Compliance with Once-Daily versus Twice or Thrice-Daily Administration of Antibiotic Regimens: A Meta-Analysis of Randomized Controlled Trials

<div><p>Objective</p><p>To investigate whether compliance of patients to antibiotic treatment is better when antibiotics are administered once than multiple times daily.</p><p>Methods</p><p>We performed a systematic search in PubMed and Scopus databases. Only randomized controlled trials were considered eligible for inclusion. Compliance to antibiotic treatment was the outcome of the meta-analysis.</p><p>Results</p><p>Twenty-six studies including 8246 patients with upper respiratory tract infections in the vast majority met the inclusion criteria. In total, higher compliance was found among patients treated with once-daily treatment than those receiving treatment twice, thrice or four times daily [5011 patients, RR=1.22 (95% CI, 1.11, 1.34]. Adults receiving an antibiotic once-daily were more compliant than those receiving the same antibiotic multiple times daily [380 patients, RR=1.09 (95% CI, 1.02, 1.16)]. Likewise, children that received an antibiotic twice-daily were more compliant than those receiving the same antibiotic thrice-daily [2118 patients, RR=1.10 (95% CI, 1.02, 1.19)]. Higher compliance was also found among patients receiving an antibiotic once compared to those receiving an antibiotic of different class thrice or four times daily [395 patients, RR=1.20 (95% CI, 1.12, 1.28)]. The finding of better compliance with lower frequency daily was consistent regardless of the study design, and treatment duration.</p><p>Conclusion</p><p>This meta-analysis showed that compliance to antibiotic treatment might be associated with higher when an antibiotic is administered once than multiple times daily for the treatment of specific infections and for specific classes of antibiotics. </p></div

Forest plot depicting the risk ratios (RR) of compliance of patients receiving antibiotic treatment once-daily versus multiple times daily.

<p><i>(Vertical line = “no difference” point between the two regimens. Squares = risk ratios; Diamonds = pooled risk ratios for all studies. Horizontal lines = 95% CI)</i>.</p

Forest plot depicting the risk ratios (RR) of compliance of patients receiving antibiotic treatment twice-daily versus thrice or four times daily.

<p>Forest plot depicting the risk ratios (RR) of compliance of patients receiving antibiotic treatment twice-daily versus thrice or four times daily.</p

Flow diagram of the systematic search and study selection process.

<p>Flow diagram of the systematic search and study selection process.</p

Forest plot depicting the risk ratios (RR) of compliance of patients receiving an antibiotic once-daily versus an antibiotic of the same broad class thrice-daily.

<p>Forest plot depicting the risk ratios (RR) of compliance of patients receiving an antibiotic once-daily versus an antibiotic of the same broad class thrice-daily.</p

Forest plot depicting the risk ratios (RR) of compliance of patients receiving an antibiotic once-daily versus an antibiotic of different class thrice or four times daily.

<p>Forest plot depicting the risk ratios (RR) of compliance of patients receiving an antibiotic once-daily versus an antibiotic of different class thrice or four times daily.</p

Forest plot depicting the risk ratios (RR) of compliance of patients receiving an antibiotic twice-daily versus the same antibiotic or antibiotic of the same class thrice-daily.

<p>Forest plot depicting the risk ratios (RR) of compliance of patients receiving an antibiotic twice-daily versus the same antibiotic or antibiotic of the same class thrice-daily.</p

Zebrafish MCH receptor mRNA expression and regulation by intestinal inflammation.

<div><p>A) Relative expression of zebrafish MCHR1b and MCHR2 in brain and the intestine.</p> <p>B) Expression of intestinal MCHR1b and MCHR2 mRNA following treatment with TNBS or vehicle (n=9-10 fish per group). Values in the vehicle treatment group are set to 100.</p> <p>AU: arbitrary units.</p></div

Adult zebrafish are susceptible to TNBS-induced enterocolitis.

<p>Kaplan-Meier survival analysis in response to different concentrations of TNBS (40mM-320mM). TNBS was administered by intrarectal infusion and doses were adjusted for body weight to a volume of 1 uL/0.1 g of body weight. Fish were monitored for a total of 96 hours in 6-12 hour intervals. For each TNBS dose, 13-14 fish per group were assigned to TNBS or vehicle (30% ethanol) treatments. </p

Relative mRNA expression of various cytokines in the intestine of zebrafish with TNBS-induced enterocolitis, at 6 hours post-exposure (n=9-10 fish per group).

<p>For each gene, expression in the vehicle treated group was set to 100. AU=arbitrary units.</p