Wee Ian, Lo Adeline, Rodrigo Chaturaka
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Trans R Soc Trop Med Hyg. 2017 Aug 1;111(8):336-344. doi: 10.1093/trstmh/trx066.
Scrub typhus, a potentially fatal infection caused by the pathogen Orientia tsutsugamushi, has a wide geographical distribution. This systematic review analyses the evidence from prospective controlled clinical studies for the efficacy of antibiotics in the treatment of scrub typhus. PubMed, Embase, Scopus, Cochrane Library, CINAHL and clinical trial registries in China, India and Sri Lanka were searched for controlled prospective clinical trials (randomized, quasi-randomized or non-randomized) enrolling patients with confirmed scrub typhus for treatment with antibiotics. The PROSPERO registration number for this review is CRD42017071374. Eleven studies (from Southeast Asia and China) that enrolled 957 patients into 28 study groups met the inclusion criteria. Doxycycline was the most frequent comparator with other antibiotics. Chloramphenicol, tetracycline and azithromycin (limited evidence for roxithromycin, telithromycin, levofloxacin and rifampicin) had equal efficacy to doxycycline in achieving clinical cure. The cure rates in all studies varied from 64 to 100%. Of the antibiotics frequently used in current practice, azithromycin had the best evidence compared with doxycycline for equal efficacy in clinical cure (three trials, 280 participants, moderate quality evidence) with fewer gastrointestinal adverse events. The preferred choice of antibiotics for each patient depends on the adverse effect profile, personal circumstances (e.g., age, pregnancy), cost and local prescription guidelines.
恙虫病是由恙虫病东方体病原体引起的一种潜在致命感染，具有广泛的地理分布。本系统评价分析了前瞻性对照临床研究中关于抗生素治疗恙虫病疗效的证据。检索了PubMed、Embase、Scopus、Cochrane图书馆、CINAHL以及中国、印度和斯里兰卡的临床试验注册库，以查找纳入确诊恙虫病患者并用抗生素治疗的对照前瞻性临床试验（随机、半随机或非随机）。本评价的PROSPERO注册号为CRD42017071374。11项研究（来自东南亚和中国）将957名患者纳入28个研究组，符合纳入标准。多西环素是与其他抗生素最常比较的药物。氯霉素、四环素和阿奇霉素（罗红霉素、泰利霉素、左氧氟沙星和利福平的证据有限）在实现临床治愈方面与多西环素疗效相当。所有研究中的治愈率从64%到100%不等。在当前实践中常用的抗生素中，与多西环素相比，阿奇霉素在临床治愈方面疗效相当（三项试验，280名参与者，中等质量证据）且胃肠道不良事件较少，证据最为充分。每位患者抗生素的首选取决于不良反应情况、个人情况（如年龄、妊娠）、成本和当地处方指南。
