Mo Yin, Tan Wei Cong, Cooper Ben S
Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
JAC Antimicrob Resist. 2025 Jan 29;7(1):dlae215. doi: 10.1093/jacamr/dlae215. eCollection 2025 Feb.
Reducing antibiotic duration is a key stewardship intervention to mitigate antimicrobial resistance (AMR). We examined current evidence informing antibiotic duration for common bacterial infections to identify any gaps in terms of settings, patient populations and infectious conditions. Trial methodologies were assessed to identify areas for improvement.
MEDLINE and Embase were searched up to July 2024 for randomized trials comparing antibiotic durations in hospital and community settings (PROSPERO 2021, CRD42021276209). A narrative synthesis of the results was performed with a review on the major guidelines published by IDSA, NICE, WHO and other international societies to assess the impact of these trials on practice guidance.
Out of 315 studies, 85% concluded equivalence or non-inferiority of shorter courses. Adult bacterial sinusitis, community-acquired pneumonia, female cystitis/pyelonephritis, uncomplicated cellulitis and intra-abdominal infection with adequate source control and perioperative prophylaxis had robust evidence supporting shorter durations. Few trials studied severe infections, such as bloodstream infections and ventilator-associated pneumonia. Twenty-three (7%) of the trials were conducted in intensive care settings and only 43 trials (14%) enrolled patients from low-to-middle- or low-income countries. Only 15% of studies were at low risk for bias.
Reducing antibiotic duration likely remains an important strategy for antibiotic stewardship, and an area of active research. While shorter antibiotic courses may be suitable for many bacterial infections, more evidence is needed for severe infections and in low- and middle-income settings.
缩短抗生素使用时长是减轻抗菌药物耐药性（AMR）的一项关键管理干预措施。我们研究了目前关于常见细菌感染抗生素使用时长的证据，以确定在环境、患者群体和感染情况方面是否存在任何差距。对试验方法进行了评估，以确定需要改进的领域。
检索截至2024年7月的MEDLINE和Embase数据库，查找比较医院和社区环境中抗生素使用时长的随机试验（PROSPERO 2021，CRD42021276209）。对结果进行叙述性综合分析，并回顾美国感染病学会（IDSA）、英国国家卫生与临床优化研究所（NICE）、世界卫生组织（WHO）和其他国际协会发布的主要指南，以评估这些试验对实践指南的影响。
在315项研究中，85%的研究得出较短疗程具有等效性或非劣效性的结论。成人细菌性鼻窦炎、社区获得性肺炎、女性膀胱炎/肾盂肾炎、单纯性蜂窝织炎以及腹腔内感染且源头控制充分和围手术期进行了预防的情况，有充分证据支持缩短疗程。很少有试验研究严重感染，如血流感染和呼吸机相关性肺炎。23项（7%）试验在重症监护环境中进行，只有43项试验（14%）纳入了来自中低收入或低收入国家的患者。只有15%的研究存在低偏倚风险。
缩短抗生素使用时长可能仍然是抗生素管理的一项重要策略，也是一个积极研究的领域。虽然较短的抗生素疗程可能适用于许多细菌感染，但对于严重感染以及中低收入环境，还需要更多证据。
