Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark.
Basic Clin Pharmacol Toxicol. 2019 May;124(5):550-559. doi: 10.1111/bcpt.13205. Epub 2019 Feb 21.
It is well known that antibiotic use is the main driver for the increasing problems with resistant bacteria. Consequently, some countries have recommended shortening the duration of antibiotic treatment of community-acquired pneumonia (CAP). The aim of this study was to investigate whether the effectiveness of a short-course antibiotic is comparable to a longer course of antibiotics in adults with CAP and to assess whether the duration of an antibiotic course influences the development of resistant bacteria.
A literature search was performed in PubMed and EMBASE. We included randomized, controlled trials (RCTs) comparing clinical success, microbiological efficacy, patient safety and antibiotic resistance in a short-course (5 days) vs a long-course antibiotic treatment (7+ days) for CAP.
Six RCTs were included. Clinical success rates were 87%-95% in patients treated with short-course antibiotics and 88%-94% in patients treated with a longer course. Eradication of pathogenic bacteria was found to be 100% and 95%-100% in patients treated with short-course and long-course antibiotics, respectively. No significant differences in adverse events were reported. However, none of the trials reported on the impact on the development of resistant bacteria.
Only few trials were included in this review and more RCTs are highly needed to be able to provide solid evidence for optimal treatment durations for patients diagnosed with CAP. Importantly, fluoroquinolones were often the drug of choice, and trials testing beta-lactam antibiotics, which are the type of antibiotics most often used in many European countries, should be aimed for in near future.
众所周知，抗生素的使用是导致耐药菌问题日益严重的主要原因。因此，一些国家建议缩短社区获得性肺炎（CAP）的抗生素治疗疗程。本研究旨在探讨短期抗生素治疗与 CAP 成人患者的长期抗生素治疗相比是否具有等效疗效，并评估抗生素疗程的长短是否会影响耐药菌的产生。
在 PubMed 和 EMBASE 中进行文献检索。我们纳入了比较短期（5 天）与长期（7+天）抗生素治疗 CAP 的临床疗效、微生物疗效、患者安全性和抗生素耐药性的随机对照试验（RCT）。
纳入了 6 项 RCT。接受短期抗生素治疗的患者临床成功率为 87%-95%，接受长期抗生素治疗的患者临床成功率为 88%-94%。接受短期和长期抗生素治疗的患者分别有 100%和 95%-100%的患者清除了病原菌。未报告有不良反应的显著差异。然而，没有一项试验报告了对耐药菌发展的影响。
本综述仅纳入了少数试验，需要更多的 RCT 来提供 CAP 患者最佳治疗疗程的可靠证据。重要的是，氟喹诺酮类药物通常是首选药物，应针对未来的试验检测β-内酰胺类抗生素，因为这类抗生素是许多欧洲国家最常使用的抗生素类型。
