A systematic review and meta-analysis of the efficacy and safety of N-acetylcysteine in preventing aminoglycoside-induced ototoxicity: implications for the treatment of multidrug-resistant TB
A systematic review and meta-analysis of the efficacy and safety of N-acetylcysteine in preventing aminoglycoside-induced ototoxicity: implications for the treatment of multidrug-resistant TB
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DOI：
10.1136/thoraxjnl-2015-207245
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发表时间：
2015-11-01
期刊：
影响因子：
10
通讯作者：
Drobniewski, Francis
中科院分区：
文献类型：
--
作者：
Kranzer, Katharina;Elamin, Wael F.;Drobniewski, Francis
背景：耳毒性是氨基糖苷类抗生素的严重副作用。氨基糖苷类被推荐用于治疗耐多药结核病（MDR-TB）。N-乙酰半胱氨酸（NAC）似乎可以防止药物和噪音引起的听力损失。这篇综述旨在确定是否共同管理NAC与氨基糖苷类药物影响耳毒性发展，并评估长期NAC administration.Methods的安全性和耐受性合格的研究报告的疗效伴随NAC和氨基糖苷类药物管理的耳毒性预防或长期（>= 6周）管理的NAC，无论适应症。使用固定效应模型计算合并估计值。Heteroadministration进行了评估，使用I-2 statistics.Results三项研究报道，NAC减少了146例终末期肾功能衰竭患者接受氨基糖苷类药物的耳毒性。4-6周时耳保护的合并相对风险为0.14（95% CI 0.05至0.45），风险差异为-33.3%（95% CI 45.5%至21.2%）。83项研究（N=9988）描述了NAC给药>6周。腹痛，恶心和呕吐，腹泻和关节痛增加1.4-2.2倍。Discussion这篇综述提供了证据的安全性和otoprotective效果的NAC时，共同管理与氨基糖苷类。这为临床试验提供了强有力的理由，以研究在接受氨基糖苷类药物作为耐多药结核治疗的一部分的患者中伴随NAC治疗的效果。
Background Ototoxicity is a severe side effect of aminoglycoside antibiotics. Aminoglycosides are recommended for the treatment of multidrug-resistant TB (MDR-TB). N-Acetylcysteine (NAC) appears to protect against drug-and noise-induced hearing loss. This review aimed to determine if coadministering NAC with aminoglycoside affected ototoxicity development, and to assess the safety and tolerability of prolonged NAC administration.Methods Eligible studies reported on the efficacy of concomitant NAC and aminoglycoside administration for ototoxicity prevention or long-term (>= 6 weeks) administration of NAC regardless of indication. Pooled estimates were calculated using a fixed-effects model. Heterogeneity was assessed using the I-2 statistic.Results Three studies reported that NAC reduced ototoxicity in 146 patients with end-stage renal failure receiving aminoglycosides. Pooled relative risk for otoprotection at 4-6 weeks was 0.14 (95% CI 0.05 to 0.45), and the risk difference was -33.3% (95% CI 45.5% to 21.2%). Eighty-three studies (N=9988) described the administration of NAC for >6 weeks. Abdominal pain, nausea and vomiting, diarrhoea and arthralgia were increased 1.4-2.2 times.Discussion This review provides evidence for the safety and otoprotective effect of NAC when coadministered with aminoglycoside. It represents a strong justification for a clinical trial to investigate the effect of concomitant NAC treatment in patients receiving aminoglycosides as part of MDR-TB treatment.