中华皮肤科杂志 ›› 2018, Vol. 51 ›› Issue (9): 691-695.doi: 10.3760/cma.j.issn.0412-4030.2018.09.019
秦蓓1,刘全忠2
收稿日期:
2017-11-07
修回日期:
2018-03-27
出版日期:
2018-09-15
发布日期:
2018-08-30
通讯作者:
刘全忠
E-mail:liuquanzhong@medmail.com.cn
基金资助:
Qin-Bei 1,quanzhong liu
Received:
2017-11-07
Revised:
2018-03-27
Online:
2018-09-15
Published:
2018-08-30
Contact:
quanzhong liu
E-mail:liuquanzhong@medmail.com.cn
Supported by:
摘要: 目的 系统评价阿奇霉素与多西环素治疗生殖道沙眼衣原体感染的疗效。方法 计算机检索Cochrane图书馆、PubMed、EMBASE、CBMdisc、CNKI和万方数据库,搜索关于阿奇霉素与多西环素治疗生殖道沙眼衣原体感染的临床随机对照试验(RCT),以微生物学转阴作为判愈标准。治疗组采用阿奇霉素治疗,对照组采用多西环素治疗。检索时间为1980年1月1日至2017年10月。由两名研究者共同独立提取资料并评估纳入研究质量。采用 Stata?12.0软件对试验数据进行统计分析。结果 共纳入24篇文章,包括24个RCT、2 369例患者,阿奇霉素治疗组1 302例,多西环素治疗组1 067例。Meta分析结果显示,阿奇霉素与多西环素治疗生殖道沙眼衣原体感染的微生物学有效率差异有统计学意义。采用固定效应模型对数据合并分析后显示,多西环素有效率优于阿奇霉素,有效率差异为2.8%(95% CI,0.9% ~ 4.6%)。结论 阿奇霉素治疗生殖道沙眼衣原体感染后的微生物学有效率低于多西环素,但临床应用的确切疗效尚需更多的RCT证实。
秦蓓 刘全忠. 阿奇霉素与多西环素治疗生殖道沙眼衣原体感染疗效的Meta分析[J]. 中华皮肤科杂志, 2018, 51(9): 691-695.
Qin-Bei quanzhong liu. Efficacy of azithromycin versus doxycycline in the treatment of genital Chlamydia trachomatis infection: a meta-analysis[J]. Chinese Journal of Dermatology, 2018, 51(9): 691-695.
[1] | Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015[J]. MMWR Recomm Rep, 2015,64(RR⁃03):1⁃137.<br /> |
[2] | Walker J, Tabrizi SN, Fairley CK, et al. Chlamydia trachomatis incidence and re⁃infection among young women⁃⁃behavioural and microbiological characteristics[J]. PLoS One, 2012,7(5):e37778. doi: 10.1371/journal.pone.0037778.<br /> |
[3] | Scott LD, Baster K, Emmett L, et al. Incidence and reinfection rates of genital chlamydial infection among women aged 16⁃24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group[J]. Sex Transm Infect, 2007,83(4):292⁃303. doi: 10.1136/sti.2006.022053.<br /> |
[4] | Batteiger BE, Tu W, Ofner S, et al. Repeated Chlamydia trachomatis genital infections in adolescent women[J]. J Infect Dis, 2010,201(1):42⁃51. doi: 10.1086/648734.<br /> |
[5] | Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection[J]. N Engl J Med, 2005,352(7):676⁃685. doi: 10.1056/NEJMoa041681.<br /> |
[6] | Steingrimsson O, Olafsson JH, Thorarinsson H, et al. Azithromycin in the treatment of sexually transmitted disease[J]. J Antimicrob Chemother, 1990,25 Suppl A:109⁃114.<br /> |
[7] | Lassus A. Comparative studies of azithromycin in skin and soft⁃tissue infections and sexually transmitted infections by Neisseria and Chlamydia species[J]. J Antimicrob Chemother, 1990,25 Suppl A:115⁃121.<br /> |
[8] | Whatley JD, Thin RN, Mumtaz G, et al. Azithromycin vs doxy⁃cycline in the treatment of non⁃gonococcal urethritis[J]. Int J STD AIDS, 1991,2(4):248⁃251. doi: 10.1177/095646249100200404.<br /> |
[9] | Martin DH, Mroczkowski TF, Dalu ZA, et al. A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. The Azithromycin for Chlamydial Infections Study Group[J]. N Engl J Med, 1992,327(13):921⁃925. doi: 10.1056/NEJM199209243271304.<br /> |
