A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis.
A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis.
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DOI：
10.1136/bmj.b1865
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发表时间：
2009-06-03
期刊：
影响因子：
--
通讯作者：
Bhutta ZA
中科院分区：
文献类型：
--
作者：
Thaver D;Zaidi AK;Critchley J;Azmatullah A;Madni SA;Bhutta ZA
目的回顾支持氟喹诺酮类药物作为治疗伤寒和副伤寒（肠热）一线药物的证据。设计随机对照试验的荟萃分析。数据来源：Cochrane传染病组专业登记，CENTRAL（2007年第4期），Medline (1966-2007), Embase (1974-2007)， LILACS(1982-2007)，精选会议，参考文献列表和正在进行的试验登记（2007年11月）。综述方法纳入了比较氟喹诺酮类药物与氯霉素、头孢菌素或阿奇霉素治疗经培养证实的肠热病的试验。两名审稿人提取数据并评估方法学质量。估计95%置信区间的比值比。招募超过60%儿童的试验与成人试验分开分析。研究的主要结果是临床失败、微生物学失败和复发。结果共纳入20项试验。试验规模小，而且通常方法质量有限。只有10个试验隐瞒了分配，只有3个是盲法试验。在成人试验中，氟喹诺酮类药物在临床失败（594名参与者）或微生物失败（n=378）方面与氯霉素没有显著差异，但减少了临床复发（优势比0.14(95%可信区间0.04至0.50),n= 467,6项试验）。阿奇霉素和氟喹诺酮类药物具有可比性（n=152, 2项试验）。与头孢曲松相比，氟喹诺酮类药物减少了临床失败（0.08 (0.01 ~ 0.45),n=120, 3项试验），但没有减少微生物失败或复发。与头孢克肟相比，氟喹诺酮类药物减少了临床失败（0.05 (0.01 ~ 0.24),n=238, 2项试验）和复发率（0.18 (0.03 ~ 0.91),n=218, 2项试验）。在耐钠地酸菌株感染儿童的试验中，较老的氟喹诺酮类药物（氧氟沙星）比阿奇霉素产生更多的临床失败（2.67 (1.16 ~ 6.11),n=125, 1项试验），但与较新的氟喹诺酮类药物（加替沙星，n=285, 1项试验）无差异。氟喹诺酮类药物与头孢克肟无显著差异（n=82, 1项试验）。结论氟喹诺酮类药物在预防成人临床复发方面可能优于氯霉素。其他比较的数据有限，特别是对儿童的比较。
Objectives To review evidence supporting use of fluoroquinolones as first line agents over other antibiotics for treating typhoid and paratyphoid fever (enteric fever). Design Meta-analysis of randomised controlled trials. Data sources Cochrane Infectious Diseases Group specialised register, CENTRAL (issue 4, 2007), Medline (1966-2007), Embase (1974-2007), LILACS (1982-2007), selected conferences, reference lists, and ongoing trial register (November 2007). Review methods Trials comparing fluoroquinolones with chloramphenicol, cephalosporins, or azithromycin in culture-proven enteric fever were included. Two reviewers extracted data and assessed methodological quality. Odds ratios with 95% confidence intervals were estimated. Trials recruiting over 60% children were analysed separately from trials on adults. Primary outcomes studied were clinical failure, microbiological failure, and relapse. Results Twenty trials were included. Trials were small and often of limited methodological quality. Only 10 trials concealed allocation and only three were blinded. In trials on adults, fluoroquinolones were not significantly different from chloramphenicol for clinical failure (594 participants) or microbiological failure (n=378), but reduced clinical relapse (odds ratio 0.14 (95% confidence interval 0.04 to 0.50), n=467, 6 trials). Azithromycin and fluoroquinolones were comparable (n=152, 2 trials). Compared with ceftriaxone, fluoroquinolones reduced clinical failure (0.08 (0.01 to 0.45), n=120, 3 trials) but not microbiological failure or relapse. Compared with cefixime, fluoroquinolones reduced clinical failure (0.05 (0.01 to 0.24), n=238, 2 trials) and relapse (0.18 (0.03 to 0.91), n=218, 2 trials). In trials on children infected with nalidixic acid resistant strains, older fluoroquinolones (ofloxacin) produced more clinical failures than azithromycin (2.67 (1.16 to 6.11), n=125, 1 trial), but there were no differences with newer fluoroquinolones (gatifloxacin, n=285, 1 trial). Fluoroquinolones and cefixime were not significantly different (n=82, 1 trial). Conclusions In adults, fluoroquinolones may be better than chloramphenicol for preventing clinical relapse. Data were limited for other comparisons, particularly for children.
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