儿童肺炎和下呼吸道感染短疗程与标准或更长疗程口服抗生素治疗对比：随机对照试验的系统评价和荟萃分析。
完整摘要 · 中文译文
背景：减少不必要的抗生素暴露是儿科抗菌药物管理的一项主要优先事项。短疗程与标准疗程或更长疗程口服抗生素治疗儿童非复杂性细菌感染 comparative effectiveness 仍不确定。 目的：评估在非复杂性细菌感染患儿中，与标准疗程或更长疗程治疗相比，短疗程口服抗生素治疗是否会增加临床治疗失败，主要关注同种抗生素儿科肺炎/下呼吸道感染（LRTI）试验。 方法：我们开展了一项随机对照试验的系统综述和荟萃分析。检索了 MEDLINE/PubMed、Embase、Web of Science 和 CENTRAL，并辅以引文检索和试验注册库审查。纳入研究为 0-18 岁、在门诊或非卧床环境中接受口服抗生素治疗的非复杂性细菌感染患儿。主要结局为临床治疗失败；更广泛的肺炎/LRTI 和所有感染分析作为敏感性或探索性分析处理。随机效应荟萃分析使用风险比（RRs）和风险差（RDs），并报告 95% 置信区间（CIs）。采用 Cochrane 偏倚风险工具评估偏倚风险。该综述已在 PROSPERO 注册（CRD420261339263）。 结果：共纳入 14 项随机试验；9 项同种抗生素肺炎/LRTI 比较纳入主要汇总分析。短疗程治疗与治疗失败增加无关（RR，1.01 ；95% CI，0.92-1.11；I2 = 0.0%），绝对效应分析显示无有意义差异（RD，0.001；95% CI，-0.010至0.013；I2 = 10.0%）。纳入不同抗生素比较的广泛肺炎/下呼吸道感染（LRTI）敏感性分析同样无统计学意义（RR，0.94；95% CI，0.66-1.33），但存在异质性。全感染探索性分析同样无统计学意义（RR，0.89；95% CI，0.63-1.25），鉴于临床异质性，解释较为谨慎。14项试验中，5项为低偏倚风险，2项存在一些担忧，7项为高偏倚风险。 结论：在同类抗生素儿童肺炎/下呼吸道感染试验中，与标准疗程或较长疗程治疗相比，短疗程治疗与临床治疗失败增加无关。跨不同抗生素策略和感染综合征的更广泛分析未实质性改变这一解释，但显示出显著异质性。这些发现支持谨慎地、针对特定感染缩短抗生素疗程，而非广泛推广至所有无并发症的儿童细菌感染。 系统综述注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD420261339263，注册号CRD420261339263。
完整摘要 · 英文原文
BACKGROUND: Reducing unnecessary antibiotic exposure is a major priority in pediatric antimicrobial stewardship. The comparative effectiveness of short-course versus standard- or longer-course oral antibiotic therapy for uncomplicated bacterial infections in children remains uncertain. OBJECTIVE: To evaluate whether short-course oral antibiotic therapy increases clinical treatment failure compared with standard- or longer-course therapy in children with uncomplicated bacterial infections, with a primary focus on same-antibiotic pediatric pneumonia/lower respiratory tract infection (LRTI) trials. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials. MEDLINE/PubMed, Embase, Web of Science, and CENTRAL were searched, supplemented by citation searching and trial registry review. Eligible studies enrolled children aged 0-18 years with uncomplicated bacterial infections treated with oral antibiotics in outpatient or ambulatory settings. The primary outcome was clinical treatment failure; broader pneumonia/LRTI and all-infection analyses were treated as sensitivity or exploratory analyses. Random-effects meta-analysis used risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals (CIs). Risk of bias was assessed with the Cochrane risk-of-bias tool. The review was registered in PROSPERO (CRD420261339263). RESULTS: Fourteen randomized trials were included; nine same-antibiotic pneumonia/LRTI comparisons contributed to the primary pooled analysis. Short-course therapy was not associated with increased treatment failure (RR, 1.01; 95% CI, 0.92-1.11; I2 = 0.0%), and the absolute-effect analysis showed no meaningful difference (RD, 0.001; 95% CI, -0.010 to 0.013; I2 = 10.0%). A broad pneumonia/LRTI sensitivity analysis including different-antibiotic comparisons was also non-significant (RR, 0.94; 95% CI, 0.66-1.33) but heterogeneous. The all-infection exploratory analysis was similarly non-significant (RR, 0.89; 95% CI, 0.63-1.25) and interpreted cautiously given clinical heterogeneity. Of the 14 trials, 5 were at low risk of bias, 2 had some concerns, and 7 were at high risk. CONCLUSION: In same-antibiotic pediatric pneumonia/LRTI trials, short-course therapy was not associated with increased clinical treatment failure compared with standard- or longer-course therapy. Broader analyses across different antibiotic strategies and infection syndromes did not materially change this interpretation but showed substantial heterogeneity. These findings support cautious, infection-specific antibiotic duration reduction rather than broad generalization across all uncomplicated pediatric bacterial infections. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261339263, identifier CRD420261339263.