Rothrock S G, Harper M B, Green S M, Clark M C, Bachur R, McIlmail D P, Giordano P A, Falk J L
Department of Emergency Medicine, Orlando Regional Medical Center, FL 32806, USA.
Pediatrics. 1997 Mar;99(3):438-44. doi: 10.1542/peds.99.3.438.
To determine whether oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia.
Using the Medline database, the English-language literature was searched for all publications concerning bacteremia, fever, or S pneumoniae from 1966 to April 1996.
All studies that included a series of children with S pneumoniae occult bacteremia containing orally treated and untreated groups. Children were excluded from individual studies if they were immunocompromised, had a serious bacterial infection, underwent a lumbar puncture, or received parenteral antibiotics.
Three authors independently reviewed each article to determine the number of eligible children and the outcome of children meeting entry criteria.
Eleven of 21 studies were excluded, leaving 10 evaluable studies with 656 total cases of S pneumoniae occult bacteremia identified. Patients who received oral antibiotics had fewer serious bacterial infections than untreated patients (3.3% vs 9.7%; pooled odds ratio, 0.35; 95% confidence interval, 0.17 to 0.73). Meningitis developed in 3 (0.8%) of 399 children in the oral antibiotic group and 7 (2.7%) of 257 untreated children (pooled odds ratio, 0.51; 95% confidence interval, 0.12 to 2.09).
Although oral antibiotics modestly decreased the risk of serious bacterial infections in children with S pneumoniae occult bacteremia, there was insufficient evidence to conclude that oral antibiotics prevent meningitis. Published recommendations that oral antibiotics be administered to prevent serious bacterial infections in children with possible S pneumoniae occult bacteremia should be reevaluated in light of the lower risk of sequelae from S pneumoniae occult bacteremia and newer data concerning side effects from treatment.
确定口服抗生素能否预防肺炎链球菌隐匿性菌血症患儿发生脑膜炎和严重细菌感染。
利用Medline数据库检索1966年至1996年4月间所有关于菌血症、发热或肺炎链球菌的英文文献。
所有纳入了一系列肺炎链球菌隐匿性菌血症患儿且包含口服治疗组和未治疗组的研究。若儿童存在免疫功能低下、患有严重细菌感染、接受过腰椎穿刺或接受过静脉用抗生素治疗，则将其排除在个别研究之外。
三位作者独立审阅每篇文章，以确定符合条件的儿童数量以及符合入选标准的儿童的结局。
21项研究中的11项被排除，剩下10项可评估研究，共确定了656例肺炎链球菌隐匿性菌血症病例。接受口服抗生素治疗的患者发生严重细菌感染的情况少于未治疗的患者（3.3%对9.7%；合并比值比为0.35；95%置信区间为0.17至0.73）。口服抗生素组399名儿童中有3名（0.8%）发生脑膜炎，未治疗组257名儿童中有7名（2.7%）发生脑膜炎（合并比值比为0.51；95%置信区间为0.12至2.09）。
尽管口服抗生素可适度降低肺炎链球菌隐匿性菌血症患儿发生严重细菌感染的风险，但尚无足够证据得出口服抗生素可预防脑膜炎的结论。鉴于肺炎链球菌隐匿性菌血症后遗症风险较低以及有关治疗副作用的新数据，已发表的关于对可能患有肺炎链球菌隐匿性菌血症的儿童使用口服抗生素预防严重细菌感染的建议应重新评估。
