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头孢菌素对链球菌性扁桃体咽炎的细菌学和临床治愈效果好于青霉素


35个试验共涉及7125名儿童。作者报告,头孢菌素清除细菌的可能比青霉素大3倍,临床治愈的可能大2.4倍

    

据4月《儿科》杂志(Pediatrics 2004;113:866-882)上的一项报告,头孢菌素对链球菌性扁桃体咽炎的细菌学和临床治愈效果好于青霉素

作者、纽约罗彻斯特大学的皮奇彻罗(Michael E. Pichichero)和凯西(Janet R. Casey)解释,上世纪90年代早期的荟萃分析总结说,头孢菌素在清除急症患儿的A组β-溶血性链球菌(GABHS)方面较好。这以后,共发表了22个 新的临床对照试验(儿童的)。他们对所有这些随机、对照试验又进行了一次严密的荟萃分析,以比较头孢菌素和青霉素治疗GABHS性扁桃体咽炎患儿的效果。

35个试验共涉及7125名儿童。作者报告,头孢菌素清除细菌的可能比青霉素大3倍,临床治愈的可能大2.4倍。而且在这两方面,三代头孢菌素都优于青霉素。

“青霉素治疗确实可能失败,而且很常见”,凯西告诉路透社记者,“而使用头孢菌素,特别是第一代,清除细菌的可能较大”。“对培养证实为GABHS感染 的扁桃体咽炎患儿,尤其是本年内已发作过的……我支持使用头孢菌素”,“医生们要知道并承诺减少不正确地使用抗生素,以免产生耐药性细菌”。“最后,在治 疗前要通过培养物来证实GABHS,并使用最窄抗菌谱的抗生素。对病人来说,最有效的治疗就是最好的”。

Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children.
Casey JR, Pichichero ME.

Department of Pediatrics, Elmwood Pediatric Group, University of Rochester, Rochester, New York 14620, USA. jrcasey@rochester.rr.com

OBJECTIVE: To conduct a meta-analysis of randomized, controlled trials of cephalosporin versus penicillin treatment of group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis in children. METHODOLOGY: Medline, Embase, reference lists, and abstract searches were conducted to identify randomized, controlled trials of cephalosporin versus penicillin treatment of GABHS tonsillopharyngitis in children. Trials were included if they met the following criteria: patients <18 years old, bacteriologic confirmation of GABHS tonsillopharyngitis, random assignment to antibiotic therapy of an orally administered cephalosporin or penicillin for 10 days of treatment, and assessment of bacteriologic outcome using a throat culture after therapy. Primary outcomes of interest were bacteriologic and clinical cure rates. Sensitivity analyses were performed to assess the impact of careful clinical illness descriptions, compliance monitoring, GABHS serotyping, exclusion of GABHS carriers, and timing of the test-of-cure visit. RESULTS: Thirty-five trials involving 7125 patients were included in the meta-analysis. The overall summary odds ratio (OR) for the bacteriologic cure rate significantly favored cephalosporins compared with penicillin (OR: 3.02; 95% confidence interval [CI]: 2.49-3.67, with the individual cephalosporins [cephalexin, cefadroxil, cefuroxime, cefpodoxime, cefprozil, cefixime, ceftibuten, and cefdinir] showing superior bacteriologic cure rates). The overall summary OR for clinical cure rate was 2.33 (95% CI: 1.84-2.97), significantly favoring the same individual cephalosporins. There was a trend for diminishing bacterial cure with penicillin over time, comparing the trials published in the 1970s, 1980s, and 1990s. Sensitivity analyses for bacterial cure significantly favored cephalosporin treatment over penicillin treatment when trials were grouped as double-blind (OR: 2.31; 95% CI: 1.39-3.85), high-quality (OR: 2.50; 95% CI: 1.85-3.36) trials with well-defined clinical status (OR: 2.12; 95% CI: 1.54-2.90), with detailed compliance monitoring (OR: 2.85; 95% CI: 2.33-3.47), with GABHS serotyping (OR: 3.10; 95% CI: 2.42-3.98), with carriers eliminated (OR: 2.51; 95% CI: 1.55-4.08), and with test of cure 3 to 14 days posttreatment (OR: 3.53; 95% CI: 2.75-4.54). Analysis of comparative bacteriologic cure rates for the 3 generations of cephalosporins did not show a difference. CONCLUSIONS: This meta-analysis indicates that the likelihood of bacteriologic and clinical failure of GABHS tonsillopharyngitis is significantly less if an oral cephalosporin is prescribed, compared with oral penicillin.

Pediatrics 2004;113:866-882

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