[10] | Nilsen A, Halsos A, Johansen A, et al. A double blind study of single dose azithromycin and doxycycline in the treatment of chlamydial urethritis in males[J]. Genitourin Med, 1992,68(5):325⁃327.<br /> |
[11] | Ossewaarde JM, Plantema FH, Rieffe M, et al. Efficacy of single⁃dose azithromycin versus doxycycline in the treatment of cervical infections caused by Chlamydia trachomatis[J]. Eur J Clin Microbiol Infect Dis, 1992,11(8):693⁃697.<br /> |
[12] | Hammerschlag MR, Golden NH, Oh MK, et al. Single dose of azithromycin for the treatment of genital chlamydial infections in adolescents[J]. J Pediatr, 1993,122(6):961⁃965.<br /> |
[13] | Lister PJ, Balechandran T, Ridgway GL, et al. Comparison of azithromycin and doxycycline in the treatment of non⁃gonococcal urethritis in men[J]. J Antimicrob Chemother, 1993,31 Suppl E:185⁃192.<br /> |
[14] | Lauharanta J, Saarinen K, Mustonen MT, et al. Single⁃dose oral azithromycin versus seven⁃day doxycycline in the treatment of non⁃gonococcal urethritis in males[J]. J Antimicrob Chemother, 1993,31 Suppl E:177⁃183.<br /> |
[15] | Steingrímsson O, Olafsson JH, Thórarinsson H, et al. Single dose azithromycin treatment of gonorrhea and infections caused by C. trachomatis and U. urealyticum in men[J]. Sex Transm Dis, 1994,21(1):43⁃46.<br /> |
[16] | Horner M, Heller⁃Vitouch C, Ziegler C, et al. Azithromycin in the treatment of chlamydial cervicitis and urethritis[J]. Acta Dermatovenerol A.P.A, 1995,4,95(3):121⁃125.<br /> |
[17] | Stamm WE, Hicks CB, Martin DH, et al. Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men. A randomized double⁃blind study[J]. JAMA, 1995, 274(7): 545⁃549.<br /> |
[18] | Thorpe EM, Stamm WE, Hook EW, et al. Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises[J]. Genitourin Med, 1996,72(2):93⁃97.<br /> |
[19] | Gruber F, Tomic D, Brajac I. Comparative trial with azithromycin and doxycycline in gonococcal and chlamydial infections in females [J]. G Ital Dermatol Venereol,1996,131:403⁃406.<br /> |
[20] | Hillis SD, Coles FB, Litchfield B, et al. Doxycycline and azithromycin for prevention of chlamydial persistence or recurrence one month after treatment in women. A use⁃effectiveness study in public health settings[J]. Sex Transm Dis, 1998,25(1):5⁃11.<br /> |
[21] | Tan HH, Chan RK. An open label comparative study of azithromycin and doxycycline in the treatment of non⁃gonococcal urethritis in males and Chlamydia trachomatis cervicitis in female sex workers in an STD clinic in Singapore[J]. Singapore Med J, 1999,40(8):519⁃523.<br /> |
[22] | Sendag F, Terek C, Tuncay G, et al. Single dose oral azithromycin versus seven day doxycycline in the treatment of non⁃gonococcal mucopurulent endocervicitis[J]. Aust N Z J Obstet Gynaecol, 2000,40(1):44⁃47.<br /> |
[23] | Skerk V, Schönwald S, Strapac Z, et al. Duration of clinical symptoms in female patients with acute urethral syndrome caused by Chlamydia trachomatis treated with azithromycin or doxycycline[J]. J Chemother, 2001,13(2):176⁃181. doi: 10.1179/joc.2001.13.2.176.<br /> |
