Effectiveness and Safety of Short-Course vs Long-Course Antibiotic Therapy for Group A β-Hemolytic Streptococcal Tonsillopharyngitis: A Meta-analysis of Randomized Trials

2008 ◽  
Vol 83 (8) ◽  
pp. 880-889 ◽  
Author(s):  
Matthew E. Falagas ◽  
Evridiki K. Vouloumanou ◽  
Dimitrios K. Matthaiou ◽  
Anastasios M. Kapaskelis ◽  
Drosos E. Karageorgopoulos
Keyword(s):  
Antibiotic Therapy ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Short Course ◽  
Group A ◽  
Long Course

Effectiveness and Safety of Short-Course vs Long-Course Antibiotic Therapy for Group A β-Hemolytic Streptococcal Tonsillopharyngitis: A Meta-analysis of Randomized Trials

2008 ◽  
Vol 83 (8) ◽  
pp. 880-889 ◽  
Author(s):  
Matthew E. Falagas ◽  
Evridiki K. Vouloumanou ◽  
Dimitrios K. Matthaiou ◽  
Anastasios M. Kapaskelis ◽  
Drosos E. Karageorgopoulos
Keyword(s):  
Antibiotic Therapy ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Short Course ◽  
Group A ◽  
Long Course

scholarly journals Short- vs. Long-Course Antibiotic Treatment for Acute Streptococcal Pharyngitis: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 733
Author(s):  
Anna Engell Holm ◽  
Carl Llor ◽  
Lars Bjerrum ◽  
Gloria Cordoba
Keyword(s):  
Antibiotic Therapy ◽  
Randomized Controlled Trials ◽  
Antibiotic Treatment ◽  
Clinical Cure ◽  
Randomized Clinical Trials ◽  
Streptococcal Pharyngitis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Short Course ◽  
Long Course

BACKGROUND: To evaluate the effectiveness of short courses of antibiotic therapy for patients with acute streptococcal pharyngitis. METHODS: Randomized controlled trials comparing short-course antibiotic therapy (≤5 days) with long-course antibiotic therapy (≥7 days) for patients with streptococcal pharyngitis were included. Two primary outcomes: early clinical cure and early bacterial eradication. RESULTS: Fifty randomized clinical trials were included. Overall, short-course antibiotic treatment was as effective as long-course antibiotic treatment for early clinical cure (odds ratio (OR) 0.85; 95% confidence interval (CI) 0.79 to 1.15). Subgroup analysis showed that short-course penicillin was less effective for early clinical cure (OR 0.43; 95% CI, 0.23 to 0.82) and bacteriological eradication (OR 0.34; 95% CI, 0.19 to 0.61) in comparison to long-course penicillin. Short-course macrolides were equally effective, compared to long-course penicillin. Finally, short-course cephalosporin was more effective for early clinical cure (OR 1.48; 95% CI, 1.11 to 1.96) and early microbiological cure (OR 1.60; 95% CI, 1.13 to 2.27) in comparison to long-course penicillin. In total, 1211 (17.7%) participants assigned to short-course antibiotic therapy, and 893 (12.3%) cases assigned to long-course, developed adverse events (OR 1.35; 95% CI, 1.08 to 1.68). CONCLUSIONS: Macrolides and cephalosporins belong to the list of “Highest Priority Critically Important Antimicrobials”; hence, long-course penicillin V should remain as the first line antibiotic for the management of patients with streptococcal pharyngitis as far as the benefits of using these two types of antibiotics do not outweigh the harms of their unnecessary use.

scholarly journals 195. Duration of Therapy for Streptococcal Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S205-S205
Author(s):  
John M Boulos ◽  
Valeria Fabre ◽  
Kate Dzintars ◽  
Kate Dzintars ◽  
George Jones ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Hospital Readmission ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Multivariable Logistic Regression Analysis ◽  
Eligibility Criteria ◽  
Short Course ◽  
All Cause Mortality ◽  
Long Course

