背景:长期使用抗生素与毒性有关,抗性生物的选择,和继发感染,如艰难梭菌结肠炎。新出现的临床数据表明,短期抗生素可用于免疫功能正常的患者中的常见细菌感染。但对于许多随机对照试验(RCT),免疫力低下的患者,包括实体器官移植受者(SOTRs),已被排除在外。
方法:通过PubMed和Embase搜索确定同行评审的出版物。
结果:我们回顾了在免疫功能正常和免疫功能低下患者中检查较短抗生素疗程的数据,以及在SOTR中使用较短抗生素疗程的理由。
结论:已知与抗生素相关的危害,当被研究时,现有数据未显示与SOTR中抗生素疗程较短相关的危害.此外,一些RCTs确实包括一些免疫功能受损的患者,并且发现较短的治疗可导致相似的临床疗效,且不良反应减少.在SOTR中,应考虑较短的抗生素持续时间,在临床试验中,应优先考虑SOTR中抗生素使用时间的问题。
BACKGROUND: Prolonged antibiotics are associated with toxicity, selection for resistant organisms, and secondary infections such as Clostridioides difficile colitis. Emerging clinical data suggest that short courses of antibiotics can be used for common bacterial infections among immune competent patients, but for many randomized controlled trials (RCTs), immunocompromised patients, including solid organ transplant recipients (SOTRs), have been excluded.
METHODS: Peer-reviewed publications were identified through PubMed and Embase searches.
RESULTS: We review data examining shorter antibiotic courses among immunocompetent and immunocompromised patients and the rationale for use of short antibiotic courses in SOTRs.
CONCLUSIONS: There are known harms associated with antibiotics and, when studied, existing data do not demonstrate harm associated with shorter courses of antibiotics among SOTRs. Furthermore, several RCTs did include some immune compromised patients and found shorter therapy to result in similar clinical efficacy with diminished adverse effects. Shorter antibiotic durations should be considered in SOTRs, and questions of antibiotic duration among SOTRs should be prioritized for study in clinical trials.