J Am Pharm Assoc (2003). 2023 Sep-Oct;63(5):1461-1471. doi: 10.1016/j.japh.2023.06.028. Epub 2023 Jul 4.
The 2011 Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Diseases guidelines recommend ciprofloxacin or sulfamethoxazole-trimethoprim (SMX-TMP) as first-line agents to treat uncomplicated acute pyelonephritis (APN).
With increasing antimicrobial resistance rates and recent changes in practice patterns, the objective of this systematic review was to describe the effectiveness of cephalosporins for uncomplicated APN in more recently published literature.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting. We searched PubMed, Embase, and Scopus for publications between January 2010 and September 2022. Eligible articles detailed patients with uncomplicated APN, treated with first- to fourth-generation cephalosporins, and identified a clinical, microbiological, or health care utilization outcome. Studies with more than 30% of complicated APN patients, non-English-language studies, case reports, case series, pharmacodynamic or pharmacokinetic studies, and in vitro laboratory or animal studies were excluded. Screening, review, and extraction were performed independently by 2 researchers, plus a third for conflict resolution. Critical appraisal of studies was performed using Joanna Briggs Institute checklists.
Eight studies met inclusion, including 5 cohort studies (62.5%), 2 randomized controlled trials (25%), and 1 nonrandomized experimental study (12.5%). Cephalosporins most used across the studies included cefazolin, cephalexin, cefuroxime, cefotaxime, cefdinir, cefditoren, and ceftriaxone. Outcomes assessed were diverse, including clinical or microbiological success and time to defervescence or symptom resolution. Cephalosporins displayed effectiveness for the treatment of acute uncomplicated APN regardless of study design or the presence of a comparison group. No trials reported inferiority of clinical treatment outcomes compared with a fluoroquinolone or SMX-TMP.
Cephalosporins may be viable treatment options for the management of uncomplicated APN.
2011 年美国传染病学会和欧洲临床微生物学和传染病学会指南推荐环丙沙星或复方磺胺甲噁唑（SMX-TMP）作为治疗单纯性急性肾盂肾炎（APN）的一线药物。
随着抗菌药物耐药率的不断增加以及最近实践模式的改变，本系统评价的目的是描述头孢菌素类药物在最近发表的文献中治疗单纯性 APN 的疗效。
采用系统评价和荟萃分析首选报告项目的报告标准。我们在 PubMed、Embase 和 Scopus 中检索了 2010 年 1 月至 2022 年 9 月期间的文献。合格的文章详细描述了患有单纯性 APN 的患者，这些患者接受了第一代至第四代头孢菌素治疗，并确定了临床、微生物学或医疗保健利用结果。排除了复杂性 APN 患者比例超过 30%、非英语语言研究、病例报告、病例系列、药效学或药代动力学研究以及体外实验室或动物研究的文章。筛选、审查和提取由 2 名研究人员独立进行，再有第 3 名人员解决冲突。使用 Joanna Briggs 研究所清单对研究进行批判性评估。
8 项研究符合纳入标准，包括 5 项队列研究（62.5%）、2 项随机对照试验（25%）和 1 项非随机实验研究（12.5%）。研究中最常使用的头孢菌素包括头孢唑林、头孢氨苄、头孢呋辛、头孢噻肟、头孢地尼、头孢地嗪和头孢曲松。评估的结果多种多样，包括临床或微生物学疗效以及退热或症状缓解时间。无论研究设计或是否存在对照组，头孢菌素对治疗急性单纯性 APN 均有效。没有试验报告与氟喹诺酮类药物或 SMX-TMP 相比临床治疗结果较差。
头孢菌素类药物可能是治疗单纯性急性肾盂肾炎的可行治疗选择。
