The Use of Long-term Antibiotics for Suppression of Bacterial Infections.

IF 8.2 1区 医学 Q1 IMMUNOLOGY Clinical Infectious Diseases Pub Date : 2024-10-15 DOI:10.1093/cid/ciae302
Molly Horne, Ian Woolley, Jillian S Y Lau
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Abstract

Suppressive antibiotic therapy is prescribed when a patient has an infection that is presumed to be incurable by a defined course of therapy or source control. The cohort receiving suppressive antibiotic therapy is typically highly comorbid and the infections often involve retained prosthetic material. In part due to a lack of clear guidelines regarding the use of suppressive antibiotics, and in part due to the complex nature of the infections in question, patients are often prescribed suppressive antibiotics for extremely long, if not indefinite, courses. The risks of prolonged antibiotic exposure in this context are not fully characterized, but they include adverse drug effects ranging from mild to severe, the development of antibiotic-resistant organisms, and perturbations of the gastrointestinal microbiome. In this narrative review we present the available evidence for the use of suppressive antibiotic therapy in 4 common indications, examine the gaps in the current literature, and explore the known and potential risks of this therapy. We also make suggestions for improving the quality of evidence in future studies, particularly by highlighting the need for a standardized term to describe the use of long courses of antibiotics to suppress hard-to-treat infections.

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长期使用抗生素抑制细菌感染。
当患者的感染被假定为无法通过确定的疗程或病源控制治愈时,就会处方抑制性抗生素疗法。接受抑制性抗生素治疗的人群通常合并症较多,感染通常涉及残留的假体材料。部分由于缺乏明确的抑制性抗生素使用指南,部分由于相关感染的复杂性,患者通常会被处以极长甚至无限期的抑制性抗生素治疗。在这种情况下,长期接触抗生素的风险尚未完全定性,但其中包括轻微到严重的药物不良反应、耐抗生素生物的发展以及胃肠道微生物群的扰乱。在这篇叙述性综述中,我们介绍了在四种常见适应症中使用抑制性抗生素疗法的现有证据,研究了现有文献中的不足之处,并探讨了这种疗法的已知和潜在风险。我们还就如何提高未来研究的证据质量提出了建议,特别是强调需要一个标准化术语来描述使用长疗程抗生素抑制难治性感染的情况。
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来源期刊
Clinical Infectious Diseases
Clinical Infectious Diseases 医学-传染病学
CiteScore
25.00
自引率
2.50%
发文量
900
审稿时长
3 months
期刊介绍: Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.
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