Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
Los Angeles County and University of Southern California Medical Center, Los Angeles, California, USA.
Transpl Infect Dis. 2022 Oct;24(5):e13896. doi: 10.1111/tid.13896.
Prolonged antibiotics are associated with toxicity, selection for resistant organisms, and secondary infections such as Clostridioides difficile colitis. Emerging clinical data suggest that short courses of antibiotics can be used for common bacterial infections among immune competent patients, but for many randomized controlled trials (RCTs), immunocompromised patients, including solid organ transplant recipients (SOTRs), have been excluded.
Peer-reviewed publications were identified through PubMed and Embase searches.
We review data examining shorter antibiotic courses among immunocompetent and immunocompromised patients and the rationale for use of short antibiotic courses in SOTRs.
There are known harms associated with antibiotics and, when studied, existing data do not demonstrate harm associated with shorter courses of antibiotics among SOTRs. Furthermore, several RCTs did include some immune compromised patients and found shorter therapy to result in similar clinical efficacy with diminished adverse effects. Shorter antibiotic durations should be considered in SOTRs, and questions of antibiotic duration among SOTRs should be prioritized for study in clinical trials.
长期使用抗生素会导致毒性、耐药菌的选择和继发性感染，如艰难梭菌结肠炎。新出现的临床数据表明，对于免疫功能正常的患者常见的细菌感染，可以使用较短疗程的抗生素，但对于许多随机对照试验（RCT），免疫功能低下的患者，包括实体器官移植受者（SOTR），已被排除在外。
通过 PubMed 和 Embase 搜索确定同行评审的出版物。
我们回顾了检查免疫功能正常和免疫功能低下患者中较短抗生素疗程的数据，以及在 SOTR 中使用短疗程抗生素的理由。
抗生素存在已知的危害，在研究中，现有数据并未表明 SOTR 中较短疗程的抗生素会带来危害。此外，几项 RCT 确实纳入了一些免疫功能低下的患者，发现较短的治疗时间可产生相似的临床疗效，同时减少不良反应。在 SOTR 中应考虑较短的抗生素持续时间，并且在临床试验中应优先研究 SOTR 中的抗生素持续时间问题。
