Department of Pediatrics and Clinical Epidemology, Sitaram Bhartia Institute of Science and Research, Qutab Institutional Area, New Delhi 110 016, India.
Indian Pediatr. 2010 Jan;47(1):74-87. doi: 10.1007/s13312-010-0010-9. Epub 2009 Sep 3.
To determine the efficacy of a short course of antibiotics (<4 days) in comparison to a longer course (>4 days) for the treatment of acute otitis media in children.
Electronic databases, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences.
Randomized controlled trials of the empiric treatment of acute otitis media comparing antibiotic regimens of <4 days versus > 4 days in children between four weeks to eighteen years of age were included. The trials were grouped by pharmacokinetic behavior of short-course antibiotics into short-acting antibiotics, parenteral ceftriaxone, and long-acting azithromycin.
We reviewed 35 trials, which provided 38 analytic components. Overall, there was no evidence of an increased risk of treatment failure until one month with a short-course of antibiotics (RR=1.06, 95% CI 0.95 to 1.17, P=0.298). Use of short-acting oral antibiotic in short-course was associated with a significantly increased risk of treatment failure (RR=2.27, 95% CI: 1.04 to 4.99). There was a slightly increased risk of treatment failure with parenteral ceftriaxone (RR=1.13, 95% CI 0.99 to 1.30). The risk of adverse effects was significantly lower with short-course regimens (RR=0.58, 95% CI: 0.48 to 0.70).
There is no evidence of an increased risk of treatment failure with short course of antibiotics for acute otitis media. Among the short course regimens, azithromycin use was associated with a lower risk of treatment failure while short acting oral antibiotics and parenteral ceftriaxone may be associated with a higher risk of treatment failure.
比较疗程<4 天与>4 天的抗生素治疗方案对儿童急性中耳炎的疗效。
电子数据库、综述的手工检索、书籍的参考文献、国际会议的摘要和会议录。
纳入了比较 4 周至 18 岁儿童经验性治疗急性中耳炎时疗程<4 天与>4 天的抗生素方案的随机对照试验。试验按短程抗生素的药代动力学行为分为短效抗生素、头孢曲松静脉给药和阿奇霉素长程治疗。
我们复习了 35 项试验，提供了 38 个分析成分。总体而言，直到 1 个月时，短程抗生素治疗的失败风险没有增加（RR=1.06，95%CI 0.95 至 1.17，P=0.298）。短程使用短效口服抗生素与治疗失败的风险显著增加相关（RR=2.27，95%CI：1.04 至 4.99）。头孢曲松静脉给药的治疗失败风险略有增加（RR=1.13，95%CI 0.99 至 1.30）。短程方案的不良反应风险显著降低（RR=0.58，95%CI：0.48 至 0.70）。
急性中耳炎短程抗生素治疗无失败风险增加的证据。在短程方案中，阿奇霉素的使用与较低的治疗失败风险相关，而短效口服抗生素和头孢曲松静脉给药可能与较高的治疗失败风险相关。
