Once-daily aminoglycoside dosing in immunocompetent adults: A meta-analysis
Once-daily aminoglycoside dosing in immunocompetent adults: A meta-analysis
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DOI：
10.7326/0003-4819-124-8-199604150-00003
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发表时间：
1996-04-15
影响因子：
39.2
通讯作者：
Cook, DJ
中科院分区：
文献类型：
--
作者：
Hatala, R;Dinh, T;Cook, DJ
目的：比较每日一次氨基糖苷类药物给药的疗效、肾毒性和耳毒性，并与免疫功能正常的成人中标准氨基糖苷类药物给药方案进行比较。数据来源：1966年至1995年4月使用关键词氨基糖苷类药物、给药时间表和成人进行结构化MEDLINE检索;与所选文章的主要作者联系，以获取已发表报告中未包含的信息和潜在相关文章列表。随机对照试验，1）在免疫功能正常的感染成人中比较每日一次静脉注射氨基糖苷类药物方案与标准氨基糖苷类药物方案，2）检查疗效、死亡率，数据提取：对于每一个选定的研究，两个独立的评论者评估方法学质量和提取的数据。个体研究风险比的异质性进行了评估，并使用随机效应model.Results：42项研究进行了审查，可能包括数据汇总。13项独立研究符合选择标准，并将其结果汇总。这些试验的平均方法学质量评分为0.69（范围为0.50至0.91）。临床治愈的个体风险比之间存在异质性（P = 0.07）;其他结局不存在显著异质性。对于汇总疗效结局，细菌学治愈的风险比为1.02（95% CI，0.99至1.05），死亡率的风险比为0.91（CI，0.63至1.31）。对于合并的毒性结果，肾毒性的风险比为0.87（CI，0.60至1.26），耳毒性的风险比为0.67（CI，0.35至1.28）。结论：标准和每日一次的氨基糖苷类药物给药方案是等效的细菌学治愈，每日一次给药显示出降低死亡率和毒性的趋势。然而，需要更多的研究来更精确地估计死亡率和毒性风险比。与每日一次给药相关的给药方案的等效性、易于给药、减少的护理时间和减少的给药时间变异性可能意味着每日一次给药方案具有临床优势。
Objective: To compare the efficacy, nephrotoxicity, and ototoxicity of once-daily aminoglycoside dosing with those of standard aminoglycoside regimens in immunocompetent adults.Data Sources: A structured MEDLINE search from 1966 to April 1995 using the keywords aminoglycosides, drug administration schedule, and adult; bibliographic searching of review articles, position papers, and references of the selected articles; contact with primary authors of selected articles to obtain information not in the published reports and lists of potentially relevant articles.Study Selection: Randomized, controlled trials that 1) compared an intravenous once-daily aminoglycoside regimen with a standard aminoglycoside regimen in infected immunocompetent adults and 2) examined efficacy, mortality, or toxicity.Data Extraction: For each selected study, two indepen dent reviewers assessed methodologic quality and abstracted data. The heterogeneity of individual study risk ratios was assessed and data were pooled using a random-effects model.Results: Forty-two studies were reviewed for possible inclusion. Thirteen independent studies met the selection criteria, and their results were pooled. The trials had a mean methodologic quality score of 0.69 (range, 0.50 to 0.91). Heterogeneity exists among the individual risk ratios for clinical cure (P = 0.07); significant heterogeneity does not exist for the other outcomes. For the pooled efficacy outcomes, the risk ratio for bacteriologic cure is 1.02 (95% CI, 0.99 to 1.05), and the risk ratio for mortality is 0.91 (CI, 0.63 to 1.31). For the pooled toxicity outcomes, the risk ratio for nephrotoxicity is 0.87 (CI, 0.60 to 1.26), and the risk ratio for ototoxicity is 0.67 (CI, 0.35 to 1.28).Conclusions: Standard and once-daily aminoglycoside dosing regimens are equivalent with regard to bacteriologic cure, and once-daily dosing shows a trend toward reduced mortality and toxicity. However, additional studies are needed for more precise estimates of mortality and toxicity risk ratios. The equivalency of the dosing regimens, the ease of administration, reduced nursing time, and reduced variability in the timing of drug administration that are associated with once-daily dosing may mean that the once-daily regimen is clinically advantageous.