Azithromycin Versus Doxycycline for the Treatment of Genital Chlamydia Infection: A Meta-analysis of Randomized Controlled Trials
Azithromycin Versus Doxycycline for the Treatment of Genital Chlamydia Infection: A Meta-analysis of Randomized Controlled Trials
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DOI：
10.1093/cid/ciu220
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发表时间：
2014-07-15
影响因子：
11.8
通讯作者：
Hocking, J. S.
中科院分区：
文献类型：
--
作者：
Kong, F. Y. S.;Tabrizi, S. N.;Hocking, J. S.
背景最近有争论质疑阿奇霉素治疗泌尿生殖道衣原体感染的疗效。我们进行了一项荟萃分析，比较1g阿奇霉素与100 mg强力霉素每日两次（7天）治疗泌尿生殖道衣原体感染的疗效。检索了Medline、PubMed、Embase、科克伦对照试验注册库、科克伦综述以及护理和相关健康文献累积索引，检索截止日期为2013年12月31日。随机对照试验比较阿奇霉素与多西环素治疗生殖器衣原体感染，评价治疗3个月内的微生物学治愈。提取性别、诊断试验、随访时间、损耗、患者症状状态和微生物学治愈。主要结局是最终随访时的疗效差异。研究偏倚进行了定量和定性总结。纳入了23项研究，分别评估了1147名和912名阿奇霉素和多西环素患者。我们发现支持多西环素的合并疗效差异为1.5%（95%置信区间[CI]，-0.1%至3.1%; I-2 = 1.9%; P = 0.435;随机效应）至2.6%（95% CI，0.5%-4.7%;固定效应）。亚组分析显示，有症状男性的固定效应合并疗效差异为7.4%（95%CI，2.0%-12.9%），随机效应为5.5%（95%CI，-1.4%至12.4%）。与阿奇霉素相比，多西环素治疗泌尿生殖道衣原体感染的疗效可能略有增加，最高可达3%，多西环素治疗男性症状性尿道感染的疗效增加约7%。然而，证据的质量差异很大，几乎没有进行双盲安慰剂对照试验。考虑到对潜在阿奇霉素失败的关注日益增加，需要进一步设计良好和具有统计学效力的双盲安慰剂对照试验。
Background. There has been recent debate questioning the efficacy of azithromycin for the treatment of urogenital chlamydia infection. We conducted a meta-analysis to compare the efficacy of 1 g azithromycin with 100 mg doxycycline twice daily (7 days) for the treatment of urogenital chlamydia infection.Methods. Medline, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane reviews, and Cumulative Index to Nursing and Allied Health Literature were searched until 31 December 2013. Randomized controlled trials comparing azithromycin with doxycycline for the treatment of genital chlamydia with evaluation of microbiological cure within 3 months of treatment were included. Sex, diagnostic test, follow-up time, attrition, patient symptomatic status, and microbiological cure were extracted. The primary outcome was the difference in efficacy at final follow-up. Study bias was quantitatively and qualitatively summarized.Results. Twenty-three studies were included evaluating 1147 and 912 patients for azithromycin and doxycycline, respectively. We found a pooled efficacy difference in favor of doxycycline of 1.5% (95% confidence interval [CI], -.1% to 3.1%; I-2 = 1.9%; P = .435; random effects) to 2.6% (95% CI,.5%-4.7%; fixed effects). Subgroup analyses showed that the fixed effects pooled efficacy difference for symptomatic men was 7.4% (95% CI, 2.0%-12.9%), and the random effects was 5.5% (95% CI, -1.4% to 12.4%).Conclusions. There may be a small increased efficacy of up to 3% for doxycycline compared with azithromycin for the treatment of urogenital chlamydia and about 7% increased efficacy for doxycycline for the treatment of symptomatic urethral infection in men. However, the quality of the evidence varies considerably, with few double-blind placebo-controlled trials conducted. Given increasing concern about potential azithromycin failure, further well-designed and statistically powered double-blind, placebo-controlled trials are needed.