Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta-analysis
Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta-analysis
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长期使用抗生素预防儿童复发性尿路感染：系统评价和荟萃分析
DOI：
10.1136/adc.2009.173112
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发表时间：
2010-07-01
影响因子：
5.2
通讯作者：
Mei, Changlin
中科院分区：
文献类型：
--
作者：
Dai, Bing;Liu, Yawei;Mei, Changlin
目的通过随机对照试验的meta分析，评价长期预防性抗生素治疗儿童复发性尿路感染（UTI）的有效性和安全性。方法检索电子数据库和综述文章参考文献，查找相关试验。结果指标为有症状的尿路感染复发、尿培养重复阳性、新的或恶化的肾瘢痕以及治疗期间和治疗后的不良事件。结果共纳入11项试验，共纳入2046例患者。分析显示，有症状的尿路感染复发率在抗生素组（12.4%）和对照组（15.5%）之间无显著差异（RR 0.83, 95% CI 0.66 ~ 1.05）。根据患者膀胱输尿管反流（VUR）状态、患者特征、尿路感染史、尿路感染部位和治疗时间进行的后续敏感性和亚组分析也没有显著影响。然而，当试验按研究质量划分时，只有在分配足够隐蔽性的试验中，抗生素预防才能减少复发性症状性尿路感染。预防性抗生素降低尿培养重复阳性的风险（RR 0.50, 95% CI 0.34 ~ 0.74）。一项仅限于无VUR患者的亚组分析显示了类似的结果（0.52,0.33至0.83），而有VUR患者尿培养重复阳性的风险没有显著降低（0.82,0.61至1.09）。七项研究报告了新的或恶化的肾疤痕率，并没有显着差异（0.95,0.51至1.78）。结论预防性抗生素降低儿童尿路感染复发的证据不足。由于所回顾的研究在方法学设计上存在局限性，需要进行大规模、高质量、安慰剂对照、双盲试验。
Objective To evaluate the effectiveness and safety of long-term prophylactic antibiotics for recurrent urinary tract infection (UTI) in children through meta-analysis of randomised controlled trials. Methods Electronic databases and reference lists of review articles were searched for relevant trials. Outcome measures were recurrence of symptomatic UTI, repeat positive urine culture, new or deteriorated renal scarring and adverse events during and after treatment. Results Eleven trials with 2046 patients were identified. Analysis suggested rates of recurrent symptomatic UTI were not significantly different between antibiotic (12.4%) and control groups (15.5%) (RR 0.83, 95% CI 0.66 to 1.05). Subsequent sensitivity and subgroup analyses according to patient vesicoureteric reflux (VUR) status, patient characteristics, history of UTI, site of UTI and duration of treatment also produced no significant effect. However, when trials were divided by study quality, only in trials with adequate allocation concealment was recurrent symptomatic UTI reduced by antibiotic prophylaxis. Prophylactic antibiotics reduced the risk of repeat positive urine culture (RR 0.50, 95% CI 0.34 to 0.74). A subgroup analysis limited to patients without VUR showed similar results (0.52, 0.33 to 0.83), whereas patients with VUR showed a non-significant decrease (0.82, 0.61 to 1.09) in risk of repeat positive urine culture. Seven studies reported the rate of new or deteriorated renal scars and showed no significant difference (0.95, 0.51 to 1.78). Conclusions Evidence is lacking that prophylactic antibiotics reduce the incidence of recurrent childhood UTI. Since the reviewed studies had limitations in methodological design, large scale, high quality, placebo-controlled, double-blind trials are required.