儿科人群中最常见的细菌性脑膜炎病因的抗生素治疗的最佳持续时间,即肺炎链球菌,流感嗜血杆菌,和脑膜炎奈瑟菌,在文献中没有得到很好的确立。因此,我们的目的是进行一项更新的荟萃分析,比较较短和较长的抗生素治疗对脑膜炎儿童的治疗.PubMed,EMBASE,在Cochrane数据库中搜索随机对照试验(RCT),比较了脑膜炎患儿抗生素治疗时间较短(长达7天)与较长(相当于短期疗程的10天或两倍)的比较,并报告了治疗失败的结果,死亡,神经系统后遗症,非神经系统并发症,听力障碍,医院感染,和复发。用I2统计量检查异质性。RevMan5.4.1用于统计分析,RoB-2(Cochrane)用于偏倚风险评估。在684个搜索结果中,包括6项RCT,有1333名3周至15.5岁的儿童,其中49.51%接受了短期抗生素疗程。所有随机对照试验包括头孢曲松单药治疗,除了一个,也加入了万古霉素。比较治疗失败的短期和长期治疗没有差异,复发,死亡率,出院和随访时的神经系统并发症。结论:由于分析结果在组间没有发现统计学上的显著差异,本荟萃分析的结果支持较短的治疗.然而,将这些结果推广到由其他病原体引起的复杂脑膜炎和感染应谨慎。(PROSPERO标识符:CRD42022369843)。已知内容:•关于细菌性脑膜炎的抗生素治疗的持续时间的当前建议主要基于临床实践。•定义抗生素治疗的最佳持续时间对于实现抗菌药物管理至关重要,改善患者预后,尽量减少不利影响。关于治疗失败,较短的抗生素治疗持续时间与较长的抗生素治疗持续时间之间没有差异,复发,死亡率,神经系统并发症,出院和随访时听力受损。
The optimal duration of antibiotic treatment for the most common bacterial meningitis etiologies in the pediatric population, namely Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, is not well-established in the literature. Therefore, we aimed to perform an updated meta-analysis comparing shorter versus longer antibiotic treatment in children with meningitis. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) that compared shorter (up to 7 days) versus longer (10 days or double the days of the equivalent short course) duration of antibiotic treatment in children with meningitis and reported the outcomes of treatment failure, death, neurologic sequelae, non-neurologic complications, hearing impairment, nosocomial infection, and relapse. Heterogeneity was examined with I2 statistics. RevMan 5.4.1 was used for statistical analysis and RoB-2 (Cochrane) for risk of bias assessment. Of 684 search results, 6 RCTs were included, with a cohort of 1333 children ages 3 weeks to 15.5 years, of whom 49.51% underwent a short antibiotic course. All RCTs included monotherapy with ceftriaxone, except one, which added vancomycin as well. No differences were found comparing the short and long duration of therapy concerning treatment failure, relapse, mortality, and neurologic complications at discharge and at follow-up. Conclusion: Because no statistically significant differences were found between groups for the analyzed outcomes, the results of this meta-analysis support shorter therapy. However, generalizing these results to complicated meningitis and infections caused by other pathogens should be made with caution. (PROSPERO identifier: CRD42022369843). What is Known: • Current recommendations on the duration of antibiotic therapy for bacterial meningitis are mostly based on clinical practice. • Defining an optimal duration of antibiotic therapy is essential for antimicrobial stewardship achievement, improving patient outcomes, and minimizing adverse effects. What is New: • There are no differences between shorter versus longer antibiotic treatment duration in regard to treatment failure, relapse, mortality, neurologic complications, and hearing impairment at discharge and at follow-up.