Busting the Myth of "Static vs Cidal": A Systemic Literature Review.
Busting the Myth of "Static vs Cidal": A Systemic Literature Review.
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打破“静态与西达尔”的神话：系统文献综述。
DOI：
10.1093/cid/cix1127
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Spellberg,Brad
中科院分区：
文献类型：
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作者：
Wald-Dickler,Noah;Holtom,Paul;Spellberg,Brad
我们试图确定临床数据是否证实了杀菌抗生素在临床上比抑菌剂更有效的论断。我们对已发表的随机对照试验（rct）进行了系统的文献回顾，这些试验比较了抑菌剂和杀菌剂在治疗临床细菌感染中的作用。在1985年以来发表的56项已确定的试验中，有49项发现抑菌剂和杀菌剂的疗效没有显著差异。在6次试验中发现抑菌剂的效果优于杀菌剂。只有1次试验发现杀菌剂具有优越性；在这种情况下，根据药代动力学-药效学分析，静态剂的劣势可以通过药物剂量不足来解释。因此，几乎所有来自高质量随机对照试验的可用数据都表明，与抑菌剂相比，杀菌剂没有内在的优势。其他药物特性如最佳剂量、药代动力学和组织渗透可能是更重要的药效驱动因素。
We sought to determine if clinical data validate the dogma that bactericidal antibiotics are more clinically effective than bacteriostatic agents. We performed a systematic literature review of published, randomized, controlled trials (RCTs) that compared a bacteriostatic agent to a bactericidal agent in the treatment of clinical, bacterial infections. Of 56 identified trials published since 1985, 49 found no significant difference in efficacy between bacteriostatic and bactericidal agents. In 6 trials it was found that the bacteriostatic agent was superior to the bactericidal agent in efficacy. Only 1 trial found that the bactericidal agent was superior; in that case, the inferiority of the static agent was explainable by underdosing of the drug based on pharmacokinetic–pharmacodynamic analysis. Thus, virtually all available data from high-quality, RCTs demonstrate no intrinsic superiority of bactericidal compared to bacteriostatic agents. Other drug characteristics such as optimal dosing, pharmacokinetics, and tissue penetration may be more important efficacy drivers.