Higher dosages of azithromycin are more effective in treatment of group A streptococcal tonsillopharyngitis
Higher dosages of azithromycin are more effective in treatment of group A streptococcal tonsillopharyngitis
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DOI：
10.1086/430307
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发表时间：
2005-06-15
影响因子：
11.8
通讯作者：
Pichichero, ME
中科院分区：
文献类型：
--
作者：
Casey, JR;Pichichero, ME
背景阿奇霉素已成为治疗A组链球菌（GAS）扁桃体咽炎的常用药物。在这项研究中，我们的目的是通过分析使用不同剂量方案的试验来确定阿奇霉素治疗儿童和成人GAS扁桃体咽炎的最佳剂量。我们对随机对照试验进行了荟萃分析，这些试验涉及GAS扁桃体咽炎的细菌学确认，随机分配接受阿奇霉素或10天的对照抗生素，并通过治疗后的咽喉培养评估细菌学根除。主要结果是细菌学和临床治愈率。19项试验共纳入4626例患者。一项试验使用了2种不同的对照抗生素的10天疗程，2项试验比较了阿奇霉素的2种剂量方案与对照抗生素的10天疗程;所有其他试验比较了阿奇霉素的1种剂量方案与对照抗生素的单次10天疗程。在儿童中，阿奇霉素以60 mg/kg/疗程给药上级优于对照药物10天疗程（P <0.00001），细菌衰竭发生率在接受抗生素10天疗程的患者中高5倍（P <0.0001）。阿奇霉素以30 mg/kg/疗程给药劣于对照药物10天疗程（P = 0.02），阿奇霉素治疗患者细菌性失效的发生率高3倍。3天方案劣于5天方案（P = .002）。在成年人中，没有研究按体重比较剂量。500 mg/天的3天方案显示了阿奇霉素优于对照药物10天疗程的趋势（P = .14）; 5天方案劣于3天方案（P = .006）。不同阿奇霉素治疗方案的临床治愈率差异有统计学意义，其差异与细菌治愈率的差异相似。该分析表明，阿奇霉素在儿童中以60 mg/kg的剂量给药或在成人中以500 mg/天的剂量给药3天，在产生GAS扁桃体咽炎的根除和临床治愈方面比其他治疗方案更有效。
Background. Azithromycin has become a frequent choice for the treatment of group A streptococcal ( GAS) tonsillopharyngitis. In this study, our objective was to determine the optimal dose of azithromycin for treatment of GAS tonsillopharyngitis in children and adults by analyzing trials that used different dose regimens.Methods. We performed a meta-analysis of randomized, controlled trials that involved bacteriological confirmation of GAS tonsillopharyngitis, random assignment to receive either azithromycin or a 10-day comparator antibiotic, and assessment of bacteriological eradication by throat culture after therapy. The primary outcomes of interest were bacteriological and clinical cure rates.Results. Nineteen trials involving 4626 patients were included in the analysis. One trial used 10-day course of 2 different comparator antibiotics, and 2 trials compared 2 dose regimens of azithromycin with a 10-day course of comparator antibiotic; all other trials compared 1 dose regimen of azithromycin with a single 10-day course of comparator antibiotic. In children, azithromycin administered at 60 mg/kg per course was superior to the 10-day courses of comparators (P < .00001), with bacterial failure occurring 5 times more often in patients receiving P < 00001 the 10-day courses of antibiotics. Azithromycin administered at 30 mg/kg per course was inferior to the 10-day courses of comparators (P = .02), with bacterial failure occurring 3 times more frequently in patients receiving azithromycin. Three-day regimens were inferior to 5-day regimens (P = .002). In adults, no studies compared dosages by weight. Three-day regimens of 500 mg/day showed a trend favoring azithromycin over the 10-day courses of comparators (P = .14); 5-day regimens were inferior to 3-day regimens (P = .006). Clinical cure rates were significantly different for the different azithromycin regimens, with differences that resembled those for bacterial cure rate.Conclusion. This analysis suggests that azithromycin administered at a dosage of 60 mg/kg in children or administered for 3 days at a dosage of 500 mg/day in adults is more effective than other treatment regimens in producing eradication and clinical cure of GAS tonsillopharyngitis.