Kong Fabian Yuh Shiong, Tabrizi Sepehr N, Fairley Christopher Kincaid, Vodstrcil Lenka A, Huston Wilhelmina M, Chen Marcus, Bradshaw Catriona, Hocking Jane S
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie St, Melbourne 3004, Australia
Murdoch Children's Research Institute, 50 Flemington Rd, Parkville 3052, Australia Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, 20 Flemington Road, Parkville 3052, Australia.
J Antimicrob Chemother. 2015 May;70(5):1290-7. doi: 10.1093/jac/dku574. Epub 2015 Jan 29.
There are increasing concerns about treatment failure following treatment for rectal chlamydia with 1 g of azithromycin. A systematic review and meta-analysis was conducted to investigate the efficacy of 1 g of azithromycin as a single dose or 100 mg of doxycycline twice daily for 7 days for the treatment of rectal chlamydia.
Medline, Embase, PubMed, Cochrane Controlled Trials Register, Australia New Zealand Clinical Trial Register and ClinicalTrials.gov were searched to the end of April 2014. Studies using 1 g of azithromycin or 7 days of doxycycline for the treatment of rectal chlamydia were eligible. Gender, diagnostic test, serovar, symptomatic status, other sexually transmitted infections, follow-up time, attrition and microbial cure were extracted. Meta-analysis was used to calculate pooled (i) azithromycin and doxycycline efficacy and (ii) efficacy difference.
All eight included studies were observational. The random-effects pooled efficacy for azithromycin (based on eight studies) was 82.9% (95% CI 76.0%-89.8%; I(2) = 71.0%; P < 0.01) and for doxycycline (based on five studies) was 99.6% (95% CI 98.6%-100%; I(2) = 0%; P = 0.571), resulting in a random-effects pooled efficacy difference (based on five studies) of 19.9% (95% CI 11.4%-28.3%; I(2) = 48.5%; P = 0.101) in favour of doxycycline.
The efficacy of single-dose azithromycin may be considerably lower than 1 week of doxycycline for treating rectal chlamydia. However, the available evidence is very poor. Robust randomized controlled trials are urgently required.
对于采用1克阿奇霉素治疗直肠衣原体感染后出现治疗失败的情况，人们越来越担忧。开展了一项系统评价和荟萃分析，以研究1克阿奇霉素单剂量给药或100毫克多西环素每日两次、连用7天治疗直肠衣原体感染的疗效。
检索了截至2014年4月底的Medline、Embase、PubMed、Cochrane对照试验注册库、澳大利亚和新西兰临床试验注册库以及ClinicalTrials.gov。纳入使用1克阿奇霉素或7天多西环素治疗直肠衣原体感染的研究。提取了性别、诊断检测、血清型、症状状态、其他性传播感染、随访时间、失访情况和微生物学治愈情况。采用荟萃分析计算合并的（i）阿奇霉素和多西环素疗效以及（ii）疗效差异。
纳入的8项研究均为观察性研究。阿奇霉素的随机效应合并疗效（基于8项研究）为82.9%（95%置信区间76.0%-89.8%；I² = 71.0%；P < 0.01），多西环素的随机效应合并疗效（基于5项研究）为99.6%（95%置信区间98.6%-100%；I² = 0%；P = 0.571），导致随机效应合并疗效差异（基于5项研究）为19.9%（95%置信区间11.4%-28.3%；I² = 48.5%；P = 0.101），多西环素更具优势。
单剂量阿奇霉素治疗直肠衣原体感染的疗效可能显著低于使用1周多西环素的疗效。然而，现有证据质量很差。迫切需要开展有力的随机对照试验。
