Godfred-Cato Shana, Cooley Katharine M, Fleck-Derderian Shannon, Becksted Heidi A, Russell Zachary, Meaney-Delman Dana, Mead Paul S, Nelson Christina A
Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Synergy America, contracting agency for Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA.
Clin Infect Dis. 2020 May 21;70(70 Suppl 1):S11-S19. doi: 10.1093/cid/ciz1230.
Plague, caused by the bacterium Yersinia pestis, has killed millions in historic pandemics and continues to cause sporadic outbreaks. Numerous antimicrobials are considered effective for treating plague; however, well-defined information on the relative efficacy of various treatments is lacking. We conducted a systematic review of published data on antimicrobial treatment of plague reported in aggregate.
We searched databases including Embase, Medline, CINAHL, Cochrane Library, and others for publications with terms related to plague and antimicrobials. Articles were included if they contained 1) a group of patients treated for plague, with outcomes reported by antimicrobial regimen, and 2) laboratory evidence of Y. pestis infection or an epidemiologic link to patients with laboratory evidence of Y. pestis. Case fatality rate by antimicrobial regimen was calculated.
In total, 5837 articles were identified; among these, 26 articles published between 1939 and 2008 met inclusion criteria. A total of 2631 cases of human plague reported within these articles were included. Among cases classified by primary clinical form of plague, 93.6% were bubonic, 5.9% pneumonic, and 0.5% septicemic with associated case fatalities of 14.2%, 31.1%, and 20.0%, respectively. Case fatality rate among patients who received monotherapy with tetracyclines, chloramphenicol, aminoglycosides, or sulfonamides was 1.3%, 1.4%, 7.5%, and 20.2%, respectively. Fluoroquinolones were only given as part of combination therapy. Penicillin was associated with a case fatality rate of 75%.
Tetracyclines, chloramphenicol, and aminoglycosides were associated with the lowest case fatality rates of all antimicrobials used for treatment of plague. Additional research is needed to determine the efficacy of fluoroquinolones as monotherapy.
由鼠疫耶尔森菌引起的鼠疫在历史上的大流行中导致数百万人死亡，并且仍在引发散发性疫情。许多抗菌药物被认为对治疗鼠疫有效；然而，关于各种治疗方法相对疗效的明确信息却很缺乏。我们对汇总报道的鼠疫抗菌治疗的已发表数据进行了系统评价。
我们在包括Embase、Medline、CINAHL、Cochrane图书馆等在内的数据库中搜索与鼠疫和抗菌药物相关术语的出版物。如果文章包含以下内容则被纳入：1）一组接受鼠疫治疗的患者，并按抗菌治疗方案报告结果；2）鼠疫耶尔森菌感染的实验室证据或与有鼠疫耶尔森菌实验室证据患者的流行病学联系。计算各抗菌治疗方案的病死率。
总共识别出5837篇文章；其中，1939年至2008年发表的26篇文章符合纳入标准。这些文章中共纳入2631例人类鼠疫病例。在按鼠疫主要临床类型分类的病例中，93.6%为腺鼠疫，5.9%为肺鼠疫，0.5%为败血症型鼠疫，相关病死率分别为14.2%、31.1%和20.0%。接受四环素、氯霉素、氨基糖苷类或磺胺类单药治疗的患者病死率分别为1.3%、1.4%、7.5%和20.2%。氟喹诺酮类仅作为联合治疗的一部分使用。青霉素的病死率为75%。
四环素、氯霉素和氨基糖苷类在用于治疗鼠疫的所有抗菌药物中病死率最低。需要进一步研究以确定氟喹诺酮类作为单药治疗的疗效。
