This is not the most recent version of the article. View current version (4 FEB 2014)
Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis
Editorial Group: Cochrane Cystic Fibrosis and Genetic Disorders Group
Published Online: 20 JAN 2010
Assessed as up-to-date: 13 APR 2009
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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.
- Publication Status: Edited (no change to conclusions)
- Published Online: 20 JAN 2010
This is not the most recent version of the article. View current version (04 FEB 2014)
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.
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.
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.
All randomised controlled trials, whether published or unpublished, in which once-daily dosing of aminoglycosides has been compared with multiple-daily dosing in terms of efficacy or toxicity or both, in people with cystic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 As yet unpublished data were obtained for one of the included studies.
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).
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
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.
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。
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)。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。