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Intervention Review

Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis

  1. Alan R Smyth1,*,
  2. Jayesh Bhatt2

Editorial Group: Cochrane Cystic Fibrosis and Genetic Disorders Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 13 APR 2009

DOI: 10.1002/14651858.CD002009.pub3

How to Cite

Smyth AR, Bhatt J. Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD002009. DOI: 10.1002/14651858.CD002009.pub3.

Author Information

  1. 1

    University of Nottingham, Department of Child Health, School of Clinical Sciences & Nottingham Respiratory BRU, Nottingham, UK

  2. 2

    Nottingham University Hospitals, Paediatric Respiratory Medicine, Nottingham, UK

*Alan R Smyth, Department of Child Health, School of Clinical Sciences & Nottingham Respiratory BRU, University of Nottingham, E Floor East Block, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK. alan.smyth@nottingham.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2010

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This is not the most recent version of the article. View current version (04 FEB 2014)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

People with cystic fibrosis, who are chronically colonised with the organism Pseudomonas aeruginosa, often require multiple courses of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations. The properties of aminoglycosides suggest that they could be given in higher doses less often.

Objectives

To assess the effectiveness and safety of once-daily versus multiple-daily dosing of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations in cystic fibrosis.

Search methods

We searched the Cystic Fibrosis Specialist Register held at the Cochrane Cystic Fibrosis and Genetic Disorders Group's editorial base, comprising references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings.

Date of the most recent search: 19 August 2008.

Selection criteria

All randomised controlled trials, whether published or unpublished, in which once-daily dosing of aminoglycosides has been compared with multiple-daily dosing in terms of efficacy or toxicity or both, in people with cystic fibrosis.

Data collection and analysis

The two authors independently selected the studies to be included in the review and assessed methodological quality of each study. Data were independently extracted by each author. Authors of the included studies were contacted for further information. As yet unpublished data were obtained for one of the included studies.

Main results

Thirteen studies were identified for possible inclusion in the review. Four studies reporting results from a total of 328 participants were included in this review. All studies compared once-daily dosing with thrice-daily dosing. There was no significant difference between treatment groups in: forced expiratory volume at one second, mean difference (MD) 0.33 (95% confidence interval (CI) -2.81 to 3.48); forced vital capacity, MD 0.29 (95% CI -6.58 to 7.16); % weight for height, MD -0.82 (95% CI -3.77 to 2.13); body mass index, MD 0.00 (95% CI -0.42 to 0.42); or in the incidence of ototoxicity, relative risk 0.56 (95% CI 0.04 to 7.96). The percentage change in creatinine significantly favoured once-daily treatment in children, MD -8.20 (95% CI -15.32 to -1.08), but showed no difference in adults, MD 3.25 (95% CI -1.82 to 8.33).

Authors' conclusions

Once and three times daily aminoglycoside antibiotics appear to be equally effective in the treatment of pulmonary exacerbations of cystic fibrosis. There is evidence of less nephrotoxicity in children.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Giving aminoglycoside antibiotics intravenously once daily compared to giving them several times per day in people with cystic fibrosis

Cystic fibrosis is a serious genetic disorder which affects the lungs and the exocrine glands (sweat glands and others). Most people with cystic fibrosis develop persistent lung infections and they may receive frequent courses of intravenous antibiotics. Once-a-day doses reduce the cost and the time involved in giving the antibiotics, compared to several dose per day. This review includes four trials with a total of 328 people. All trials compared once-a-day dosing with three times-a-day dosing. The review found that giving the antibiotics once per day was just as good at treating lung infections in people with cystic fibrosis as the alternative treatment. Results suggest once daily treatment is less toxic to the kidneys in children, but may not be in adults. There were no differences between treatments for other outcomes. While once-daily treatment can be just as effective and more convenient than three-times daily treatment, we recommend further studies to look at the long-term safety of this treatment regimen.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

比較1天1次與1天多次靜脈注射Aminoglycosides類在囊狀纖維化病患的使用

受到綠膿桿菌慢性群聚於肺部的囊狀纖維化患者,常需要多重的靜脈注射治療,藉以處理肺部問題的惡化。Aminoglycosides類抗生素本身的特性讓研究者認為應該減少使用高劑量的頻率。

目標

為了評估比較一天一次與一天多次靜脈注射Aminoglycosides類抗生素用於囊狀纖維化病患肺感染加重時的有效度及安全性。

搜尋策略

我們搜尋了Cochrane Cystic Fibrosis和Genetic Disorders Group's editorial base中的Cystic Fibrosis Specialist Register,其蒐集了綜合電子資料庫的參考資料,也人工搜尋相關的期刊,以及各種學術會議的摘要文集。最近一次的搜尋日期是在2007年2月。

選擇標準

所有的隨機對照試驗,不管有沒有出版,都比較了1天1次與1天多次靜脈注射Aminoglycosides類抗生素用於囊狀纖維化病患時的有效度、毒性,或兩者皆有。

資料收集與分析

兩位作者各自獨立地選出應包含在此回顧的研究,並且確定了各個研究的方法學品質。兩位作者更獨立地擷取資料。並連絡被納入回顧的文章作者也有被連絡,以求得相關資訊。其中一個研究取得的數據尚未出版。

主要結論

共有13個試驗被納入回顧。其中4個報告了328位研究對象。每個試驗都比較了1天1次與1天3次的劑量。實驗顯示在以下向度中,兩者並沒有顯著差異:用力呼氣一秒量weighted mean difference (WMD) 0.33 (95% CI −2.81 至3.48)、出力肺活量WMD 0.29 (95% CI −6.58 至 7.16)、身體質量指數WMD 0.00 (95% CI −0.42 至 0.42)以及耳毒性,相對危險性 0.56 (95% CI 0.04 至 7.96)。肌酸酐在孩童族群以一天一次較為正常WMD −8.20 (95% CI −15.32 至 −1.08),但在成人中則沒有差異WMD 3.25 (95% CI −1.82 至 8.33)。

作者結論

1天1次與1天3次靜脈注射Aminoglycosides類抗生素用於囊狀纖維化病患,對於肺部感染的惡化的治療效果並無差別。有證據顯示在兒童族群中有較低的腎毒性。

翻譯人

本摘要由臺灣大學附設醫院林皓陽翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

1天1次與傳統的1天多次靜脈注射Aminoglycosides類抗生素用於囊狀纖維化病患,對於肺部感染的惡化的治療效果並無差別。囊狀纖維化是一個嚴重的基因變異,影響了外泌腺如:汗腺或其他。囊狀纖維化的病患相較於一般人,有較高的危險性會有慢性的肺部感染,且常常因為這些感染而需要間歇性地接受抗生素注射治療。1天1次的注射在所付出的金錢與時間方面,優於1天多次的注射治療。這個研究顯示1天1次的靜脈注射Aminoglycosides類抗生素在治療肺部感染方面,跟一天多次的注射治療一樣有效。然而,資料顯示一天多次的注射治療在孩童中有較少的腎毒性,但是對於成人而言則有較高的腎毒性。