Fitzgerald Anita, Mori Rintaro, Lakhanpaul Monica, Tullus Kjell
Clinical Practice Committee, Auckland District Health Board, Auckland, New Zealand.
Cochrane Database Syst Rev. 2012 Aug 15;2012(8):CD006857. doi: 10.1002/14651858.CD006857.pub2.
Urinary tract infection (UTI) is one of the most common bacterial infections in infants and children. Lower UTI is the most commonly presenting and in the majority of cases can be easily treated with a course of antibiotic therapy with no further complications. A number of antimicrobials have been used to treat children with lower UTIs; however is it unclear what are the specific benefits and harms of such treatments.
This review aims to summarise the benefits and harms of antibiotics for treating lower UTI in children.
We searched the Renal Group's Specialised Register (April 2012), CENTRAL (The Cochrane Library 2012, Issue 5), MEDLINE OVID SP (from 1966), and EMBASE OVID SP (from 1988) without language restriction. Date of last search: May 2012.
Randomised controlled trials (RCTs) and quasi-RCTs in which antibiotic therapy was used to treat bacteriologically proven, symptomatic, lower UTI in children aged zero to 18 years in primary and community healthcare settings were included.
Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratios (RR) with 95% confidence intervals (CI).
Sixteen RCTs, analysing 1,116 children were included. Conventional 10-day antibiotic treatment significantly increased the number of children free of persistent bacteriuria compared to single-dose therapy (6 studies, 228 children: RR 2.01, 95%CI 1.06 to 3.80). No heterogeneity was observed. Persistent bacteriuria at the end of treatment was reported in 24% of children receiving single-dose therapy compared to 10% of children who were randomised to 10-day therapy. There were no significant differences between groups for persistent symptoms, recurrence following treatment, or re-infection following treatment. There was insufficient data to analyse the effect of antibiotics on renal parenchymal damage, compliance, development of resistant organisms or adverse events. Despite the inclusion of 16 RCTs, methodological weakness and small sample sizes made it difficult to conclude if any of the included antibiotics or regimens were superior to another.
AUTHORS' CONCLUSIONS: Although antibiotic treatment is effective for children with UTI, there are insufficient data to answer the question of which type of antibiotic or which duration is most effective to treat symptomatic lower UTI. This review found that 10-day antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments. No differences were observed for persistent bacteriuria, recurrence or re-infection between short and long-course antibiotics where the antibiotic differed between groups. This data adds to an existing Cochrane review comparing short and long-course treatment of the same antibiotic who also reported no evidence of difference between short and long-course antibiotics.
尿路感染（UTI）是婴幼儿和儿童中最常见的细菌感染之一。下尿路感染是最常见的表现形式，在大多数情况下，通过一个疗程的抗生素治疗即可轻松治愈，且不会出现进一步的并发症。已有多种抗菌药物用于治疗儿童下尿路感染；然而，此类治疗的具体益处和危害尚不清楚。
本综述旨在总结抗生素治疗儿童下尿路感染的益处和危害。
我们检索了肾脏组专业注册库（2012年4月）、CENTRAL（考克兰系统评价数据库2012年第5期）、MEDLINE OVID SP（自1966年起）和EMBASE OVID SP（自1988年起），无语言限制。最后检索日期：2012年5月。
纳入在初级和社区医疗环境中，使用抗生素治疗0至18岁儿童经细菌学证实的、有症状的下尿路感染的随机对照试验（RCT）和半随机对照试验。
两位作者独立评估研究质量并提取数据。采用随机效应模型进行统计分析，结果以风险比（RR）及95%置信区间（CI）表示。
纳入16项RCT，分析了1116名儿童。与单剂量治疗相比，传统的10天抗生素治疗显著增加了无持续性菌尿的儿童数量（6项研究，228名儿童：RR 2.01，95%CI 1.06至3.80）。未观察到异质性。接受单剂量治疗的儿童中，24%在治疗结束时出现持续性菌尿，而随机接受10天治疗的儿童中这一比例为10%。两组在持续性症状、治疗后复发或治疗后再感染方面无显著差异。没有足够的数据来分析抗生素对肾实质损伤、依从性、耐药菌的产生或不良事件的影响。尽管纳入了16项RCT，但方法学上的缺陷和样本量较小使得难以得出所纳入的任何抗生素或治疗方案是否优于其他方案的结论。
尽管抗生素治疗对尿路感染患儿有效，但没有足够的数据来回答哪种类型的抗生素或哪种疗程对治疗有症状的下尿路感染最有效的问题。本综述发现，10天的抗生素治疗比单剂量治疗更有可能清除尿液中的细菌。在两组抗生素不同的短疗程和长疗程抗生素之间，持续性菌尿、复发或再感染方面未观察到差异。这些数据补充了考克兰现有一项关于同一抗生素短疗程和长疗程治疗比较的综述，该综述也未发现短疗程和长疗程抗生素之间存在差异的证据。
