Smyth Alan R, Bhatt Jayesh
Department of Child Health, School of Clinical Sciences & Nottingham Respiratory BRU, University of Nottingham, Nottingham,UK.
Cochrane Database Syst Rev. 2012 Feb 15(2):CD002009. doi: 10.1002/14651858.CD002009.pub4.
People with cystic fibrosis, who are chronically colonised with the organism Pseudomonas aeruginosa, often require multiple courses of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations. The properties of aminoglycosides suggest that they could be given in higher doses less often.
To assess the effectiveness and safety of once-daily versus multiple-daily dosing of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations in cystic fibrosis.
We searched the Cystic Fibrosis Specialist Register held at the Cochrane Cystic Fibrosis and Genetic Disorders Group's editorial base, comprising references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings.Date of the most recent search: 29 September 2011.
All randomised controlled trials, whether published or unpublished, in which once-daily dosing of aminoglycosides has been compared with multiple-daily dosing in terms of efficacy or toxicity or both, in people with cystic fibrosis.
The two authors independently selected the studies to be included in the review and assessed methodological quality of each study. Data were independently extracted by each author. Authors of the included studies were contacted for further information. As yet unpublished data were obtained for one of the included studies.
Sixteen studies were identified for possible inclusion in the review. Four studies reporting results from a total of 328 participants were included in this review. All studies compared once-daily dosing with thrice-daily dosing. There was no significant difference between treatment groups in: forced expiratory volume at one second, mean difference 0.33 (95% confidence interval -2.81 to 3.48); forced vital capacity, mean difference 0.29 (95% confidence interval -6.58 to 7.16); % weight for height, mean difference -0.82 (95% confidence interval -3.77 to 2.13); body mass index, mean difference 0.00 (95% confidence interval -0.42 to 0.42); or in the incidence of ototoxicity, relative risk 0.56 (95% confidence interval 0.04 to 7.96). The percentage change in creatinine significantly favoured once-daily treatment in children, mean difference -8.20 (95% confidence interval -15.32 to -1.08), but showed no difference in adults, mean difference 3.25 (95% confidence interval -1.82 to 8.33).
AUTHORS' CONCLUSIONS: Once- and three-times daily aminoglycoside antibiotics appear to be equally effective in the treatment of pulmonary exacerbations of cystic fibrosis. There is evidence of less nephrotoxicity in children.
囊性纤维化患者长期感染铜绿假单胞菌，在治疗肺部病情加重时通常需要多次静脉注射氨基糖苷类抗生素。氨基糖苷类药物的特性表明可以减少用药频率并提高剂量。
评估每日一次与每日多次静脉注射氨基糖苷类抗生素治疗囊性纤维化患者肺部病情加重的有效性和安全性。
我们检索了Cochrane囊性纤维化和遗传疾病小组编辑基地保存的囊性纤维化专科注册库，其中包括通过全面电子数据库检索、手工检索相关期刊以及手工检索会议论文摘要书籍确定的参考文献。最近一次检索日期：2011年9月29日。
所有随机对照试验，无论是否发表，只要是将囊性纤维化患者中氨基糖苷类药物每日一次给药与每日多次给药在疗效或毒性或两者方面进行比较的研究。
两位作者独立选择纳入综述的研究，并评估每项研究的方法学质量。每位作者独立提取数据。与纳入研究的作者联系以获取更多信息。其中一项纳入研究获得了尚未发表的数据。
确定了16项可能纳入综述的研究。本综述纳入了4项研究，共报告了328名参与者的结果。所有研究均比较了每日一次给药与每日三次给药。治疗组之间在以下方面无显著差异：一秒用力呼气量，平均差值0.33（95%置信区间-2.81至3.48）；用力肺活量，平均差值0.29（95%置信区间-6.58至7.16）；身高体重百分比，平均差值-0.82（95%置信区间-3.
