Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei, 430022, P.R. China.
Information and Data Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, P.R. China.
Arch Dermatol Res. 2024 Sep 6;316(8):603. doi: 10.1007/s00403-024-03317-1.
This study systematically evaluated and ranked the efficacy of first- and second-line antibiotics antibiotic options for the clinical management of cellulitis and erysipelas through a network meta-analysis approach. From inception to July 04, 2024, a search for relevant randomized clinical trials (RCTs) was carried out using several databases. Antibiotics including azithromycin, cefaclor, cephalexin, cloxacillin, erythromycin, cephalexin plus trimethoprim-sulfamethoxazole, cephalexin plus placebo, flucloxacillin, clindamycin, ceftriaxone, penicillin, roxithromycin, and pristinamycin were assessed regarding cure rate, the eradication of baseline pathogens, diarrhea or vomiting, and rash. In total, 10 RCTs with 1,936 cellulitis or erysipelas patients were eligible for inclusion. There were no significant differences in the cure rates for cellulitis among the antibiotics analysed, with cefaclor demonstrating the most favorable profile for curative outcomes. In terms of side effects, ceftriaxone was identified as the least likely to induce diarrhea or vomiting. For erysipelas, pristinamycin showed the most promising results in achieving cure rates. Although a comparison of the three antibiotics revealed no significant differences in rash as a side effect in erysipelas, pristinamycin was observed to carry the highest risk for rash. Our findings indicate no significant differences in cure rates among antibiotics for cellulitis. However, ceftriaxone had the fewest gastrointestinal side effects. Pristinamycin showed the highest cure rates for erysipelas but with a higher risk of rash. Future research should focus on optimizing antibiotic selection for cellulitis and erysipelas.
本研究通过网络荟萃分析方法，系统评估和排序了治疗蜂窝织炎和丹毒的一线和二线抗生素治疗方案的疗效。从创建到 2024 年 7 月 04 日，使用多个数据库对相关随机对照试验（RCT）进行了检索。评估了包括阿奇霉素、头孢克洛、头孢氨苄、氯唑西林、红霉素、头孢氨苄加甲氧苄啶-磺胺甲噁唑、头孢氨苄加安慰剂、氟氯西林、克林霉素、头孢曲松、青霉素、罗红霉素和壮观霉素在内的抗生素的治愈率、基线病原体的清除率、腹泻或呕吐以及皮疹情况。共有 10 项 RCT 纳入了 1936 例蜂窝织炎或丹毒患者，符合纳入标准。分析的抗生素治疗蜂窝织炎的治愈率无显著差异，头孢克洛对治愈结果的影响最有利。在副作用方面，头孢曲松最不易引起腹泻或呕吐。对于丹毒，壮观霉素在达到治愈率方面显示出最有前景的结果。尽管三种抗生素之间的比较并未显示出丹毒作为副作用时皮疹的差异，但壮观霉素显示出皮疹的风险最高。我们的研究结果表明，抗生素治疗蜂窝织炎的治愈率没有显著差异。然而，头孢曲松胃肠道副作用最少。壮观霉素对丹毒的治愈率最高，但皮疹风险较高。未来的研究应侧重于优化蜂窝织炎和丹毒的抗生素选择。
