Timing of Antibiotic Therapy for Neisseria Gonorrhoeae Infection
Notice bibliographique
Résumé
What Is the Issue? Gonorrhea is the second most prevalent sexually transmitted infection in Canada. It is caused by Neisseria gonorrhoeae and can be treated with antibiotic therapy. However, gonorrhoeae has developed antibiotic resistance, which may decrease the efficacy of current therapy. Antibiotic therapy can be administered after a positive gonorrhoeae test, but the turnaround time of laboratory testing may result in patients being lost to follow-up (i.e., not returning to the clinic after test results are available). Presumptive or empiric antibiotic therapy can be given before the laboratory confirmation of gonorrhoeae to individuals at high risk of gonorrhea or those with uncertain follow-up; however, such treatment may lead to overtreating those without N. gonorrhoeae, increasing the risk of antibiotic resistance and possible side effects to the individuals. It is important to understand the ideal timing of antibiotic therapy that balances concerns of antibiotic resistance and timely patient care. What Did We Do? To inform decisions about timing of antibiotic therapy for the treatment of adults and adolescents with suspected uncomplicated gonorrhoeae infection, CADTH sought to identify and summarize literature comparing the clinical effectiveness and safety of delaying antibiotic therapy until confirmatory results of testing for N. gonorrhoeae infection are available, versus empiric treatment before test results are available. A research information specialist conducted a literature search of the peer-reviewed and grey literature published since January 1, 2013. What Did We Find? We did not find any studies directly evaluating the clinical effectiveness and safety of delayed antibiotic treatment compared to presumptive treatment for uncomplicated gonorrhoeae infections in adult and adolescent populations. We included 2 nonrandomized studies that compared the rates of accurate treatment and overtreatment in individuals who received presumptive treatment and those who did not. In the 2 studies, gonorrhoeae test positivity rates in the presumptive treatment group were less than 50%, suggesting that less than half of the patients in this group received accurate presumptive treatment. We also found high overtreatment rates, which were up to 90% in the included studies. The certainty of these findings is very low due to methodological limitations of the included studies. We also identified 5 single-arm studies that evaluated these outcomes in individuals who received presumptive therapy. The findings are generally consistent with the 2 included studies. What Does It Mean? Available evidence points to high rates of overtreatment when presumptive antibiotics are given. Results also suggest that there is value in clinical assessment in detecting gonorrhoeae infections. The downstream clinical effectiveness implications of these results for antimicrobial resistance or increasing spread of N. gonorrhoeae are unclear. Contextual factors, such as the local prevalence of gonorrhoeae infection and potential barriers to care that could hinder post-test follow-up for certain individuals or groups, may also be useful considerations when making decisions about appropriate timing for N. gonorrhoeae antibiotic therapy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,053 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,003 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».