Abbott Linsey, Plummer Amanda, Hoo Zhe Hui, Wildman Martin
Pharmacy Department, Northern General Hospital, Herries Road, Sheffield, UK, S5 7AU.
Cochrane Database Syst Rev. 2019 Sep 5;9(9):CD006682. doi: 10.1002/14651858.CD006682.pub6.
Progressive lung damage from recurrent exacerbations is the major cause of mortality and morbidity in cystic fibrosis. Life expectancy of people with cystic fibrosis has increased dramatically in the last 40 years. One of the major reasons for this increase is the mounting use of antibiotics to treat chest exacerbations caused by bacterial infections. The optimal duration of intravenous antibiotic therapy is not clearly defined. Individuals usually receive intravenous antibiotics for 14 days, but treatment may range from 10 to 21 days. A shorter duration of antibiotic treatment risks inadequate clearance of infection which could lead to further lung damage. Prolonged courses of intravenous antibiotics are expensive and inconvenient. The risk of systemic side effects such as allergic reactions to antibiotics also increases with prolonged courses and the use of aminoglycosides requires frequent monitoring to minimise some of their side effects. However, some organisms which infect people with cystic fibrosis are known to be multi-resistant to antibiotics, and may require a longer course of treatment. This is an update of previously published reviews.
To assess the optimal duration of intravenous antibiotic therapy for treating chest exacerbations in people with cystic fibrosis.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals, abstract books and conference proceedings. Most recent search of the Group's Cystic Fibrosis Trials Register: 30 May 2019.We also searched online trials registries. Most recent search of the ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) portal: 06 January 2019.
Randomised and quasi-randomised controlled trials comparing different durations of intravenous antibiotic courses for acute respiratory exacerbations in people with CF, either with the same drugs at the same dosage, the same drugs at a different dosage or frequency or different antibiotics altogether, including studies with additional therapeutic agents.
No eligible trials were identified for inclusion. A trial looking at the standardised treatment of pulmonary exacerbations is currently ongoing and will be included when the results are published. MAIN RESULTS: No eligible trials were included.
AUTHORS' CONCLUSIONS: There are no clear guidelines on the optimum duration of intravenous antibiotic treatment. Duration of treatment is currently based on unit policies and response to treatment. Shorter duration of treatment should improve quality of life and adherence, result in a reduced incidence of drug reactions and be less costly. However, the shorter duration may not be sufficient to clear a chest infection and may result in an early recurrence of an exacerbation. This systematic review identifies the need for a multicentre, randomised controlled trial comparing different durations of intravenous antibiotic treatment as it has important clinical and financial implications. The currently ongoing STOP2 trial is expected to provide some guidance on these questions when published.
反复加重导致的进行性肺损伤是囊性纤维化患者死亡和发病的主要原因。在过去40年中，囊性纤维化患者的预期寿命大幅增加。这一增长的主要原因之一是越来越多地使用抗生素来治疗由细菌感染引起的胸部病情加重。静脉抗生素治疗的最佳持续时间尚无明确定义。个体通常接受14天的静脉抗生素治疗，但治疗时间可能为10至21天。抗生素治疗时间过短有感染清除不充分的风险，这可能导致进一步的肺损伤。延长静脉抗生素疗程既昂贵又不方便。随着疗程延长，抗生素全身副作用（如过敏反应）的风险也会增加，使用氨基糖苷类药物需要频繁监测以尽量减少其一些副作用。然而，已知一些感染囊性纤维化患者的病原体对抗生素具有多重耐药性，可能需要更长的疗程。这是对先前发表的综述的更新。
评估治疗囊性纤维化患者胸部病情加重时静脉抗生素治疗的最佳持续时间。
我们检索了Cochrane囊性纤维化和遗传疾病小组试验注册库，该注册库包含从全面电子数据库检索、相关期刊手工检索、摘要书籍和会议论文集识别出的参考文献。该小组囊性纤维化试验注册库的最新检索时间：2019年5月30日。我们还检索了在线试验注册库。ClinicalTrials.gov和世界卫生组织国际临床试验注册平台（ICTRP）门户的最新检索时间：2019年1月6日。
比较囊性纤维化患者急性呼吸道病情加重时不同静脉抗生素疗程持续时间的随机和半随机对照试验，这些试验使用相同药物、相同剂量、不同剂量或频率的相同药物或完全不同的抗生素，包括使用额外治疗药物的研究。
未识别出符合纳入标准的试验。一项关于肺部病情加重标准化治疗的试验正在进行中，结果发表后将纳入。
未纳入符合条件的试验。
关于静脉抗生素治疗的最佳持续时间尚无明确指南。目前的治疗持续时间基于单位政策和对治疗的反应。较短的治疗持续时间应能改善生活质量和依从性，降低药物反应发生率并降低成本。然而，较短的持续时间可能不足以清除胸部感染，可能导致病情加重早期复发。本系统评价确定需要进行一项多中心随机对照试验，比较不同静脉抗生素治疗持续时间，因为这具有重要的临床和经济意义。目前正在进行的STOP2试验发表后有望为这些问题提供一些指导。
