Comparative Efficacy and Safety of Vancomycin versus Teicoplanin: Systematic Review and Meta-Analysis
Comparative Efficacy and Safety of Vancomycin versus Teicoplanin: Systematic Review and Meta-Analysis
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DOI：
10.1128/aac.00341-09
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发表时间：
2009-10-01
影响因子：
4.9
通讯作者：
Paul, Mical
中科院分区：
文献类型：
--
作者：
Svetitsky, Shuli;Leibovici, Leonard;Paul, Mical
万古霉素和替考拉宁是目前用于治疗由侵袭性β-内酰胺耐药革兰氏阳性细菌引起的感染的糖肽。我们对随机对照试验进行了系统回顾和荟萃分析，这些试验比较了系统应用万古霉素和替考拉宁治疗可疑或确诊感染的疗效。对没有年份、语言或出版状态限制的试验进行全面搜索。主要结果是全因死亡。两位评价者独立提取了数据。采用固定效应模型合并95%可信区间(CI)的风险比(RR)。共纳入24项试验。全因死亡率总体相似(RR，0.95；95%CI，0.74比1.21)，没有显著的异质性。在使用适当分配隐藏的试验中，结果有利于替考拉宁(RR，0.82；95%CI，0.63至1.06)，而在方法未知或隐藏不充分的试验中，结果有利于万古霉素(RR，3.61；95%CI，1.27至10.30)。后一项试验可能招募了更多病情严重的患者。没有其他变量影响死亡率的RRS，包括对经验性给药或证实感染、中性粒细胞减少、参与者的年龄和药物剂量的评估。替考拉宁和万古霉素在临床失败(RR，0.92；95%CI，0.81~1.05)、微生物失败(RR，1.24；95%CI，0.93~1.65)和其他疗效结果方面没有显著差异。临床失败的RR较低(倾向于替考拉宁)，偏倚风险较低，当由革兰氏阳性菌引起的感染开始治疗时，而不是经验性的。服用替考拉宁后，总的不良事件(RR，0.61；95%CI，0.50~0.74)、肾毒性(RR，0.44；95%CI，0.32~0.61)和红人综合征的发生率显著降低。替考拉宁在疗效方面不逊于万古霉素，且不良事件发生率低于万古霉素。
Vancomycin and teicoplanin are the glycopeptides currently in use for the treatment of infections caused by invasive beta-lactam-resistant gram-positive organisms. We conducted a systematic review and meta-analysis of randomized controlled trials that have compared vancomycin and teicoplanin administered systemically for the treatment of suspected or proven infections. A comprehensive search of trials without year, language, or publication status restrictions was performed. The primary outcome was all-cause mortality. Two reviewers independently extracted the data. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled by using the fixed-effect model ( RRs of > 1 favor vancomycin). Twenty-four trials were included. All-cause mortality was similar overall (RR, 0.95; 95% CI, 0.74 to 1.21), and there was no significant heterogeneity. In trials that used adequate allocation concealment, the results favored teicoplanin ( RR, 0.82; 95% CI, 0.63 to 1.06), while in trials with unknown methods or inadequate concealment, the results favored vancomycin ( RR, 3.61; 95% CI, 1.27 to 10.30). The latter trials might have recruited more severely ill patients. No other variable affected the RRs for mortality, including the assessment of glycopeptides administered empirically or for proven infections, neutropenia, the participant's age, and drug dosing. There were no significant differences between teicoplanin and vancomycin with regard to clinical failure ( RR, 0.92; 95% CI, 0.81 to 1.05), microbiological failure ( RR, 1.24; 95% CI, 0.93 to 1.65), and other efficacy outcomes. Lower RRs ( in favor of teicoplanin) for clinical failure were observed with a lower risk of bias and when treatment was initiated for infections caused by gram-positive organisms rather than empirically. Total adverse events ( RR, 0.61; 95% CI, 0.50 to 0.74), nephrotoxicity ( RR, 0.44; 95% CI, 0.32 to 0.61), and red man syndrome were significantly less frequent with teicoplanin. Teicoplanin is not inferior to vancomycin with regard to efficacy and is associated with a lower adverse event rate than vancomycin.