabia, 11563.
Cochrane Database Syst Rev. 2009 Jan 21(1):CD004872. doi: 10.1002/14651858.CD004872.pub2.
The standard duration of treatment for acute group A beta hemolytic streptococcus (GABHS) pharyngitis with oral penicillin is 10 days. Shorter duration antibiotics may have comparable efficacy.
To summarize the evidence regarding the efficacy of two to six days of newer oral antibiotics (short duration) compared to 10 days of oral penicillin (standard duration) in treating children with acute GABHS pharyngitis.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, issue 4), which contains the Acute Respiratory Infections Group's Specialized Register; the Database of Abstracts of Reviews of Effects (DARE); MEDLINE (1966 to October 2007); OLDMEDLINE (1950 to December 1965); and EMBASE (January 1990 to November 2007).
Randomized controlled trials (RCTs) comparing short duration oral antibiotics to standard duration oral penicillin in children aged 1 to 18 years with acute GABHS pharyngitis.
Two review authors scanned the titles and abstracts of retrieved citations and applied the inclusion criteria. We retrieved included studies in full and extracted data. Two review authors independently assessed trial quality.
Twenty studies were included with 13,102 cases of acute GABHS pharyngitis. Compared to standard duration treatment, the short duration treatment had shorter periods of fever (mean difference (MD) -0.30 days, 95% CI -0.45 to -0.14) and throat soreness (MD -0.50 days, 95% CI -0.78 to -0.22); lower risk of early clinical treatment failure (OR 0.80, 95% CI 0.67 to 0.94); no significant difference in early bacteriological treatment failure (OR 1.08, 95% CI 0.97 to 1.20), or late clinical recurrence (OR 0.95, 95% CI 0.83 to 1.08). However, the overall risk of late bacteriological recurrence was worse in the short duration treatment (OR 1.31, 95% CI 1.16 to 1.48), although no significant differences were found when studies of low dose azithromycin (10mg/kg) were eliminated (OR 1.06, 95% CI 0.92 to 1.22). Three studies reported long duration complications with no statistically significant difference (OR 0.53, 95% CI 0.17 to 1.64).
AUTHORS' CONCLUSIONS: Three to six days of oral antibiotics had comparable efficacy compared to the standard duration 10 day oral penicillin in treating children with acute GABHS pharyngitis. In countries with low rates of rheumatic fever, it appears safe and efficacious to treat children with acute GABHS pharyngitis with short duration antibiotics. In areas where the prevalence of rheumatic heart disease is still high, our results must be interpreted with caution.
口服青霉素治疗急性A组β溶血性链球菌（GABHS）咽炎的标准疗程为10天。较短疗程的抗生素可能具有相当的疗效。
总结与口服青霉素10天（标准疗程）相比，使用新型口服抗生素2至6天（短疗程）治疗儿童急性GABHS咽炎疗效的相关证据。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（Cochrane图书馆2007年第4期），其中包含急性呼吸道感染组的专业注册库；循证医学数据库（DARE）；医学索引数据库（MEDLINE，1966年至2007年10月）；旧医学文献分析与联机检索系统（OLDMEDLINE，1950年至1965年12月）；以及荷兰医学文摘数据库（EMBASE，1990年1月至2007年11月）。
比较短疗程口服抗生素与标准疗程口服青霉素治疗1至18岁急性GABHS咽炎儿童的随机对照试验（RCT）。
两位综述作者浏览检索到的文献标题和摘要，并应用纳入标准。我们获取纳入研究的全文并提取数据。两位综述作者独立评估试验质量。
纳入20项研究，共13102例急性GABHS咽炎病例。与标准疗程治疗相比，短疗程治疗的发热时间（平均差（MD）-0.30天，95%置信区间-0.45至-0.14）和咽痛时间（MD -0.50天，95%置信区间-0.78至-0.22）更短；早期临床治疗失败风险更低（比值比（OR）0.80，95%置信区间0.67至0.94）；早期细菌学治疗失败无显著差异（OR 1.08，95%置信区间0.97至1.20），或晚期临床复发无显著差异（OR 0.95，95%置信区间0.83至1.08）。然而，短疗程治疗的晚期细菌学复发总体风险更差（OR 1.31，95%置信区间1.16至1.48），不过排除低剂量阿奇霉素（10mg/kg）的研究后未发现显著差异（OR 1.06，95%置信区间0.92至1.22）。三项研究报告了长期并发症，无统计学显著差异（OR 0.53，95%置信区间0.17至1.64）。
与标准疗程10天口服青霉素相比，口服抗生素3至6天治疗儿童急性GABHS咽炎具有相当的疗效。在风湿热发病率较低的国家，用短疗程抗生素治疗儿童急性GABHS咽炎似乎安全有效。在风湿性心脏病患病率仍然较高的地区，对我们的结果必须谨慎解读。
