Intervention Review

Granulocyte-Colony Stimulating Factor (G-CSF) as an adjunct to antibiotics in the treatment of pneumonia in adults

  1. Allen C Cheng1,*,
  2. Dianne P Stephens2,
  3. Bart J Currie3

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 18 APR 2007

Assessed as up-to-date: 28 JAN 2007

DOI: 10.1002/14651858.CD004400.pub3


How to Cite

Cheng AC, Stephens DP, Currie BJ. Granulocyte-Colony Stimulating Factor (G-CSF) as an adjunct to antibiotics in the treatment of pneumonia in adults. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004400. DOI: 10.1002/14651858.CD004400.pub3.

Author Information

  1. 1

    2nd Floor, Burnet Centre, Alfred Hospital, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

  2. 2

    Royal Darwin Hospital, Intensive Care Unit, Darwin, Northern Territory, Australia

  3. 3

    Menzies School of Health Research, Charles Darwin University and Northern Territory Clinical School, Northern Territory Clinical School, Casuarina, Northern Territory, Australia

*Allen C Cheng, Department of Epidemiology and Preventive Medicine, Monash University, 2nd Floor, Burnet Centre, Alfred Hospital, Commercial Road, Melbourne, Victoria, 3004, Australia. allencheng@ozemail.com.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 APR 2007

SEARCH

 

Abstract

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

Background

Granulocyte colony stimulating factor (G-CSF) is a naturally-occurring cytokine that has been shown to increase neutrophil function and number. Exogenous administration of recombinant G-CSF (filgrastim, pegfilgrastim or lenograstim) has found extensive use in the treatment of febrile neutropenia, but its role in the treatment of infection in non-neutropenic hosts is less well defined.

Objectives

We explored the role of G-CSF as an adjunct to antibiotics in the treatment of pneumonia in non-neutropenic adults.

Search methods

For this updated review we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2006, issue 4); MEDLINE (1950 to January 2007); EMBASE (1988 to January 2007); and online databases of clinical trials (www.controlled-trials.com, updated 10 November, 2006).

Selection criteria

We considered randomized controlled trials (RCTs) which included hospitalized adult patients with either community-acquired pneumonia or hospital-acquired pneumonia.

Data collection and analysis

Two review authors independently extracted data and assessed trial quality. The primary outcome measure was 28-day mortality. Secondary outcome measures included other markers of mortality as well as markers of adverse events, including organ dysfunction. An assessment of methodological quality was made for each study.

Main results

Six studies with a total of 2018 people were identified. G-CSF use appeared to be safe with no increase in the incidence of total serious adverse events (pooled odds ratio (OR) 0.91; 95% confidence interval (CI): 0.73 to 1.14) or organ dysfunction. However, the use of G-CSF was not associated with improved 28-day mortality (pooled OR 0.81; 95% CI: 0.52 to 1.27).

Authors' conclusions

There is no current evidence supporting the routine use of G-CSF in the treatment of pneumonia. Studies in which G-CSF is administered prophylactically or earlier in therapy may be of interest.

 

Plain language summary

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

Granulocyte colony stimulating factor (G-CSF), when given with antibiotics, does not appear to reduce mortality in adults with pneumonia

Pneumonia, or infection involving the lungs, is responsible for a significant number of deaths worldwide. Pneumonia is especially life-threatening in older people and people with other illnesses that may affect the immune system (such as diabetes). In addition to antibiotics, granulocyte colony stimulating factor (G-CSF) has been suggested as a possible option for treatment. G-CSF stimulates the production of white blood cells that fight infection, and is used for people with cancer after chemotherapy, and in febrile neutropenia (infection associated with very low levels of white cells). The review of trials found that, when combined with antibiotics, G-CSF appears to be a safe treatment for people with pneumonia, but it does not appear to reduce mortality. More research is needed to define the optimal timing of dosing (earlier, or prophylactically before the onset of infection) and possible problems when given to patients with severe infection.

 

摘要

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

背景

以顆粒球生成刺激素(GCSF)作為成人肺炎的輔助治療

顆粒球生成刺激素(GCSF)是一種自然生成的細胞激素,具有改善多核球功能、增加多核球細胞數的效果。人為給予重組顆粒球生成刺激素(GCSF),如filgrastim、pegfilgrastim、lenograstim,被廣泛用於顆粒球低下時的發燒,但在非顆粒球低下的感染,其治療的角色未明。

目標

我們探索在非白血球減少成人肺炎的治療上,用顆粒球生成刺激素(GCSF)輔助抗生素治療的功用。

搜尋策略

在本次的更新我們搜尋了the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2006年)、MEDLINE (1950年 −2007年1月)、 EMBASE (1988年 −2007年1月)、以及線上的臨床試驗資料庫。 (www.controlledtrials.com,更新日:2006年11月10日)。

選擇標準

我們考慮包含:社區感染肺炎或是院內感染肺炎的住院成年病患的隨機對照試驗。

資料收集與分析

兩位作者獨立摘錄資料並分析試驗品質。主要結果定義為第28天的死亡率;次要的結果包括其他死亡率指標,如不良事件指標,包括器官衰竭等。並且評估每篇試驗的研究方法品質。

主要結論

我們找到6個試驗、包括2018位病人。顆粒球生成刺激素似乎是安全的,因為它並沒有增加嚴重併發症或器官衰竭的總數。以嚴重併發症數來說,其相對危險性(odds ratio) 為0.91,95%信賴區間為0.73 – 1.14。不過我們發現使用顆粒球生成刺激素併未改善28天的死亡率,其相對危險性為0.81;95%信賴區間為0.52 – 1.27。

作者結論

目前沒有證據支持在肺炎的治療中常規使用顆粒球生成刺激素。至於預防性或治療早期投予顆粒球生成刺激素則是另一個有趣的議題。

翻譯人

本摘要由臺灣大學附設醫院簡郁珊翻譯。

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

總結

顆粒球生成刺激素 (GCSF)假若予抗生素一起使用,似乎並不能減少成人肺炎病患死亡率。 肺炎或肺部感染是全球病人死亡的重要原因,尤其在老人或免疫功能受影響的病人(如糖尿病患)由其致命。除了抗生素,顆粒球生成刺激素曾被建議成一個治療的選擇。顆粒球生成刺激素刺激可對抗感染的白血球生成,在癌症病人化學治療後、或顆粒球低下的發燒使用。這篇回顧發現,對肺炎的病人同時給予顆粒球生成刺激素跟抗生素是安全的,但似乎不能減少死亡率。我們仍需要更多的研究,來界定在嚴重感染的病人,適當的使用時機及藥物劑量。