目的:单纯性蜂窝织炎的抗生素治疗在药物方面是高度可变的,剂量,和管理途径。由于对重新评估的最佳/适当时间存在不确定性,我们旨在评估达到临床反应的时间.
方法:我们对多个时间点报告无并发症蜂窝织炎对抗生素治疗的临床反应的随机对照试验进行了系统评价。PubMed,Embase,中部,世卫组织ICTRP,和clinicaltrials.gov从开始到2021年6月进行了搜索,没有语言限制。主要结果是达到临床反应的时间。其他结果是临床反应的组成部分(疼痛,严重程度评分,发红,在≥2个时间点测量的水肿)和治疗失败的患者比例。我们使用随机效应模型对平均临床反应时间和95%置信区间进行了汇总估计。
结果:我们纳入了32项随机对照试验(n=13,576名参与者)。平均临床缓解时间为1.68天(95CI1.48-1.88;I2=76%)。对特定组分的治疗的反应如下:到第5天疼痛和严重程度评分减少~50%,到第2-3天发红面积减少~33%,到第2-4天水肿患者比例减少30-50%。治疗失败的定义不同,总失败率为12%(95CI9-16%)。
结论:现有的最佳数据表明,临床重新评估的最佳时间为2至4天,但由于相当大的异质性和纳入研究数量少,因此必须谨慎解释.
OBJECTIVE: Antibiotic treatment of uncomplicated cellulitis is highly variable with respect to agent, dose, and route of administration. As there is uncertainty about optimal/appropriate time to reassess, we aimed to assess time to clinical response.
METHODS: We conducted a systematic
review of randomized controlled trials reporting clinical response of uncomplicated cellulitis to antibiotic treatment over multiple timepoints. PubMed, Embase, CENTRAL, WHO ICTRP, and clinicaltrials.gov were searched from inception to June 2021 without language restrictions. The primary outcome was time to clinical response. Other outcomes were components of clinical response (pain, severity score, redness, edema measured at ≥ 2 timepoints) and the proportion of patients with treatment failure. We performed a pooled estimate of the average time to clinical response together with 95% confidence intervals using a random effects model.
RESULTS: We included 32 randomized controlled trials (n = 13,576 participants). The mean time to clinical response was 1.68 days (95%CI 1.48-1.88; I2 = 76%). The response to treatment for specific components was as follows: ~ 50% reduction of pain and severity score by day 5, a ~ 33% reduction in area of redness by day 2-3, and a 30-50% reduction of proportion of patients with edema by day 2-4. Treatment failure was variably defined with an overall failure rate of 12% (95%CI 9-16%).
CONCLUSIONS: The best available data suggest the optimal time to clinical reassessment is between 2 and 4 days, but this must be interpreted with caution due to considerable heterogeneity and small number of included studies.