抗生素与安慰剂治疗急性细菌性结膜炎的疗效比较：Cochrane系统评价结果
Antibiotics Versus Placebo for Acute Bacterial Conjunctivitis: Findings From a Cochrane Systematic Review.
作者信息
Liu Su-Hsun, Chen Yu-Yen, Nurmatov Ulugbek, van Schayck Onno C P, Kuo Irene C
机构信息
From the Department of Ophthalmology, School of Medicine (S.-H.L.); Department of Epidemiology, School of Public Health (S.-H.L.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan (Y.-Y.C.); Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (Y.-Y.C., I.C.K.); School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (Y.-Y.C.).
出版信息
Am J Ophthalmol. 2024 Jan;257:143-153. doi: 10.1016/j.ajo.2023.06.027. Epub 2023 Jul 21.
PURPOSE
To summarize key findings from a Cochrane review of the benefits and safety of antibiotic therapy compared with placebo (or vehicle) for acute bacterial conjunctivitis.
DESIGN
Systematic review and meta-analysis.
METHODS
We included placebo-controlled randomized controlled trials (RCTs) that compared topical antibiotics with placebo. We followed Cochrane methods for trial selection, data extraction, risk of bias assessment, and evidence synthesis.
RESULTS
Twenty-one RCTs involving 8805 participants with acute bacterial conjunctivitis were included. Fifteen (71%) RCTs examined fluoroquinolone (FQ) drops, 3 tested macrolides, alone or in combination with steroids, and another 3 compared other non-FQ antibiotics. Intention-to-treat estimates suggested that compared with placebo, antibiotics may increase clinical recovery by 26% (risk ratio [RR]: 1.26; 95% confidence interval [CI]: 1.09-1.46) at the end of therapy (5 RCTs, 1474 participants). Modified intention-to-treat estimates, in which only participants with laboratory-confirmed bacterial conjunctivitis were analyzed, indicated that antibiotics were associated with 53% higher likelihood of microbiological cure as compared with placebo (RR: 1.53; 95% CI: 1.34-1.74; 10 RCTs, 2827 participants). Non-FQs (RR: 4.05; 95% CI: 1.36-12.00), but not FQs (RR: 0.70; 95% CI: 0.54-0.90), were likely to increase treatment-associated ocular complications such as eye pain, discomfort, and allergic reactions; the certainty of level of evidence was very low.
CONCLUSIONS
Moderate level certainty of evidence suggested that antibiotics may increase the likelihood of clinical recovery and microbiological clearance compared with placebo. Very low-level certainty of evidence suggested that antibiotics may be associated with potential harm in patients with acute bacterial conjunctivitis, but the potential risk of bias from study design, inconsistency in outcome measurement, and reporting limit the evidence to very low certainty.
目的
总结Cochrane系统评价中关于急性细菌性结膜炎使用抗生素治疗与使用安慰剂（或赋形剂）相比的获益和安全性的主要研究结果。
设计
系统评价和荟萃分析。
方法
纳入将局部用抗生素与安慰剂进行比较的安慰剂对照随机对照试验（RCT）。我们遵循Cochrane方法进行试验选择、数据提取、偏倚风险评估和证据综合。
结果
纳入了21项涉及8805例急性细菌性结膜炎患者的RCT。15项（71%）RCT研究了氟喹诺酮（FQ）滴眼液，3项测试了大环内酯类药物，单独使用或与类固醇联合使用，另外3项比较了其他非FQ抗生素。意向性分析估计，与安慰剂相比，抗生素在治疗结束时可能使临床治愈率提高26%（风险比[RR]：1.26；95%置信区间[CI]：1.09 - 1.46）（5项RCT，1474例患者）。修正的意向性分析估计，即仅分析实验室确诊为细菌性结膜炎的患者，表明与安慰剂相比，抗生素使微生物学治愈率提高的可能性高53%（RR：1.53；95%CI：1.34 - 1.74；10项RCT，2827例患者）。非FQ抗生素（RR：4.05；95%CI：1.36 - 12.00），而非FQ抗生素（RR：0.70；95%CI：0.54 - 0.90），可能会增加与治疗相关的眼部并发症，如眼痛、不适和过敏反应；证据水平的确定性非常低。
结论
中等确定性水平的证据表明，与安慰剂相比，抗生素可能会增加临床治愈和微生物清除的可能性。极低确定性水平的证据表明，抗生素可能与急性细菌性结膜炎患者的潜在危害相关，但研究设计、结局测量不一致和报告方面的潜在偏倚风险将证据的确定性限制在极低水平。
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