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Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis.

Abstract

BACKGROUND

People with cystic fibrosis, who are chronically colonised with the organism Pseudomonas aeruginosa, often require multiple courses of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations. The properties of aminoglycosides suggest that they could be given in higher doses less often.

OBJECTIVES

To assess the effectiveness and safety of once-daily versus multiple-daily dosing of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations in cystic fibrosis.

SEARCH STRATEGY

We searched the Cystic Fibrosis Specialist Register held at the Cochrane Cystic Fibrosis and Genetic Disorders Group's editorial base, comprising references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings.Date of the most recent search: August 2005.

SELECTION CRITERIA

All randomised controlled trials, whether published or unpublished, in which once-daily dosing of aminoglycosides has been compared with multiple-daily dosing in terms of efficacy and/or toxicity, in people with cystic fibrosis.

DATA COLLECTION AND ANALYSIS

The two authors independently selected the studies to be included in the review and assessed methodological quality of each study. Data were independently extracted by each author. Authors of the included studies were contacted for further information. As yet unpublished data were obtained for one of the included studies.

MAIN RESULTS

Eleven studies were identified for possible inclusion in the review. Four studies reporting results from a total of 328 participants were included in this review. All studies compared once-daily dosing with thrice-daily dosing. There was no significant difference between treatment groups in: forced expiratory volume at one second, weighted mean difference (WMD) 0.33 (95% confidence interval (CI) -2.81 to 3.48); forced vital capacity, WMD 0.29 (95% CI -6.58 to 7.16); % weight for height, WMD -0.82 (95% CI -3.77 to 2.13); body mass index, WMD 0.00 (95% CI -0.42 to 0.42); or in the incidence of ototoxicity, relative risk 0.56 (95% CI 0.04 to 7.96). The percentage change in creatinine significantly favoured once-daily treatment in children, WMD -8.20 (95% CI -15.32 to -1.08), but showed no difference in adults, WMD 3.25 (95% CI -1.82 to 8.33).

AUTHORS' CONCLUSIONS

Once and three times daily aminoglycoside antibiotics appear to be equally effective in the treatment of pulmonary exacerbations of cystic fibrosis. There is evidence of less nephrotoxicity in children.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Nottingham City Hospital, Department of Respiratory Medicine, Clinical Sciences Building, Hucknall Road, Nottingham, UK NG5 1PB. alan.smyth@nottingham.ac.uk

    Source

    MeSH

    Adolescent
    Adult
    Aminoglycosides
    Anti-Bacterial Agents
    Bacterial Infections
    Child
    Cystic Fibrosis
    Drug Administration Schedule
    Drug Therapy, Combination
    Female
    Forced Expiratory Volume
    Humans
    Injections, Intravenous
    Lung Diseases
    Male
    Randomized Controlled Trials as Topic
    Vital Capacity

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    16855982

    Citation

    Smyth, A R., and K H. Tan. "Once-daily Versus Multiple-daily Dosing With Intravenous Aminoglycosides for Cystic Fibrosis." The Cochrane Database of Systematic Reviews, 2006, p. CD002009.
    Smyth AR, Tan KH. Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis. Cochrane Database Syst Rev. 2006.
    Smyth, A. R., & Tan, K. H. (2006). Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis. The Cochrane Database of Systematic Reviews, (3), p. CD002009.
    Smyth AR, Tan KH. Once-daily Versus Multiple-daily Dosing With Intravenous Aminoglycosides for Cystic Fibrosis. Cochrane Database Syst Rev. 2006 Jul 19;(3)CD002009. PubMed PMID: 16855982.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis. AU - Smyth,A R, AU - Tan,K H, Y1 - 2006/07/19/ PY - 2006/7/21/pubmed PY - 2006/10/17/medline PY - 2006/7/21/entrez SP - CD002009 EP - CD002009 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: People with cystic fibrosis, who are chronically colonised with the organism Pseudomonas aeruginosa, often require multiple courses of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations. The properties of aminoglycosides suggest that they could be given in higher doses less often. OBJECTIVES: To assess the effectiveness and safety of once-daily versus multiple-daily dosing of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations in cystic fibrosis. SEARCH STRATEGY: We searched the Cystic Fibrosis Specialist Register held at the Cochrane Cystic Fibrosis and Genetic Disorders Group's editorial base, comprising references identified from comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings.Date of the most recent search: August 2005. SELECTION CRITERIA: All randomised controlled trials, whether published or unpublished, in which once-daily dosing of aminoglycosides has been compared with multiple-daily dosing in terms of efficacy and/or toxicity, in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS: The two authors independently selected the studies to be included in the review and assessed methodological quality of each study. Data were independently extracted by each author. Authors of the included studies were contacted for further information. As yet unpublished data were obtained for one of the included studies. MAIN RESULTS: Eleven studies were identified for possible inclusion in the review. Four studies reporting results from a total of 328 participants were included in this review. All studies compared once-daily dosing with thrice-daily dosing. There was no significant difference between treatment groups in: forced expiratory volume at one second, weighted mean difference (WMD) 0.33 (95% confidence interval (CI) -2.81 to 3.48); forced vital capacity, WMD 0.29 (95% CI -6.58 to 7.16); % weight for height, WMD -0.82 (95% CI -3.77 to 2.13); body mass index, WMD 0.00 (95% CI -0.42 to 0.42); or in the incidence of ototoxicity, relative risk 0.56 (95% CI 0.04 to 7.96). The percentage change in creatinine significantly favoured once-daily treatment in children, WMD -8.20 (95% CI -15.32 to -1.08), but showed no difference in adults, WMD 3.25 (95% CI -1.82 to 8.33). AUTHORS' CONCLUSIONS: Once and three times daily aminoglycoside antibiotics appear to be equally effective in the treatment of pulmonary exacerbations of cystic fibrosis. There is evidence of less nephrotoxicity in children. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/16855982/Once_daily_versus_multiple_daily_dosing_with_intravenous_aminoglycosides_for_cystic_fibrosis_ L2 - https://doi.org/10.1002/14651858.CD002009.pub2 DB - PRIME DP - Unbound Medicine ER -