Karageorgopoulos D E, Valkimadi P E, Kapaskelis A, Rafailidis P I, Falagas M E
Alfa Institute of Biomedical Sciences (AIBS), 151 23 Marousi, Athens, Greece.
Arch Dis Child. 2009 Aug;94(8):607-14. doi: 10.1136/adc.2008.151563.
To evaluate the effectiveness and safety of short-course antibiotic therapy for bacterial meningitis, by performing a meta-analysis of randomised controlled trials (RCT).
PubMed and the Cochrane Central Register of Controlled Trials were searched for RCT on patients of all ages with community-acquired acute bacterial meningitis that compared treatment with the same antibiotics, in the same daily dosage, administered for a short course (up to 7 days) versus a longer course (2 days or more than corresponding short course).
Five open-label RCT involving children (3 weeks to 16 years) were included. No difference was demonstrated between short-course (4-7 days) and long-course (7-14 days) treatment (intravenous ceftriaxone) regarding: end-of-therapy clinical success (five RCT, 383 patients, fixed effect model (FEM), odds ratio (OR) 1.24, 95% CI 0.73 to 2.11); long-term neurological complications (five RCT, 367 patients, FEM, OR 0.60, 95% CI 0.29 to 1.27); long-term hearing impairment (four RCT, 241 patients, FEM, OR 0.59, 95% CI 0.28 to 1.23); total adverse events (two RCT, 122 patients, FEM, OR 1.29, 95% CI 0.57 to 2.91); or secondary nosocomial infections (two RCT, 139 patients, random effects model, OR 0.45, 95% CI 0.05 to 3.71). The duration of hospitalisation was lower with short-course treatment (two RCT, 137 patients, FEM, weighted mean difference -2.17 days, 95% CI -3.85 to -0.50). The available data did not allow for analysis by causative organism.
This meta-analysis of the rather limited available relevant data could not show differences between short and long-course antibiotic treatment for bacterial meningitis in children. Further research on this issue is required.
通过对随机对照试验（RCT）进行荟萃分析，评估短程抗生素疗法治疗细菌性脑膜炎的有效性和安全性。
检索了PubMed和Cochrane对照试验中央注册库，以查找关于所有年龄段社区获得性急性细菌性脑膜炎患者的RCT，这些试验比较了相同抗生素、相同日剂量、短疗程（最多7天）与长疗程（2天或超过相应短疗程）的治疗效果。
纳入了五项涉及儿童（3周龄至16岁）的开放标签RCT。在短疗程（4 - 7天）和长疗程（7 - 14天）治疗（静脉注射头孢曲松）之间，在以下方面未显示出差异：治疗结束时的临床成功率（五项RCT，383例患者，固定效应模型（FEM），比值比（OR）1.24，95%置信区间0.73至2.11）；长期神经并发症（五项RCT，367例患者，FEM，OR 0.60，95%置信区间0.29至1.27）；长期听力损害（四项RCT，241例患者，FEM，OR 0.59，95%置信区间0.28至1.23）；总不良事件（两项RCT，122例患者，FEM，OR 1.29，95%置信区间0.57至2.91）；或继发性医院感染（两项RCT，139例患者，随机效应模型，OR 0.45，95%置信区间0.05至3.71）。短疗程治疗的住院时间较短（两项RCT，137例患者，FEM，加权平均差 -2.17天，95%置信区间 -3.85至 -0.50）。现有数据不允许按致病微生物进行分析。
对相当有限的可用相关数据进行的这项荟萃分析未能显示儿童细菌性脑膜炎短程和长程抗生素治疗之间的差异。对此问题需要进一步研究。
