儿童非重症社区获得性肺炎的短疗程与长疗程抗生素治疗：一项系统评价和荟萃分析。
完整摘要 · 中文译文
未标注：优化儿童社区获得性肺炎（CAP）的抗生素疗程可能减轻治疗负担并支持抗菌药物管理。尽管最近的随机试验和证据综合报告了较短抗生素疗程的相似临床结局，但治疗时长对依从性的影响——一个在儿童中尤其相关的考虑因素——受到的系统性评估相对有限。因此，我们旨在比较短疗程与常规疗程抗生素治疗对免疫功能正常的非重症CAP儿童的治疗效果、用药依从性和抗生素相关不良事件。检索了PubMed、Cochrane Library、Scopus、ClinicalTrials.gov和WHO Global Index Medicus，截至2025年4月25日。仅考虑包含免疫功能正常、年龄<18岁、患非重症CAP儿童并比较短疗程（≤5天）与较长疗程（>5天）的随机临床试验。数据提取和偏倚风险（ROB 2）评估由两名独立评价者完成。汇总数据根据已发表报告提取。主要结局为治疗效果（通过各试验预先定义的治疗失败和复发评估）和对活性（非安慰剂）研究药物的用药不依从性。抗生素相关不良事件作为次要结局进行评估。使用随机效应模型计算风险比（RR）及其95%置信区间（CI）。最初筛选了230项研究，去除重复后 s和10项试验（n = 8970）符合纳入标准. 在治疗失败[RR = 1.07 (95% CI, 0.93-1.24), I2 = 3%]或复发[RR = 1.04 (95% CI, 0.72-1.49), I2 = 0%]方面未发现显著差异. 短程方案显著降低了不依从性[RR = 0.35 (95% CI, 0.24-0.50), I2 = 54%]，这是最一致且具有临床意义的差异. 不良事件相当[RR = 0.71 (95% CI, 0.36-1.40), I2 = 81%]. 结论：短期治疗与较长疗程方案相比，在治疗失败率或复发率方面无显著差异，且与明显较低的未依从性相关。这些发现支持短期抗生素疗程作为非重症儿童社区获得性肺炎（CAP）的合理治疗选择，同时承认本荟萃分析并非旨在正式确立非劣效性或等效性。 已知信息：• 对于非重症社区获得性肺炎患儿，短期抗生素治疗可能达到与常规较长疗程相似的临床结局。• 药物依从性仍是儿科抗生素治疗中的一个重要挑战。 新发现：• 本荟萃分析发现，短期治疗与长期治疗在治疗失败或复发方面无显著差异。• 短期治疗与明显较低的未依从性相关，突出了较短疗程的一个重要实际优势。
完整摘要 · 英文原文
UNLABELLED: Optimizing antibiotic duration for pediatric community-acquired pneumonia (CAP) may reduce treatment burden and support antimicrobial stewardship. Although recent randomized trials and evidence syntheses have reported similar clinical outcomes with shorter antibiotic courses, the effect of treatment duration on adherence-an especially relevant consideration in children-has received comparatively limited systematic evaluation. We therefore aimed to compare treatment effectiveness, medication adherence, and antibiotic-related adverse events between short-course and conventional-duration antibiotic therapy for non-severe CAP in immunocompetent children. PubMed, Cochrane Library, Scopus, ClinicalTrials.gov, and WHO Global Index Medicus were sought through April 25, 2025. Only randomized clinical trials that included immunocompetent children < 18 years with non-severe CAP and compared short-course (≤ 5 days) with longer therapy (> 5 days) were considered. Data extraction and risk of bias (ROB 2) assessment were performed by two independent reviewers. Summary data were extracted by published reports. The principal outcomes were treatment effectiveness, assessed through treatment failure and relapse according to the definitions prespecified by each trial, and medication non-adherence to the active (non-placebo) study drug. Antibiotic-related adverse events were assessed as a secondary outcome. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Two hundred thirty studies were originally screened, after removal of duplicates and 10 trials (n = 8970) met inclusion criteria. No significant differences were found in treatment failure [RR = 1.07 (95% CI, 0.93-1.24), I2 = 3%] or relapse [RR = 1.04 (95% CI, 0.72-1.49), I2 = 0%]. Shorter regimens markedly reduced non-adherence [RR = 0.35 (95% CI, 0.24-0.50), I2 = 54%], the most consistent and clinically meaningful difference. Adverse events were comparable [RR = 0.71 (95% CI, 0.36-1.40), I2 = 81%]. CONCLUSIONS: Short-course therapy was not associated with significantly different treatment failure or relapse rates compared with longer regimens and was associated with substantially lower non-adherence. These findings support shorter antibiotic courses as a reasonable treatment option for non-severe pediatric CAP, while acknowledging that the present meta-analysis was not designed to formally establish non-inferiority or equivalence. WHAT IS KNOWN: • Short-course antibiotic therapy may achieve similar clinical outcomes to conventional longer courses in children with non-severe community-acquired pneumonia. • Medication adherence remains an important challenge in pediatric antibiotic therapy. WHAT IS NEW: • This meta-analysis found no significant difference in treatment failure or relapse between short- and long-course therapy. • Short-course therapy was associated with substantially lower non-adherence, highlighting an important practical advantage of shorter regimens.