Is There Evidence on the Optimal Duration of Aminoglycoside Therapy in β-Lactam/Aminoglycoside Combination Regimens Used for the Treatment of Gram-Negative Bacterial Infections? A Systematic Review

IF 4.9 2区 医学 Q1 INFECTIOUS DISEASES
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引用次数: 0

Abstract

Background

The optimal duration of therapy of aminoglycosides in combination regimens is expected to be different from that of monotherapy regimens, and shorter durations could help minimize toxicity without compromising efficacy. The aim of this review was to assess the evidence for the optimal duration of aminoglycosides in β-lactam/aminoglycoside combinations used for the treatment of Gram-negative bacterial infections.

Materials and Methods

PubMed, Cochrane, Embase, Scopus, Web of Science, and CINHAL databases were searched. Covidence software was used for article screening and management. Studies were included if they clearly reported the duration of therapy of aminoglycosides in β-lactam/aminoglycoside combinations used against Gram-negative bacteria. The protocol is registered with PROSPERO (CRD42023392709).

Results

A total of 45 β-lactam/aminoglycoside combination courses from 32 articles were evaluated. The duration of therapy of aminoglycosides in combinations regimens ranged from 1 to 14 days, varying with the type of infection treated. In half (51.1%; (23/45) of the combinations, aminoglycosides were administered for a duration ranging from 6 to 9 days. In 26.7% (12/45) of the combinations, the duration of aminoglycoside therapy was ≤ 5 days. In the remaining 22.2% (10/45) of these combinations, the aminoglycosides were administered for a duration of ≥ 10 days. Aminoglycosides were administered for a longer duration of 7-14 days in 12 (75%) of the 16 combination courses that induced toxicity.

Conclusions

Long duration of aminoglycoside use is associated with increased risk of toxicity. However, there is a lack of evidence on defining an optimal duration of aminoglycoside therapy in β-lactam/aminoglycoside combination regimens that ensures clinical efficacy outcomes whilst minimizing toxicity outcomes.

Abstract Image

是否有证据表明治疗革兰氏阴性菌感染的β-内酰胺/氨基糖苷类复方疗法中氨基糖苷类药物治疗的最佳持续时间?-系统综述。
背景:氨基糖苷类药物在联合治疗方案中的最佳疗程预计与单药治疗方案不同;较短的疗程有助于在不影响疗效的前提下最大限度地减少毒性。本综述旨在评估用于治疗革兰氏阴性菌感染的β-内酰胺/氨基糖苷类药物联合疗法中氨基糖苷类药物最佳用药时间的证据:方法:检索了 PubMed、Cochrane、Embase、Scopus、Web of Science 和 CINHAL 数据库。文章筛选和管理采用 Covidence 软件。如果研究明确报告了针对革兰氏阴性菌的β-内酰胺类/氨基糖苷类复方制剂中氨基糖苷类药物的治疗持续时间,则将其纳入研究。该方案已在 PROSPERO 注册(CRD42023392709):结果:共评估了 32 篇文章中的 45 个β-内酰胺/氨基糖苷类复方疗程。复合疗法中氨基糖苷类药物的疗程从 1 天到 14 天不等,因治疗的感染类型而异。在半数(51.1%;23/45)的联合用药中,氨基糖苷类药物的疗程为 6 至 9 天。在 26.7%(12/45)的组合中,氨基糖苷类药物的治疗时间不超过 5 天。其余22.2%(10/45)的组合中,氨基糖苷类药物的治疗时间≥10天。在16个引起毒性的联合用药疗程中,有12个(75%)的氨基糖苷类药物用药时间较长,为7-14天:结论:氨基糖苷类药物的长期使用与毒性风险增加有关。结论:氨基糖苷类药物用药时间过长与毒性风险增加有关。然而,目前还缺乏证据来确定β-内酰胺类/氨基糖苷类药物联合疗法中氨基糖苷类药物的最佳用药时间,以确保临床疗效,同时最大限度地减少毒性结果。
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来源期刊
CiteScore
21.60
自引率
0.90%
发文量
176
审稿时长
36 days
期刊介绍: The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.
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