化脓性链球菌(S.化脓性)是革兰氏阳性细菌,可引起一系列疾病,从无症状感染到危及生命的败血症。研究报告,在症状发作后30天内,密切接触的指标病例中,侵袭性化脓性链球菌疾病的风险高达2000倍。尽管如此,在无症状携带化脓性链球菌和有继发性侵袭性化脓性链球菌感染风险的患者的管理方面存在差异。
目的:我们的系统评价评估了不同抗生素方案用于根除无症状个体咽部化脓性链球菌的疗效。
方法:我们搜索了Pubmed,EMBASE(1974-),OVIDMedline(1948-)和CochraneCENTRAL注册表。我们纳入了随机对照试验(RCT),其中无症状的参与者>50%,基线时咽部培养为化脓性链球菌阳性。仅使用微生物学方法进行研究,包括培养(+/-聚合酶链反应,PCR)包括在内。我们包括以英语发表的研究。每个纳入的研究都由两名独立的审阅者评估数据提取和偏倚风险。
结果:在确定的1166条唯一记录中,3项RCT纳入本综述.三个纳入RCT中的两个发现口服克林霉素10天是最有效的方案,与肌肉注射苄星青霉素G,然后口服利福平4天相比,或使用苄星青霉素的单一疗法,苯氧甲基青霉素或红霉素。两项随机对照试验被评估为存在高偏倚风险,第三项研究表明,偏倚风险较低/有一定程度。
结论:目前关于根除咽部化脓性链球菌携带的最佳抗生素的现有证据有限。未来的RCT应该包括青霉素,第一代头孢菌素,利福平,大环内酯类(如阿奇霉素)和克林霉素。
Streptococcus pyogenes (S. pyogenes) is a Gram-positive bacteria which causes a spectrum of diseases ranging from asymptomatic infection to life-threatening sepsis. Studies report up to 2000 times greater risk of invasive S. pyogenes disease in close contacts of index cases within 30-days of symptom onset. Despite this, there is variability in the management of asymptomatic carriage of S. pyogenes and those at risk of secondary cases of invasive S. pyogenes infection.
OBJECTIVE: Our systematic
review assessed the efficacy of different antibiotic regimens used for eradication of S. pyogenes from the pharynx in asymptomatic individuals.
METHODS: We searched Pubmed, EMBASE (1974-), OVID Medline (1948-) and the Cochrane CENTRAL registry. We included randomised controlled trials (RCTs) with asymptomatic participants with >50% with pharyngeal cultures positive with S. pyogenes at baseline. Only studies with microbiological methods including culture (+/- polymerase chain reaction, PCR) were included. We included studies published in English. Each included study was assessed by two independent reviewers for data extraction and risk of bias.
RESULTS: Of 1166 unique records identified, three RCTs were included in the
review. Two of the three included RCTs found oral clindamycin for 10-days was the most efficacious regimen, compared to intramuscular benzathine penicillin G followed by 4 days of oral rifampicin, or monotherapy using benzathine penicillin, phenoxymethylpenicillin or erythromycin. Two RCTs were assessed as being at high risk of bias, with the third study demonstrating low/some risk of bias.
CONCLUSIONS: Current available evidence for the optimal antibiotic in eradicating pharyngeal S. pyogenes carriage is limited. Future RCTs should include penicillin, first-generation cephalosporins, rifampicin, macrolides (such as azithromycin) and clindamycin.