Comparative efficacy and optimal duration of first-line antibiotic regimens for acute otitis media in children and adolescents:a systematic review and network meta-analysis of 89 randomized clinicaltrials  

作　　者：Min Seo Kim Jae Han Kim Seohyun Ryu Seung Won Lee Dong Keon Yon Eunyoung Kim Ai Koyanagi Elena Dragioti Jae Il Shin Lee Smith 

机构地区：[1]Samsung Advanced Institute forHealth Sciences&Technology(SAIHST),Samsung Medical Center,Sungkyunkwan University,Seoul,Republic of Korea [2]Yonsei University Collegeof Medicine,Seoul,Republicof Korea [3]Department of Precision Medicine,Sungkyunkwan University School of Medicine,Suwon,Republic of Korea [4]Center for Digital Health,Medical Science Research Institute,Kyung Hee University College of Medicine,Seoul,Republic of Korea [5]Evidence-Based Research Laboratory,Department of Clinical Pharmacy and Pharmaceutical Care,College of Pharmacy,Chung-Ang University,Seoul,Republic of Korea [6]Parc Sanitari Sant Joan de Deu/CIBERSAM/ISCIII,Universitat de Barcelona,Fundacio Sant Joan de Déu.Sant Boi de Llobregat,Barcelona,Spain [7]ICREA,Pg.Lluis Companys 23,Barcelona,Spain [8]Pain and Rehabilitation Centre,and Department of Medical and Health Sciences,Linkoping University,58185 Linkoping,Sweden [9]Department of Pediatrics,Yonsei University College of Medicine,Yonsei-ro 50,Seodaemun-gu,8044,Seoul 03722,Republic of Korea [10]Centre for Health,Performance,and Wellbeing,Anglia Ruskin University,Cambridge CB11PT,UK [11]Research Laboratory Psychology of Patients,Families&Health Professionals,Department of Nursing,School of Health Sciences,University of Ioannina,Ioannina 45500,Greece

出　　处：《World Journal of Pediatrics》2024年第3期219-229,共11页世界儿科杂志（英文版）

摘　　要：Introduction Antibiotic use for acute otitis media(AOM)is one of the major sources of antimicrobial resistance.However,the effective minimal antibiotic duration for AOM remains unclear.Moreover,guidelines often recommend broad ranges(5-10 days)of antibiotic use,yet the clinical impact of such a wide window has not been assessed.Methods We systematically searched PubMed/MEDLINE,Embase,Scopus,Web of Science,and Cochrane Library from database inception to 6 October 2021.Network meta-analysis was conducted on randomized controlled trials that assessed antibiotic treatment for AOM in children(PROSPERO CRD42020196107).Results For amoxicillin and amoxicillin-clavulanate,7-day regimens were noninferior to 10-day regimens in clinical responses[amoxicillin:risk ratio(RR)0.919(95%CI 0.820-1.031),amoxicillin-clavulanate:RR 1.108(0.957-1.282)],except for≤2 years.For the third-generation cephalosporins,7-day and 10-day regimens had similar clinical responses compared to placebo[7-day:RR 1.420(1.190-1.694),10-day:RR 1.238(1.125-1.362)compared to placebo].However,5-day regimens of amoxicillin-clavulanate and third-generation cephalosporins were inferior to 10-day regimens.Compared to amoxicillin,a shorter treatment duration was tolerable with amoxicillin-clavulanate.Conclusions Our findings indicated that 1O days of antibiotic use may be unnecessarily long,while the treatment duration should be longer than 5 days.Otherwise,5-day regimens would be sufficient for a modest treatment goal.Our findings revealed that the current wide range of recommended antibiotic durations may have influenced the clinical outcome of AOM,and a narrower antibiotic duration window should be re-established.

关 键 词：Amoxicillin-potassium AMOXICILLIN Antibacterial agents CEPHALOSPORINS Duration of therapy 

分 类 号：R726.5[医药卫生—儿科]