Antimicrobial Stewardship Program, Sinai Health/University Health Network, Toronto, ONT, Canada.
Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ONT, Canada.
Clin Microbiol Infect. 2022 Apr;28(4):479-490. doi: 10.1016/j.cmi.2021.10.022. Epub 2021 Nov 12.
There is growing evidence supporting the efficacy of shorter courses of antibiotic therapy for common infections. However, the risks of prolonged antibiotic duration are underappreciated.
To estimate the incremental daily risk of antibiotic-associated harms.
We searched three major databases to retrieve systematic reviews from 2000 to 30 July 2020 in any language.
Systematic reviews were required to evaluate shorter versus longer antibiotic therapy with fixed durations between 3 and 14 days. Randomized controlled trials included for meta-analysis were identified from the systematic reviews.
Adult and paediatric patients from any setting.
Primary outcomes were the proportion of patients experiencing adverse drug events, superinfections and antimicrobial resistance.
Each randomized controlled trial was evaluated for quality by extracting the assessment reported by each systematic review.
The daily odds ratio (OR) of antibiotic harm was estimated and pooled using random effects meta-analysis.
Thirty-five systematic reviews encompassing 71 eligible randomized controlled trials were included. Studies most commonly evaluated duration of therapy for respiratory tract (n = 36, 51%) and urinary tract (n = 29, 41%) infections. Overall, 23 174 patients were evaluated for antibiotic-associated harms. Adverse events (n = 20 345), superinfections (n = 5776) and antimicrobial resistance (n = 2330) were identified in 19.9% (n = 4039), 4.8% (n = 280) and 10.6% (n = 246) of patients, respectively. Each day of antibiotic therapy was associated with 4% increased odds of experiencing an adverse event (OR 1.04, 95% CI 1.02-1.07). Daily odds of severe adverse effects also increased (OR 1.09, 95% CI 1.00-1.19). The daily incremental odds of superinfection and antimicrobial resistance were OR 0.98 (0.92-1.06) and OR 1.03 (0.98-1.07), respectively.
Each additional day of antibiotic therapy is associated with measurable antibiotic harm, particularly adverse events. These data may provide additional context for clinicians when weighing benefits versus risks of prolonged antibiotic therapy.
越来越多的证据支持缩短常见感染的抗生素疗程。然而，抗生素使用时间过长的风险还没有得到充分认识。
评估抗生素相关危害的增量日风险。
我们检索了三个主要数据库，检索了 2000 年至 2020 年 7 月 30 日期间的任何语言的系统评价。
系统评价需要评估 3 至 14 天固定疗程的较短与较长抗生素治疗。从系统评价中确定了用于荟萃分析的随机对照试验。
来自任何环境的成年和儿科患者。
主要结局是发生药物不良反应、再感染和抗菌药物耐药的患者比例。
通过提取每个系统评价报告的评估，对每个随机对照试验进行质量评估。
使用随机效应荟萃分析估计并汇总抗生素危害的每日比值比（OR）。
共纳入 35 项系统评价，其中包含 71 项符合条件的随机对照试验。研究最常评估呼吸道（n=36，51%）和尿路感染（n=29，41%）感染的治疗持续时间。总共对 23174 名患者进行了抗生素相关危害的评估。在 19.9%（n=4039）、4.8%（n=280）和 10.6%（n=246）的患者中分别发现了药物不良反应（n=20345）、再感染（n=5776）和抗菌药物耐药（n=2330）。每天使用抗生素治疗与经历药物不良反应的几率增加 4%相关（OR 1.04，95%CI 1.02-1.07）。严重不良事件的每日发生几率也有所增加（OR 1.09，95%CI 1.00-1.19）。再感染和抗菌药物耐药的每日增量几率分别为 OR 0.98（0.92-1.06）和 OR 1.03（0.98-1.07）。
每天增加抗生素治疗与可衡量的抗生素危害相关，尤其是药物不良反应。这些数据可能为临床医生权衡延长抗生素治疗的益处与风险提供额外的依据。
