Short versus long duration of antibiotic therapy for bacterial meningitis: a meta-analysis of randomised controlled trials in children
Short versus long duration of antibiotic therapy for bacterial meningitis: a meta-analysis of randomised controlled trials in children
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DOI：
10.1136/adc.2008.151563
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发表时间：
2009-08-01
影响因子：
5.2
通讯作者：
Falagas, M. E.
中科院分区：
文献类型：
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作者：
Karageorgopoulos, D. E.;Valkimadi, P. E.;Falagas, M. E.
目的：通过对随机对照试验（RCT）进行荟萃分析，评价短程抗生素治疗细菌性脑膜炎的有效性和安全性。在PubMed和科克伦对照试验中心注册中心检索了所有年龄段社区获得性急性细菌性脑膜炎患者的RCT，比较了相同抗生素、相同日剂量的治疗，短期疗程（最多7天）与较长疗程（比相应的短期疗程多2天或更长）进行比较。结果：纳入了5项涉及儿童（3周到16岁）的开放标签随机对照试验。短期课程之间没有差异（4-7天）和长期（7-14天）治疗（静脉注射头孢曲松）关于：治疗结束临床成功（5个随机对照试验，383例患者，固定效应模型，比值比（OR）1.24，95% CI 0.73 ~ 2.11）;长期神经系统并发症（5项RCT，367例患者，FEM，OR 0.60，95% CI 0.29 - 1.27）;长期听力损害（4项RCT，241例患者，FEM，OR 0.59，95% CI 0.28 - 1.23）;总不良事件（2项RCT，122例患者，FEM，OR 1.29，95% CI 0.57 ~ 2.91）;或继发性院内感染（2项随机对照试验，139例患者，随机效应模型，OR 0.45，95% CI 0.05 ~ 3.71）。短期治疗的住院持续时间较短（2项RCT，137例患者，FEM，加权平均差-2.17天，95% CI -3.85至-0.50）。现有的数据不允许分析的致病organis.Conclusion：这个荟萃分析，而有限的相关数据不能显示短期和长期的抗生素治疗儿童细菌性脑膜炎之间的差异。需要进一步研究这个问题。
Objective: To evaluate the effectiveness and safety of short-course antibiotic therapy for bacterial meningitis, by performing a meta-analysis of randomised controlled trials (RCT).Review methods: PubMed and the Cochrane Central Register of Controlled Trials were searched for RCT on patients of all ages with community-acquired acute bacterial meningitis that compared treatment with the same antibiotics, in the same daily dosage, administered for a short course (up to 7 days) versus a longer course (2 days or more than corresponding short course).Results: Five open-label RCT involving children (3 weeks to 16 years) were included. No difference was demonstrated between short-course (4-7 days) and long-course (7-14 days) treatment (intravenous ceftriaxone) regarding: end-of-therapy clinical success (five RCT, 383 patients, fixed effect model (FEM), odds ratio (OR) 1.24, 95% CI 0.73 to 2.11); long-term neurological complications (five RCT, 367 patients, FEM, OR 0.60, 95% CI 0.29 to 1.27); long-term hearing impairment (four RCT, 241 patients, FEM, OR 0.59, 95% CI 0.28 to 1.23); total adverse events (two RCT, 122 patients, FEM, OR 1.29, 95% CI 0.57 to 2.91); or secondary nosocomial infections (two RCT, 139 patients, random effects model, OR 0.45, 95% CI 0.05 to 3.71). The duration of hospitalisation was lower with short-course treatment (two RCT, 137 patients, FEM, weighted mean difference -2.17 days, 95% CI -3.85 to -0.50). The available data did not allow for analysis by causative organism.Conclusion: This meta-analysis of the rather limited available relevant data could not show differences between short and long-course antibiotic treatment for bacterial meningitis in children. Further research on this issue is required.