UCL Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom.
Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
PLoS One. 2022 Jul 29;17(7):e0272043. doi: 10.1371/journal.pone.0272043. eCollection 2022.
Chronic carriage of S. Typhi or S. Paratyphi is an important source of enteric fever transmission. Existing guidance and treatment options for this condition are limited. This systematic review aims to assess the evidence concerning the efficacy of different antimicrobials in treating enteric fever chronic carriage.
We searched major bibliographic databases using relevant keywords between 1946 and September 2021. We included all interventional studies that included patients with confirmed enteric fever chronic carriage and deployed an antimicrobial that remains in clinical practice today. Case reports and case series of under 10 patients were excluded. Two reviewers screened abstracts, selected articles for final inclusion and quality-assessed the included studies for risk of bias. Extracted data was analysed, with pooling of data and eradication rates for each antimicrobial calculated. As only one randomised controlled trial was identified, no meta-analysis was performed.
Of the 593 papers identified by the initial search, a total of eight studies met the inclusion criteria and were included in the systematic review. Evidence was identified for the use of fluoroquinolones and amoxicillin/ampicillin in the treatment for enteric fever chronic carriage. Fluoroquinolones were superior to amoxicillin/ampicillin with 92% of patients achieving eradication after one antimicrobial course compared to 68% (p = 0.02). The quality of included studies was poor, and all were carried out before 1990.
This review identified fluoroquinolones and amoxicillin/ampicillin as treatment options for enteric fever chronic carriage, with fluoroquinolones the more effective option. However, this evidence pre-dates rises in antimicrobial resistance in enteric fever and therefore the significance of these findings to today's practice is unclear. Further research is needed to investigate whether these antimicrobials remain appropriate treatment options or whether alternative interventions are more effective.
慢性携带伤寒或副伤寒沙门氏菌是肠热病传播的一个重要来源。针对这种情况，现有的指导和治疗方案有限。本系统评价旨在评估不同抗生素治疗肠热病慢性携带的疗效证据。
我们使用相关关键字在 1946 年至 2021 年 9 月期间在主要文献数据库中进行了搜索。我们纳入了所有包含确诊为肠热病慢性携带且使用当今仍在临床应用的抗生素的干预性研究。排除了病例报告和少于 10 例的病例系列。两名审查员筛选了摘要，选择了最终纳入的文章，并对纳入研究进行了质量评估以确定偏倚风险。提取的数据进行了分析，计算了每种抗生素的药物清除率。由于仅确定了一项随机对照试验，因此未进行荟萃分析。
通过初步搜索共确定了 593 篇论文，其中共有八项研究符合纳入标准并纳入了系统评价。有证据表明氟喹诺酮类药物和阿莫西林/氨苄西林可用于治疗肠热病慢性携带。氟喹诺酮类药物的疗效优于阿莫西林/氨苄西林，一次疗程后 92%的患者实现清除，而 68%的患者实现清除（p = 0.02）。纳入研究的质量较差，且均在 1990 年之前进行。
本综述确定了氟喹诺酮类药物和阿莫西林/氨苄西林是肠热病慢性携带的治疗选择，氟喹诺酮类药物的疗效更为显著。然而，这一证据早于肠热病抗生素耐药性的出现，因此这些发现对当今实践的意义尚不清楚。需要进一步研究以调查这些抗生素是否仍然是合适的治疗选择，或者是否有其他干预措施更为有效。
