From the Department of Medicine, Brown University, Providence, RI.
HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Sex Transm Dis. 2023 Nov 1;50(11):701-712. doi: 10.1097/OLQ.0000000000001865. Epub 2023 Sep 4.
Sexually transmitted infections (STIs) such as syphilis, gonorrhea, and chlamydia have significantly increased over the past decade in the United States. Doxycycline as chemoprophylaxis (i.e., postexposure prophylaxis) offers promise for addressing bacterial STIs. The goal of the current study was to evaluate the safety of longer-term doxycycline use (defined as 8 or more weeks) in the context of potential use as STI chemoprophylaxis through a systematic literature review and meta-analysis.
This review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to search MEDLINE/PubMed for clinical studies published from August 2003 to January 2023 that reported on adverse events with doxycycline use with a focus on side effects and metabolic effects of long-term use.
A total of 67 studies were included in the systematic review. Overall, studies on longer-term doxycycline use reported 0% to greater than 50% adverse events ranging from mild to severe. Most common adverse events included gastrointestinal symptoms (i.e., nausea, vomiting, and abdominal pain), dermatologic (i.e., rash), and neurological (i.e., headache and dizziness) symptoms. Discontinuation of doxycycline due to adverse events was relatively uncommon in most studies. A meta-analysis of placebo controlled clinical trials (N = 18) revealed that gastrointestinal and dermatological adverse events were more likely to occur in the doxycycline group.
Longer-term (8+ weeks) doxycycline use is generally safe and may be associated with minor side effects. Further research is needed on the potential metabolic impact of longer-term doxycycline use.
在美国，过去十年间性传播感染（STI），如梅毒、淋病和衣原体感染的发病率显著上升。多西环素作为化学预防剂（即暴露后预防）为解决细菌性 STI 提供了希望。本研究的目的是通过系统文献回顾和荟萃分析，评估作为 STI 化学预防剂使用时多西环素长期使用（定义为 8 周或以上）的安全性。
本综述使用系统评价和荟萃分析的首选报告项目指南，在 2003 年 8 月至 2023 年 1 月期间，通过 MEDLINE/PubMed 搜索报道多西环素使用不良事件的临床研究，重点关注长期使用的副作用和代谢影响。
共有 67 项研究被纳入系统综述。总体而言，关于多西环素长期使用的研究报告的不良事件发生率为 0%至 50%以上，从轻度到重度不等。最常见的不良事件包括胃肠道症状（即恶心、呕吐和腹痛）、皮肤（即皮疹）和神经（即头痛和头晕）症状。在大多数研究中，由于不良事件而停止使用多西环素的情况相对较少见。对 18 项安慰剂对照临床试验（N=18）的荟萃分析显示，多西环素组更易发生胃肠道和皮肤不良事件。
长期（8 周以上）使用多西环素通常是安全的，可能伴有轻微副作用。需要进一步研究长期使用多西环素对潜在代谢的影响。
