Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta‐Analysis

Journal of Hospital Medicine - Tập 13 Số 5 - Trang 336-342 - 2018
Stephanie Royer1,2,3, Kimberley M. DeMerle2, Robert P. Dickson2, Hallie C. Prescott2,4
1Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
2Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
3Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
4Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan

Tóm tắt

BACKGROUNDInfection is a leading cause of hospitalization with high morbidity and mortality, but there are limited data to guide the duration of antibiotic therapy.PURPOSESystematic review to compare outcomes of shorter versus longer antibiotic courses among hospitalized adults and adolescents.DATA SOURCESMEDLINE and Embase databases, 1990‐2017.STUDY SELECTIONInclusion criteria were human randomized controlled trials (RCTs) in English comparing a prespecified short course of antibiotics to a longer course for treatment of infection in hospitalized adults and adolescents aged 12 years and older.DATA EXTRACTIONTwo authors independently extracted study characteristics, methods of statistical analysis, outcomes, and risk of bias.DATA SYNTHESISOf 5187 unique citations identified, 19 RCTs comprising 2867 patients met our inclusion criteria, including the following: 9 noninferiority trials, 1 superiority design trial, and 9 pilot studies. Across 13 studies evaluating 1727 patients, no significant difference in clinical efficacy was observed (d = 1.6% [95% confidence interval (CI), ‐1.0%‐4.2%]). No significant difference was detected in microbiologic cure (8 studies, d = 1.2% [95% CI, ‐4.1%‐6.4%]), short‐term mortality (8 studies, d = 0.3% [95% CI, ‐1.2%‐1.8%]), longer‐term mortality (3 studies, d = ‐0.4% [95% CI, ‐6.3%‐5.5%]), or recurrence (10 studies, d = 2.1% [95% CI, ‐1.2%‐5.3%]). Heterogeneity across studies was not significant for any of the primary outcomes.CONCLUSIONSBased on the available literature, shorter courses of antibiotics can be safely utilized in hospitalized patients with common infections, including pneumonia, urinary tract infection, and intra‐abdominal infection, to achieve clinical and microbiologic resolution without adverse effects on mortality or recurrence.

Từ khóa


Tài liệu tham khảo

Torio CM, 2006, Healthcare Cost and Utilization Project (HCUP) Statistical Briefs

10.1093/cid/ciw504

10.2165/00003495-200868130-00004

10.1016/j.amjmed.2007.04.023

10.1093/jac/dkt177

10.1016/j.clinthera.2008.10.007

10.1056/NEJMp1215093

10.1001/jamainternmed.2016.3646

10.1086/526535

10.1073/pnas.1000087107

10.1093/jac/dkr508

10.1093/jac/dkt171

10.1016/j.ijantimicag.2011.07.016

10.1086/678066

10.1378/chest.13-0076

PughR GrantC CookeRP DempseyG.Short‐course versus prolonged‐course antibiotic therapy for hospital‐acquired pneumonia in critically ill adults.Cochrane Database Syst Rev.2015(8):CD007577.

10.1186/cc10545

HaiderBA SaeedMA BhuttaZA.Short‐course versus long‐course antibiotic therapy for non‐severe community‐acquired pneumonia in children aged 2 months to 59 months.Cochrane Database Syst Rev.2008(2):CD005976.

StrohmeierY HodsonEM WillisNS WebsterAC CraigJC.Antibiotics for acute pyelonephritis in children.Cochrane Database Syst Rev.2014(7):Cd003772.

10.1164/rccm.201310-1875OC

10.4061/2010/380892

10.1097/CCM.0000000000002255

10.7326/0003-4819-151-4-200908180-00135

RoyerS DeMerleK DicksonRP PrescottHC.Shorter versus longer courses of antibiotics for infection in hospitalized patients: a systematic review and meta‐analysis.PROSPERO2016:CRD42016029549.http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016029549. Accessed May 2 2017.

10.1136/bmj.d5928

10.1186/2046-4053-2-79

10.1016/0197-2456(86)90046-2

Newton HJ, Stata Technical Bulletin 44: sbe24

10.1007/BF02310353

10.1371/journal.pone.0041290

10.1001/jama.290.19.2588

Chaudhry ZI, 2000, Short course of antibiotic treatment in spontaneous bacterial peritonitis: A randomized controlled study, Journal of the College of Physicians and Surgeons Pakistan., 10, 284

10.1016/j.apmr.2013.09.003

10.1016/0924-8579(95)00011-V

10.1086/377539

10.1128/AAC.47.5.1727-1731.2003

10.1186/cc11862

10.1179/joc.2005.17.6.636

10.1016/S0399-077X(02)00384-0

10.1183/09031936.95.08030398

10.1016/0016-5085(91)90677-D

10.1056/NEJMoa1411162

10.3310/hta16360

10.3109/00365549409008639

10.1007/BF02561528

10.1097/00045391-199907000-00007

10.1016/j.diagmicrobio.2013.11.008

Bureau of Economic Analysis

10.1016/S0140-6736(02)09994-4

10.1016/S1201-9712(01)90041-4

Thông tin
Thông tin xuất bản

Journal of Hospital Medicine

Tập 13 Số 5

336-342

Thông tin tác giả