Department of Medicine, Division of Infectious Diseases, University of Alabama Heersink School of Medicine, Birmingham, AL, USA; Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
Department of Medicine, Division of Infectious Diseases, University of Alabama Heersink School of Medicine, Birmingham, AL, USA; Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
Clin Microbiol Infect. 2023 Feb;29(2):150-159. doi: 10.1016/j.cmi.2022.08.024. Epub 2022 Sep 6.
Over the past 25 years, researchers have performed >120 randomized controlled trials (RCTs) illustrating short courses to be non-inferior to long courses of antibiotics for common bacterial infections.
We sought to determine whether clinical data from RCTs affirm the mantra of 'shorter is better' for antibiotic durations in 7 common infections: pneumonia, urinary tract infection, intra-abdominal infection, bacteraemia, skin and soft tissue infection, bone and joint infections, pharyngitis and sinusitis.
Published RCTs comparing short- versus long-course antibiotic durations were identified through searches of PubMed and clinical guideline documents.
Short-course antibiotic durations consistently result in similar treatment success rates as longer antibiotic courses among patients with community-acquired pneumonia, complicated urinary tract infections in women, gram-negative bacteraemia, and skin and soft tissue infections when the diagnosis is confirmed, appropriate antimicrobials are used, and patients show clinical signs of improvement. For patients with osteomyelitis, 6 weeks of antibiotics is adequate for the treatment of osteomyelitis in the absence of implanted foreign bodies and surgical debridement. Whether durations can be further shortened with debridement is unclear, although small studies are promising.
With few exceptions, short courses were non-inferior to long courses; future research should focus on appropriately defining the patient population, ensuring the correct choice and dose of antimicrobials and developing meaningful outcomes relevant for frontline clinicians.
在过去的 25 年中，研究人员已经进行了超过 120 项随机对照试验（RCT），表明对于常见细菌感染，短期疗程与长期疗程的抗生素治疗效果相当。
我们旨在确定 RCT 临床数据是否支持“越短越好”这一理念，即在肺炎、尿路感染、腹腔内感染、菌血症、皮肤软组织感染、骨和关节感染、咽炎和鼻窦炎这 7 种常见感染中，抗生素疗程越短越好。
通过检索 PubMed 和临床指南文件，确定了比较短期与长期抗生素疗程的已发表 RCT。
对于社区获得性肺炎、女性复杂性尿路感染、革兰氏阴性菌血症和皮肤软组织感染，如果诊断明确、使用适当的抗菌药物且患者临床症状改善，短期疗程的抗生素治疗成功率与长期疗程相当。对于骨髓炎患者，在没有植入异物和外科清创的情况下，6 周的抗生素治疗足以治疗骨髓炎。是否可以通过清创进一步缩短疗程尚不清楚，尽管一些小型研究很有前景。
除了少数例外，短期疗程与长期疗程相当；未来的研究应重点关注适当定义患者人群、确保正确选择和剂量的抗生素以及制定与一线临床医生相关的有意义的结局。
