Duration of intravenous antibiotic therapy in people with cystic fibrosis

 

Abstract

Background

Respiratory disease is the major cause of mortality and morbidity in cystic fibrosis (CF). Life expectancy of people with CF has increased dramatically in the last 40 years. One of the major reasons for this increase is the mounting use of antibiotics to treat chest exacerbations caused by bacterial infections. The optimal duration of intravenous antibiotic therapy is not clearly defined. Individuals usually receive intravenous antibiotics for 14 days, but treatment may range from 10 to 21 days. A shorter duration of antibiotic treatment risks inadequate clearance of infection which could lead to further lung damage. Prolonged courses of intravenous antibiotics are expensive and inconvenient and the incidence of allergic reactions to antibiotics also increases with prolonged courses. The use of aminoglycosides requires frequent monitoring to avoid some of their side effects. However, some organisms which infect people with CF are known to be multi-resistant to antibiotics, and may require a longer course of treatment.

Objectives

To assess the optimal duration of intravenous antibiotic therapy for treating chest exacerbations in people with cystic fibrosis.

Search methods

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals, abstract books and conference proceedings.

Most recent search of the Group's Cystic Fibrosis Trials Register: 3 December 2010.

Selection criteria

Randomised and quasi-randomised controlled trials comparing different durations of intravenous antibiotic courses for acute respiratory exacerbations in people with CF, either with the same drugs at the same dosage, the same drugs at a different dosage or frequency or different antibiotics altogether, including studies with additional therapeutic agents.

Data collection and analysis

No eligible trials were identified.

Main results

No eligible trials were identified.

Authors' conclusions

There are no clear guidelines on the optimum duration of intravenous antibiotic treatment. Duration of treatment is currently based on unit policies and response to treatment. Shorter duration of treatment should improve quality of life and compliance; result in a reduced incidence of drug reactions; and be less costly. However, this may not be sufficient to clear a chest infection and may result in an early recurrence of an exacerbation. This systematic review identifies the need for a multicentre, randomised controlled trial comparing different durations of intravenous antibiotic treatment as it has important clinical and financial implications.

 

Plain language summary

The length of time antibiotic treatment, which is administered directly into the blood stream, is needed to clear an acute chest infection in people with cystic fibrosis

Chest infections in people with cystic fibrosis are treated aggressively to prevent further damage to the lungs. This has resulted in better survival rates for people with cystic fibrosis in recent years. There are no clear guidelines on how long chest infections should be treated with intravenous antibiotics. Different centres tend to use different treatment regimens. Most centres use 10 or 14 days, extending them to 21 days if there is no improvement. We could not find any studies comparing 10 days treatment with 14 days or longer treatment. Shorter duration of treatment may be better as these courses of treatment are easier for people to complete. They are also less expensive and cause fewer drug reactions than longer treatments. However, it is not clear if shorter treatment is enough to treat infections adequately. It is also not clear whether shorter treatment results in early recurrence or increased frequency of chest infections. Further research is needed to find the optimum duration for treating chest infection.

 

摘要

背景

囊性纖維化(cystic fibrosis)患者的靜脈抗生素療法(intravenous antibiotic therapy)治療期

呼吸性疾病是造成囊性纖維化(CF)發病以及死亡的主要原因。囊性纖維化患者的壽命期望值在過去的40年之間有戲劇化地提升。造成這樣的提升其中一項最主要的原因即是使用抗生素以治療細菌感染造成的胸部惡化。靜脈抗生素療法最適當的治療期尚未被明確規範。患者通常獲得14天的靜脈內抗生素，但治療期間可能為10至21天不等。較短的抗生素療法治療期有感染未完全清除而造成進一步的肺部損傷的危險。過長的靜脈抗生素療法治療期則十分昂貴且不便，而對抗生素的過敏反應也隨著治療期的延長提高了發生率。胺基醣甘(aminoglycosides)的使用需要頻繁的監控以避免某些副作用發生。但是，一些可能感染囊性纖維化患者的生物體已知對抗生素有多重抗藥性，並且可能需要更長的療程。

目標

評估靜脈注射抗生素療法治療囊性纖維化患者胸部惡化的最適當治療期。

搜尋策略

我們搜尋了Cystic Fibrosis and Genetic Disorders Group Trials Register，其包含來自綜合電子資料庫搜尋結果、相關期刊手動搜尋結果、摘要書籍以及研討會手冊的參考文獻。Group's Cystic Fibrosis Trials Register中最新的搜尋為2008年4月。

選擇標準

隨機及半隨機對照試驗，比較靜脈抗生素療程針對囊性纖維化患者急性呼吸惡化的不同治療期，不論是使用相同的藥物和相同的劑量、相同的藥物但是不同的劑量、或是不同的頻率、不同種的抗生素混用，也包括外加治療藥物的研究。

資料收集與分析

未找到符合標準的試驗。

主要結論

未找到符合標準的試驗。

作者結論

靜脈抗生素療法的最適合治療期未有明確的指引。目前治療期是根據個別對治療的方法與反應。較短的治療期因有較少的藥物反應，可提升生活品質以及服從度。但是，這可能不足以清除胸腔感染，並可能造成胸腔惡化較快的復發。這個這個系統性回顧發現對於一個比較靜脈內抗生素療法不同治療期的多中心隨機對照試驗的需求，且其具有重要的臨床及財政意義。

翻譯人

本摘要由臺灣大學附設醫院陳玠甫翻譯。

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

總結

囊性纖維化患者的胸腔感染被積極地治療以避免進一步的肺部損傷。這也造成了近年來囊性纖維化患者有較高的存活率。有關胸腔感染以靜脈抗生素療法治療的治療期應有多長目前仍未有明確的指引。不同的醫學中心傾向使用不同的治療準則。大多數中心為10或14天，如果未見改善則延長至21天。我們無法找到任何比較10天與14天或更長治療期的研究。較短的治療期可能因為其對病患而言較容易完成而較佳。它們也較不昂貴並且比長治療期有較少的藥物反應。但是，較短的治療期是否足夠完整地治療感染仍不清楚。較短治療期是否會導致胸腔感染早期復發的機率升高亦不清楚。尚需要更進一步的研究以找出治療胸腔感染的最適合治療期。