Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India.
Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
BMC Infect Dis. 2023 Dec 18;23(1):884. doi: 10.1186/s12879-023-08893-7.
Scrub typhus is a bacterial mite-borne disease associated with poor clinical outcomes if not treated adequately. The study aimed to compare the time to defervescence, clinical failure, mortality and treatment-related adverse effects of two common drugs (doxycycline and azithromycin) used for its treatment.
This was a systematic review and meta-analysis. All studies up to 20.03.2023 were screened for eligibility in Pubmed and Embase using a search string containing terms related to scrub typhus, doxycycline and azithromycin. After two phases of screening, all comparative studies where doxycycline and azithromycin were used to treat scrub typhus were included. The studies were critically appraised using standardised tools, and a meta-analysis was performed for time to defervescence (primary outcome), clinical failure, mortality and treatment-related adverse effects.
Of 744 articles from two databases, ten were included in the meta-analysis. All but two studies had a high risk of bias. The meta-analysis for time to defervescence had a high heterogeneity and did not show any significant difference between doxycycline and azithromycin arms [Mean difference of -3.37 hours (95%CI: -10.31 to 3.57), p=0.34]. When the analysis was restricted to studies that included only severe scrub typhus, doxycycline was found to have a shorter time to defervescence [mean difference of -10.15 (95%CI: -19.83 to -0.46) hours, p=0.04]. Additionally, there was no difference between the two arms concerning clinical failure, mortality and treatment-related adverse effects.
The current data from studies with a high risk of bias did not find statistically significant differences in clinical outcomes between doxycycline and azithromycin for scrub typhus.
恙虫病是一种由细菌、螨虫传播的疾病，如果治疗不当，可能会导致不良的临床后果。本研究旨在比较两种常用于治疗恙虫病的常见药物（多西环素和阿奇霉素）的退热时间、临床疗效失败、死亡率和治疗相关不良反应。
这是一项系统评价和荟萃分析。在 Pubmed 和 Embase 中使用包含恙虫病、多西环素和阿奇霉素相关术语的搜索字符串筛选截至 2023 年 3 月 20 日的所有符合条件的研究。经过两轮筛选，所有将多西环素和阿奇霉素用于治疗恙虫病的比较研究均被纳入。使用标准化工具对研究进行严格评估，并对退热时间（主要结局）、临床疗效失败、死亡率和治疗相关不良反应进行荟萃分析。
从两个数据库中筛选出 744 篇文章，其中 10 篇被纳入荟萃分析。除了两项研究外，其余研究均存在较高的偏倚风险。退热时间的荟萃分析存在高度异质性，多西环素组和阿奇霉素组之间没有显示出任何显著差异[平均差异-3.37 小时（95%CI：-10.31 至 3.57），p=0.34]。当分析仅限于仅包括重症恙虫病的研究时，发现多西环素有更短的退热时间[平均差异-10.15 小时（95%CI：-19.83 至 -0.46），p=0.04]。此外，两组之间在临床疗效失败、死亡率和治疗相关不良反应方面没有差异。
目前来自高偏倚风险研究的数据并未发现多西环素和阿奇霉素在治疗恙虫病方面的临床结局存在统计学显著差异。
