首页|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 clinical trials

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 clinical trials

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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 10 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.

Amoxicillin-potassiumAmoxicillinAntibacterial agentsCephalosporinsDuration of therapy

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

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Samsung Advanced Institute for Health Sciences &Technology(SAIHST),Samsung Medical Center,Sungkyunkwan University,Seoul,Republic of Korea

Yonsei University College of Medicine,Seoul,Republic of Korea

Department of Precision Medicine,Sungkyunkwan University School of Medicine,Suwon,Republic of Korea

Center for Digital Health,Medical Science Research Institute,Kyung Hee University College of Medicine,Seoul,Republic of Korea

Evidence-Based Research Laboratory,Department of Clinical Pharmacy and Pharmaceutical Care,College of Pharmacy,Chung-Ang University,Seoul,Republic of Korea

Parc Sanitari Sant Joan de Déu/CIBERSAM/ISCⅢ,Universitat de Barcelona,Fundació Sant Joan de Déu,Sant Boi de Llobregat,Barcelona,Spain

ICREA,Pg.Lluis Companys 23,Barcelona,Spain

Pain and Rehabilitation Centre,and Department of Medical and Health Sciences,Linköping University,581 85 Linköping,Sweden

Research Laboratory Psychology of Patients,Families& Health Professionals,Department of Nursing,School of Health Sciences,University of Ioannina,Ioannina 45500,Greece

Department of Pediatrics,Yonsei University College of Medicine,Yonsei-ro 50,Seodaemun-gu,8044,Seoul 03722,Republic of Korea

Centre for Health,Performance,and Wellbeing,Anglia Ruskin University,Cambridge CB1 1PT,UK

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2024

10.1007/s12519-023-00716-8

世界儿科杂志(英文版)

世界儿科杂志(英文版)

CSTPCD
ISSN：
年,卷(期)：2024.20(3)
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