UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France; Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia.
Int J Antimicrob Agents. 2024 Oct;64(4):107297. doi: 10.1016/j.ijantimicag.2024.107297. Epub 2024 Aug 5.
The optimal duration of therapy of aminoglycosides in combination regimens is expected to be different from that of monotherapy regimens, and shorter durations could help minimize toxicity without compromising efficacy. The aim of this review was to assess the evidence for the optimal duration of aminoglycosides in β-lactam/aminoglycoside combinations used for the treatment of Gram-negative bacterial infections.
PubMed, Cochrane, Embase, Scopus, Web of Science, and CINHAL databases were searched. Covidence software was used for article screening and management. Studies were included if they clearly reported the duration of therapy of aminoglycosides in β-lactam/aminoglycoside combinations used against Gram-negative bacteria. The protocol is registered with PROSPERO (CRD42023392709).
A total of 45 β-lactam/aminoglycoside combination courses from 32 articles were evaluated. The duration of therapy of aminoglycosides in combinations regimens ranged from 1 to 14 days, varying with the type of infection treated. In half (51.1%; (23/45) of the combinations, aminoglycosides were administered for a duration ranging from 6 to 9 days. In 26.7% (12/45) of the combinations, the duration of aminoglycoside therapy was ≤ 5 days. In the remaining 22.2% (10/45) of these combinations, the aminoglycosides were administered for a duration of ≥ 10 days. Aminoglycosides were administered for a longer duration of 7-14 days in 12 (75%) of the 16 combination courses that induced toxicity.
Long duration of aminoglycoside use is associated with increased risk of toxicity. However, there is a lack of evidence on defining an optimal duration of aminoglycoside therapy in β-lactam/aminoglycoside combination regimens that ensures clinical efficacy outcomes whilst minimizing toxicity outcomes.
氨基糖苷类药物联合治疗方案的最佳疗程预计与单药治疗方案不同，较短的疗程可以帮助最大限度地减少毒性而不影响疗效。本综述的目的是评估β-内酰胺/氨基糖苷类药物联合治疗革兰氏阴性细菌感染的最佳氨基糖苷类药物疗程的证据。
检索了 PubMed、Cochrane、Embase、Scopus、Web of Science 和 CINHAL 数据库。使用 Covidence 软件进行文章筛选和管理。如果研究清楚地报告了β-内酰胺/氨基糖苷类药物联合治疗革兰氏阴性细菌的氨基糖苷类药物治疗疗程，则纳入研究。该方案已在 PROSPERO（CRD42023392709）中注册。
共评估了 32 篇文章中的 45 个β-内酰胺/氨基糖苷类药物联合治疗方案。联合治疗方案中氨基糖苷类药物的疗程从 1 天到 14 天不等，具体取决于治疗的感染类型。在 51.1%（23/45）的联合方案中，氨基糖苷类药物的疗程在 6 到 9 天之间。在 26.7%（12/45）的联合方案中，氨基糖苷类药物的疗程≤5 天。在其余 22.2%（10/45）的联合方案中，氨基糖苷类药物的疗程≥10 天。在 16 个引起毒性的联合治疗方案中，有 12 个（75%）的氨基糖苷类药物疗程为 7-14 天。
氨基糖苷类药物使用时间长与毒性风险增加相关。然而，目前缺乏证据表明，在β-内酰胺/氨基糖苷类药物联合治疗方案中，确定一个既能保证临床疗效结果又能最大限度减少毒性结果的最佳氨基糖苷类药物疗程。
