Holm Anna Engell, Llor Carl, Bjerrum Lars, Cordoba Gloria
Research Unit for General Practice and Section of General Practice, Department of Public Health, Øster Farimagsgade 5, 1014 Copenhagen, Denmark.
Antibiotics (Basel). 2020 Oct 26;9(11):733. doi: 10.3390/antibiotics9110733.
To evaluate the effectiveness of short courses of antibiotic therapy for patients with acute streptococcal pharyngitis.
Randomized controlled trials comparing short-course antibiotic therapy (≤5 days) with long-course antibiotic therapy (≥7 days) for patients with streptococcal pharyngitis were included. Two primary outcomes: early clinical cure and early bacterial eradication.
Fifty randomized clinical trials were included. Overall, short-course antibiotic treatment was as effective as long-course antibiotic treatment for early clinical cure (odds ratio (OR) 0.85; 95% confidence interval (CI) 0.79 to 1.15). Subgroup analysis showed that short-course penicillin was less effective for early clinical cure (OR 0.43; 95% CI, 0.23 to 0.82) and bacteriological eradication (OR 0.34; 95% CI, 0.19 to 0.61) in comparison to long-course penicillin. Short-course macrolides were equally effective, compared to long-course penicillin. Finally, short-course cephalosporin was more effective for early clinical cure (OR 1.48; 95% CI, 1.11 to 1.96) and early microbiological cure (OR 1.60; 95% CI, 1.13 to 2.27) in comparison to long-course penicillin. In total, 1211 (17.7%) participants assigned to short-course antibiotic therapy, and 893 (12.3%) cases assigned to long-course, developed adverse events (OR 1.35; 95% CI, 1.08 to 1.68).
Macrolides and cephalosporins belong to the list of "Highest Priority Critically Important Antimicrobials"; hence, long-course penicillin V should remain as the first line antibiotic for the management of patients with streptococcal pharyngitis as far as the benefits of using these two types of antibiotics do not outweigh the harms of their unnecessary use.
评估短期抗生素治疗对急性链球菌性咽炎患者的有效性。
纳入比较链球菌性咽炎患者短期抗生素治疗（≤5天）与长期抗生素治疗（≥7天）的随机对照试验。两个主要结局：早期临床治愈和早期细菌清除。
纳入50项随机临床试验。总体而言，短期抗生素治疗在早期临床治愈方面与长期抗生素治疗效果相当（优势比（OR）0.85；95%置信区间（CI）0.79至1.15）。亚组分析表明，与长期青霉素治疗相比，短期青霉素治疗在早期临床治愈（OR 0.43；95% CI，0.23至0.82）和细菌清除（OR 0.34；95% CI，0.19至0.61）方面效果较差。与长期青霉素治疗相比，短期大环内酯类药物效果相当。最后，与长期青霉素治疗相比，短期头孢菌素在早期临床治愈（OR 1.48；95% CI，1.11至1.96）和早期微生物学治愈（OR 1.60；95% CI，1.13至2.27）方面效果更好。共有1211名（17.7%）接受短期抗生素治疗的参与者和893名（12.3%）接受长期治疗的患者发生不良事件（OR 1.35；95% CI，1.08至1.68）。
大环内酯类药物和头孢菌素属于“最高优先级至关重要的抗菌药物”清单；因此，只要使用这两种抗生素的益处不超过不必要使用它们的危害，长期青霉素V仍应作为链球菌性咽炎患者管理的一线抗生素。
