环丙沙星与氨基糖苷类药物联合β-内酰胺类药物治疗发热性中性粒细胞减少症的疗效比较：一项随机对照试验的荟萃分析

Ciprofloxacin vs an aminoglycoside in combination with a beta-lactam for the treatment of febrile neutropenia: a meta-analysis of randomized controlled trials.

作者信息

Bliziotis Ioannis A, Michalopoulos Argyris, Kasiakou Sofia K, Samonis George, Christodoulou Christos, Chrysanthopoulou Stavroula, Falagas Matthew E

机构信息

Alfa Institute of Biomedical Sciences, Athens, Greece.

出版信息

Mayo Clin Proc. 2005 Sep;80(9):1146-56. doi: 10.4065/80.9.1146.

DOI:10.4065/80.9.1146

PMID:16178494

Abstract

OBJECTIVE

To compare the effectiveness and toxicity of ciprofloxacin vs an aminoglycoside, both in combination with a beta-lactam, for the treatment of febrile neutropenia in the inpatient setting.

METHODS

For this meta-analysis of randomized controlled trials (RCTs) that compared the ciprofloxacin/beta-lactam combination vs an aminoglycoside/beta-lactam combination for the treatment of febrile neutropenia and reported data on effectiveness, mortality, and/or toxicity, we searched PubMed (1950-2004), Current Contents, Cochrane Central Register of Controlled Trials, and reference lists of retrieved articles, including review articles, as well as abstracts presented at international conferences. Data for 3 primary and 2 secondary outcomes were extracted by 2 investigators.

RESULTS

Eight RCTs were included in the analysis. Comparable or better outcomes were observed with the ciprofloxacin/beta-lactam combination vs an aminoglycoside/beta-lactam combination: clinical cure without modification of the initial regimen (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.00-1.74; P=.05), clinical cure in the subset of patients with documented Infections (OR, 1.56; 95% CI, 1.05-2.31; P=.03), all-cause mortality (OR, 0.85; 95% CI, 0.54-1.35; P=.49), withdrawal of the study drugs due to toxicity (OR, 0.87; 95% CI, 0.57-1.32; P-.51), and nephrotoxicity (OR, 0.30; 95% CI, 0.16-0.59; P<.001). The ciprofloxacin/beta-lactam combination was also associated with better clinical cure compared to the aminoglycoside/beta-actam combination in the subset of RCTs with non-low-risk patients (OR, 1.38; 95% CI, 1.01-1.88; P=-.04), as well as in the subset of studies that included the same beta-lactam in both treatment arms (OR, 1.47; 95% CI, 1.06-2.05; P=.02).

CONCLUSION

The combination of ciprofloxacin with a beta-actam antibiotic should be considered an important therapeutic option in hospitalized febrile neutropenic patients who have not received a quinolone for prevention of infections and in settings in which quinolone resistance is not common.

摘要

目的

比较环丙沙星与氨基糖苷类药物（均与β-内酰胺类药物联合使用）在住院环境中治疗发热性中性粒细胞减少症的有效性和毒性。

方法

对于这项比较环丙沙星/β-内酰胺类药物联合与氨基糖苷类/β-内酰胺类药物联合治疗发热性中性粒细胞减少症并报告有效性、死亡率和/或毒性数据的随机对照试验（RCT）的荟萃分析，我们检索了PubMed（1950 - 2004年）、《现刊目次》、Cochrane对照试验中心注册库以及检索到的文章的参考文献列表，包括综述文章，以及在国际会议上发表的摘要。两名研究人员提取了3个主要结局和2个次要结局的数据。

结果

分析纳入了8项RCT。与氨基糖苷类/β-内酰胺类药物联合相比，环丙沙星/β-内酰胺类药物联合观察到了相当或更好的结局：无需调整初始治疗方案的临床治愈（优势比[OR]，1.32；95%置信区间[CI]，1.00 - 1.74；P = 0.05），有记录感染患者亚组的临床治愈（OR，1.56；95% CI，1.05 - 2.31；P = 0.03），全因死亡率（OR，0.85；95% CI，0.54 - 1.35；P = 0.49），因毒性而停用研究药物（OR，0.87；95% CI，0.57 - 1.32；P = 0.51），以及肾毒性（OR，0.30；95% CI，0.16 - 0.59；P < 0.001）。在非低风险患者的RCT亚组中（OR，1.38；95% CI，1.01 - 1.88；P = 0.04），以及在两个治疗组均包含相同β-内酰胺类药物的研究亚组中（OR，1.47；95% CI，1.06 - 2.05；P = 0.02），与氨基糖苷类/β-内酰胺类药物联合相比，环丙沙星/β-内酰胺类药物联合也与更好的临床治愈相关。