Fang Yirong, Huang Zhaohui, Tu Chunyu, Zhang Lijie, Ye Dongqing, Zhu Bao-Ping
School of Public Health, Anhui Medical University, China.
Intern Med. 2012;51(17):2313-20. doi: 10.2169/internalmedicine.51.7816. Epub 2012 Sep 1.
Scrub typhus is an important febrile disease in Asia, and antibiotics have been used to treat this disease. The purpose of this study was to generate large-scale evidence of the efficacy of different antibiotic regimens for treating scrub typhus using a meta-analysis.
PubMed, Elsevier ScienceDirect, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to identify relevant articles. The data from eligible citations were extracted by two reviewers. All analyses were performed using the Cochrane Collaboration Review Manager 4.2 and Stata 10.0 software programs.
We conducted a meta-analysis of 17 separate studies that evaluated the efficacy of treatment with the different antibiotic regimens for scrub typhus. The median time (h) to clearance of fever in the azithromycin-treated group was longer than that in the chloramphenicol-treated group (weighted mean difference [WMD] = 12.66, 95% confidence interval [CI]: 2.26,23.06). Adverse events were 2.95 (95%CI: 1.32, 6.61) times more likely to occur in the azithromycin-treated group than in the chloramphenicol-treated group. The clearance time (days) for the main symptoms (including fever, headache, rash and lymphadenectasis) in the doxycycline-treated group was shorter than that in the chloramphenicol-treated group (WMD = -0.4, 95%CI: -0.53, -0.26) in five trials. Adverse drug events occurred significantly less frequently in the azithromycin-treated group than in the doxycycline-treated group (relative risk [RR] = 0.47, 95%CI: 0.31,0.71).
Doxycycline was found to act more quickly, but more adverse drug events occur when using this regimen compared to azithromycin and chloramphenicol.
恙虫病是亚洲一种重要的发热性疾病，抗生素已被用于治疗该病。本研究的目的是通过荟萃分析得出不同抗生素方案治疗恙虫病疗效的大规模证据。
检索了PubMed、爱思唯尔科学Direct、中国生物医学文献数据库（CBM）、中国知网（CNKI）和万方（中文）以识别相关文章。两名评审员提取符合条件的文献数据。所有分析均使用Cochrane协作网Review Manager 4.2和Stata 10.0软件程序进行。
我们对17项单独研究进行了荟萃分析，这些研究评估了不同抗生素方案治疗恙虫病的疗效。阿奇霉素治疗组发热消退的中位时间（小时）长于氯霉素治疗组（加权平均差[WMD]=12.66，95%置信区间[CI]：2.26，23.06）。阿奇霉素治疗组发生不良事件的可能性是氯霉素治疗组的2.95倍（95%CI：1.32，6.61）。在五项试验中，多西环素治疗组主要症状（包括发热、头痛、皮疹和淋巴结肿大）的消退时间（天）短于氯霉素治疗组（WMD=-0.4，95%CI：-0.53，-0.26）。阿奇霉素治疗组药物不良事件的发生频率显著低于多西环素治疗组（相对危险度[RR]=0.47，95%CI：0.31，0.71）。
发现多西环素起效更快，但与阿奇霉素和氯霉素相比，使用该方案时发生的药物不良事件更多。