Abstract Background Shorter durations have shown similar clinical outcomes as longer durations for uncomplicated (source-controlled) Gram-negative bloodstream infections (BSI). There is limited data on the outcomes of patients with non-pneumococcal streptococcal BSI receiving shorter durations of therapy compared to usual durations. Methods This was a retrospective, multicenter study of adults hospitalized between January 2018 and March 2019 with ≥ 1 blood culture positive for Streptococcus spp. Exposed patients were those who received ≤ 10 days of antibiotics (i.e., short course therapy) and unexposed patients were those who received 11-21 days of antibiotics (i.e., prolonged course therapy). Patients were excluded if they had S. pneumoniae BSI, suspected contamination, did not receive or complete therapy, or treated for > 21 days. The primary outcome was a composite of recurrent bacteremia with the same pathogen, hospital readmission, or all-cause mortality, all within 30 days from completing therapy. The odds of achieving the primary outcome was compared between exposed and unexposed patients using multivariable logistic regression analysis. Results A total of 176 patients met eligibility criteria. 35 (20%) received a short course (median 8 days) and 141 (80%) received a prolonged course (median 15 days) of antibiotic therapy. Baseline characteristics were similar between short and long course groups. The most common pathogens were viridans group streptococci (22%) and S. agalactiae (23%). The most common BSI source was skin and soft tissue infection (SSTI) (40%). The primary outcome occurred in 26% (9/35) and 23% (33/141) of patients in the short course and prolonged course groups, respectively (p = 0.774). The proportion of patients in the short course and prolonged course groups who experienced recurrent BSI, hospital readmission, or all-cause mortality were also non-significant. After adjusting for receipt of an infectious diseases consult, Pitt bacteremia score, and SSTI source, the adjusted odds of meeting the composite outcome remained unchanged (aOR 1.41, 95% CI 0.55 – 3.61, p = 0.466). Table 1. Cohort Characteristics Table 2. Source/Microbiology Table 3. Outcomes Conclusion Approximately a week of antibiotic therapy may be associated with similar clinical outcomes as longer antibiotics courses in patients with uncomplicated streptococcal BSI. Disclosures Kate Dzintars, PharmD, Nothing to disclose Sara E. Cosgrove, MD, MS, Basilea (Individual(s) Involved: Self): Consultant Pranita Tamma, MD, MHS, Nothing to disclose

scholarly journals Do antibiotics decrease prostate-specific antigen levels and reduce the need for prostate biopsy in type IV prostatitis? A systematic literature review

2017 ◽  
Vol 12 (1) ◽  
pp. E25-30 ◽  
Author(s):  
Karel T. Buddingh ◽  
Marlies G.F. Maatje ◽  
Hein Putter ◽  
René F. Kropman ◽  
Rob C.M. Pelger
Keyword(s):  
Prostate Cancer ◽  
Antibiotic Therapy ◽  
Prostate Specific Antigen ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Specific Antigen ◽  
Inclusion Criteria ◽  
Prostate Biopsies ◽  
Type Iv ◽  
Significant Difference

Introduction: Inflammation of the prostate can be a cause of elevated prostate-specific antigen (PSA) in men referred for suspected prostate cancer. This systematic review assesses the evidence for antibiotic therapy in patients with type IV (asymptomatic) prostatitis with regard to reduction of PSA levels and discrimination between prostate cancer and inflammation.Methods: MEDLINE, EMBASE, and the Cochrane registry were searched for papers reporting on cohorts of men with elevated PSA and type IV prostatitis that were treated with antibiotics.Results: The search yielded 160 papers, of which 11 met the inclusion criteria: two randomized trials and nine cohort studies. In total, the studies reported on 1011 patients with type IV prostatitis, of whom 926 were treated with antibiotics. PSA normalization was seen after antibiotic treatment in 33.2% of patients (95% confidence interval [CI] 24.9‒42.8). Meta-analysis of the randomized trials did not demonstrate a higher likelihood of PSA normalization in the antibiotics arm as compared to the control arm (odds ratio [OR] 1.27; 95% CI 0.58–2.76; p=0.553). Four studies performed prostate biopsies in all patients. Although three of these studies demonstrated lower prevalence of prostate cancer in patients in whom PSA had normalized, meta-analysis failed to show a statistically significant difference (OR 0.39; 95% CI 0.06–2.49; p=0.319).Conclusions: The available evidence does not support antibiotic therapy for differentiation between benign and malignant cause of elevated PSA in men with type IV prostatitis.

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