Clinical Epidemiology Unit, Department of Emergency Medicine, University of Ottawa, 1053 Carling Avenue, F660b, Ottawa, ON, K1Y4E9, Canada.
Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Infection. 2022 Aug;50(4):859-871. doi: 10.1007/s15010-022-01842-7. Epub 2022 May 20.
Antibiotic treatment of uncomplicated cellulitis is highly variable with respect to agent, dose, and route of administration. As there is uncertainty about optimal/appropriate time to reassess, we aimed to assess time to clinical response.
We conducted a systematic review of randomized controlled trials reporting clinical response of uncomplicated cellulitis to antibiotic treatment over multiple timepoints. PubMed, Embase, CENTRAL, WHO ICTRP, and clinicaltrials.gov were searched from inception to June 2021 without language restrictions. The primary outcome was time to clinical response. Other outcomes were components of clinical response (pain, severity score, redness, edema measured at ≥ 2 timepoints) and the proportion of patients with treatment failure. We performed a pooled estimate of the average time to clinical response together with 95% confidence intervals using a random effects model.
We included 32 randomized controlled trials (n = 13,576 participants). The mean time to clinical response was 1.68 days (95%CI 1.48-1.88; I = 76%). The response to treatment for specific components was as follows: ~ 50% reduction of pain and severity score by day 5, a ~ 33% reduction in area of redness by day 2-3, and a 30-50% reduction of proportion of patients with edema by day 2-4. Treatment failure was variably defined with an overall failure rate of 12% (95%CI 9-16%).
The best available data suggest the optimal time to clinical reassessment is between 2 and 4 days, but this must be interpreted with caution due to considerable heterogeneity and small number of included studies.
在单纯性蜂窝织炎的抗生素治疗中，药物、剂量和给药途径存在很大差异。由于不确定何时需要重新评估，我们旨在评估临床反应的时间。
我们对报告抗生素治疗单纯性蜂窝织炎的临床反应的随机对照试验进行了系统评价，这些试验在多个时间点报告了临床反应。我们从建库到 2021 年 6 月，在 PubMed、Embase、CENTRAL、世界卫生组织国际临床试验注册平台（WHO ICTRP）和 clinicaltrials.gov 上进行了无语言限制的检索。主要结局是临床反应的时间。其他结局是临床反应的组成部分（疼痛、严重程度评分、在≥2 个时间点测量的发红、肿胀）和治疗失败的患者比例。我们使用随机效应模型对临床反应的平均时间和 95%置信区间进行了汇总估计。
我们纳入了 32 项随机对照试验（n=13576 名参与者）。临床反应的平均时间为 1.68 天（95%CI 1.48-1.88；I=76%）。治疗特定组成部分的反应如下：疼痛和严重程度评分在第 5 天减少约 50%，在第 2-3 天减少约 33%的发红面积，在第 2-4 天减少约 30-50%的水肿患者比例。治疗失败的定义各不相同，总体失败率为 12%（95%CI 9-16%）。
现有最佳数据表明，最佳的临床重新评估时间为 2-4 天，但由于存在很大的异质性和纳入研究数量较少，因此必须谨慎解释。