[24] | Rustomjee R, Kharsany AB, Connolly CA, et al. A randomized controlled trial of azithromycin versus doxycycline/ciprofloxacin for the syndromic management of sexually transmitted infections in a resource⁃poor setting[J]. J Antimicrob Chemother, 2002,49(5):875⁃878.<br /> |
[25] | Jang D, Sellors J, Howard M, et al. Correlation between culture testing of swabs and ligase chain reaction of first void urine from patients recently treated for Chlamydia trachomatis[J]. Sex Transm Infect, 2003,79(3):237⁃239.<br /> |
[26] | Guven MA, Gunyeli I, Dogan M, et al. The demographic and behavioural profile of women with cervicitis infected with Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum and the comparison of two medical regimens[J]. Arch Gynecol Obstet, 2005,272(3):197⁃200. doi: 10.1007/s00404⁃ 005⁃0734⁃2.<br /> |
[27] | Schwebke JR, Rompalo A, Taylor S, et al. Re⁃evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens⁃⁃a randomized clinical trial[J]. Clin Infect Dis, 2011,52(2):163⁃170. doi: 10.1093/cid/ciq074.<br /> |
[28] | Manhart LE, Gillespie CW, Lowens MS, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial[J]. Clin Infect Dis, 2013,56(7):934⁃942. doi: 10.1093/cid/cis1022.<br /> |
[29] | Geisler WM, Uniyal A, Lee JY, et al. Azithromycin versus doxy⁃cycline for urogenital Chlamydia trachomatis infection[J]. N Engl J Med, 2015,373(26):2512⁃2521. doi: 10.1056/NEJMoa1502599.<br /> |
[30] | Kong FY, Hocking JS. Treatment challenges for urogenital and anorectal Chlamydia trachomatis[J]. BMC Infect Dis, 2015,15:293. doi: 10.1186/s12879⁃015⁃1030⁃9.<br /> |
[31] | Parnham MJ, Erakovic HV, Giamarellos⁃Bourboulis EJ, et al. Azithromycin: mechanisms of action and their relevance for clinical applications[J]. Pharmacol Ther, 2014,143(2):225⁃245. doi: 10.1016/j.pharmthera.2014.03.003.<br /> |
[32] | Rank RG, Yeruva L. Hidden in plain sight: chlamydial gastrointestinal infection and its relevance to persistence in human genital infection[J]. Infect Immun, 2014,82(4):1362⁃1371. doi: 10.1128/IAI.01244⁃13.<br /> |
[33] | Heiligenberg M, Lutter R, Pajkrt D, et al. Effect of HIV and chlamydia infection on rectal inflammation and cytokine concentrations in men who have sex with men[J]. Clin Vaccine Immunol, 2013,20(10):1517⁃1523. doi: 10.1128/CVI.00763⁃12.<br /> |
[34] | Zheng S, Matzneller P, Zeitlinger M, et al. Development of a population pharmacokinetic model characterizing the tissue distribution of azithromycin in healthy subjects[J]. Antimicrob Agents Chemother, 2014,58(11):6675⁃6684. doi: 10.1128/AAC.02904⁃14.<br /> |
[35] | Vodstrcil LA, McIver R, Huston WM, et al. The Epidemiology of Chlamydia trachomatis organism load during genital infection: a systematic review[J]. J Infect Dis, 2015,211(10):1628⁃1645. doi: 10.1093/infdis/jiu670.<br /> |
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