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儿童血源性骨髓炎的抗生素选择、给药途径及持续时间
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Abstract:
目的：针对儿童血源性骨髓炎(hematogenous osteomyelitis, HO)，最佳治疗方案仍然存在争议，包括抗生素的给药途径、使用疗程和种类选择，本研究将针对上述问题展开系统综述，为儿童血源性骨髓炎的抗生素应用提供建议。方法：对2013~2023年的随机对照试验、队列研究和病例对照研究进行系统综述。结果：我们纳入了18篇文献包括4项随机对照试验，6项队列研究、8项观察性研究；其中4项涉及抗生素使用时间，7项涉及抗生素的应用途径；6项涉及抗生素选择，1项讨论了静脉转为口服的时机。结论：应尽可能缩短静脉抗生素的疗程，提倡口服治疗是更有益的，静脉抗生素疗程推荐2~7天，口服疗程推荐16~20天，优点是更少的并发症、更短的住院时间以及治愈率的提高。对于金黄色葡萄球菌感染的患者抗生素首选β-内酰胺类抗生素(β-lactam, BL)，耐甲氧西林金黄色葡萄球(methicillin-resistant Staphylococcus aureus, MRSA)感染患者可采用克林霉素治疗，对于耐克林霉素者推荐采用多肽类抗生素。
Objective: The optimal treatment regimen for hematogenous osteomyelitis (HO) in children, including the choice of route of administration, periodicity, and type of antibiotics, remains controversial, and this study will provide a systematic review of the relevant literature with the expectation of providing recommendations for the use of antibiotics in HO in children. Methods: A systematic review of relevant literature from 2013~2023. Result: We included a total of 18 articles in our review, comprising 4 randomized controlled trials, 6 cohort studies, and 8 observational studies. Among these, 4 studies addressed the duration of antibiotic use, 7 studies examined the route of antibiotic administration, 6 studies focused on antibiotic selection, and 1 study discussed the timing of transitioning from intravenous to oral antibiotics. Conclusion: It is beneficial to minimize the duration of intravenous antibiotic therapy and advocate for oral treatment whenever possible. We recommend a course of 2~7 days for intravenous antibiotics and 16~20 days for oral antibiotics. This approach offers advantages such as fewer complications, shorter hospital stays, and improved cure rates. For patients with Staphylococcus aureus infections, β-lactam (BL) antibiotics (Recommended Benzocillin) are the preferred choice. For methicillin-resistant Staphylococcus aureus (MRSA) infections, treatment with clindamycin is recommended, and for those resistant to clindamycin, peptide antibiotics are recommended.
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