高剂量和低剂量 ceftriaxone疗法的比较有效性:系统性审查和元分析
Lindsay Brust-Sisti1,2, Gwang-Yee Hu1,3, Matthew Bridgeman4
1Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
The Annals of pharmacotherapy
|August 28, 2025
概括
静脉注射较高剂量的 ceftriaxone 没有改善非中枢神经系统感染的临床治愈,住院时间或死亡率. 这一元分析表明,标准的1g剂量对于许多成年患者来说可能足够.
科学领域:
- 传染性疾病
- 药理学
- 临床药房
背景情况:
- 塞夫特里亚 (Ceftriaxone,CRO) 是一种广泛使用的第三代类抗生素.
- 对非中枢神经系统 (CNS) 感染的最佳剂量仍然是临床辩论的主题.
- 目前的剂量建议有所不同,一些临床医生选择每天静脉注射1g以上的剂量.
研究的目的:
- 系统地比较标准的1g每日IV ceftriaxone与治疗成人非中枢神经系统感染的更高剂量的疗效和安全性.
- 评估不同剂量方案对临床治愈率,住院时间和死亡率的影响.
- 与标准剂量相比,评估与较高剂量的 ceftriaxone 相关的安全性和毒性.
主要方法:
- 在PubMed,Embase,Scopus和Web of Science数据库中进行了全面的文献搜索.
- 包括的研究是随机对照试验 (RCT) 和观察性研究,比较每天1g的CEFTRIAXONE与更高剂量.
- 分析使用了Mantle- Haenszel随机效应模型来计算Peto概率 (pOR) 和临床治愈,停留时间和死亡率的标准差异.
主要成果:
- 在分析中包括了8项涉及5145名患者的研究.
- 在标准剂量和较高剂量的 ceftriaxone 之间,没有观察到临床治愈 (pOR 0. 958; 95% CI [0. 525- 1. 749]),住院时间 (SMD 0. 052; 95% CI [- 0. 418, 0. 523]) 或死亡率 (pOR 0. 932; 95% CI [- 0. 789- 1. 100]) 的统计学显著差异.
- 在临床治愈和停留时间方面发现了显著的异质性,这表明包括的研究之间存在差异.
结论:
- 在成人非中枢神经系统感染中,每天超过1g的塞夫特里克松剂量并没有改善临床治愈,减少住院时间或降低死亡率.
- 这些发现表明,在许多非中枢神经系统感染中,标准每日1g的IV剂量可能足以达到有效性和安全性.
- 建议进行进一步的前性研究,以证实这些发现,并探讨在特定患者群体或感染类型中最佳的剂量,其中改变的药理动力学可能是因素.
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