Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
J Antimicrob Chemother. 2021 Nov 12;76(12):3103-3110. doi: 10.1093/jac/dkab335.
Chlamydia trachomatis infection is the most common sexually transmitted infectious disease and carries a risk of complications. However, the optimal treatment for rectal chlamydial infection remains unclear.
To compare the efficacy of doxycycline and azithromycin for the treatment of rectal chlamydia by undertaking a systematic review and meta-analysis of published data.
We searched PubMed, EMBASE, Cochrane Library, Web of Science and clinicaltrials.gov databases from inception to 7 July 2021 for randomized controlled trials (RCTs) and observational studies that compared the efficacy of doxycycline and single-dose azithromycin on rectal chlamydia cure rates. Data were synthesized using a random-effects model, and subgroup analysis was conducted.
All included studies were conducted in developed countries. Two RCTs and nine observational studies, with a total of 2457 patients, were analysed. Doxycycline had a higher microbiological cure rate than azithromycin (risk ratio = 1.21; 95% CI = 1.15-1.28; P < 0.05). Pooled results from two RCTs also revealed a higher microbiological cure rate for doxycycline than azithromycin (risk ratio = 1.27; 95% CI = 1.20-1.35; P < 0.05). The results remained consistent in subgroups of different study designs, countries and sexes.
On the basis of our findings, we recommend doxycycline rather than azithromycin as a first-line treatment for rectal chlamydia in developed countries. More RCTs from developing countries are warranted.
沙眼衣原体感染是最常见的性传播传染病，存在并发症风险。然而，直肠衣原体感染的最佳治疗方法仍不明确。
通过对已发表数据进行系统评价和荟萃分析，比较多西环素和阿奇霉素治疗直肠衣原体的疗效。
我们检索了 PubMed、EMBASE、Cochrane 图书馆、Web of Science 和 clinicaltrials.gov 数据库，检索时间从建库至 2021 年 7 月 7 日，纳入比较多西环素和单次剂量阿奇霉素治疗直肠衣原体治愈率的随机对照试验（RCT）和观察性研究。采用随机效应模型对数据进行综合分析，并进行亚组分析。
所有纳入的研究均在发达国家进行。分析了 2 项 RCT 和 9 项观察性研究，共纳入 2457 例患者。多西环素的微生物学治愈率高于阿奇霉素（风险比=1.21；95%CI=1.15-1.28；P<0.05）。来自 2 项 RCT 的汇总结果也显示，多西环素的微生物学治愈率高于阿奇霉素（风险比=1.27；95%CI=1.20-1.35；P<0.05）。不同研究设计、国家和性别的亚组分析结果一致。
基于我们的研究结果，建议在发达国家将多西环素而非阿奇霉素作为直肠衣原体感染的一线治疗药物。需要来自发展中国家的更多 RCT。
