Solera J, Martínez-Alfaro E, Sáez L
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General de Albacete.
Med Clin (Barc). 1994 May 21;102(19):731-8.
The aim of this study was to determine whether a conclusion could be obtained through meta-analysis of the published trials on the relative efficacy of rifampicin and doxycycline versus streptomycin and doxycycline or another tetracycline (SD).
The comparative and randomized trials identified by a search in the reference data base MEDLINE from 1967 to 1992 and through manual review of the articles cited in these studies or other reviews were included. The evaluation of quality was performed by a standardized scale. The differences in efficacy were expressed as odds ratio and the results were contrasted by the Mantel-Haenszel method. Heterogenicity was graphically analyzed by the Woolf method with an adjustment being made for small subgroups. The confidence intervals were calculated for each trial and for the combined data by the Cornfield method.
Six trials including 581 patients of whom 544 were considered evaluable were analyzed. In the RD treatment group 261 (242 valid) patients were included with 268 (253 valid) being included in the SD group. Five cases of initial therapeutic failure were observed in each group without significant differences. The secondary effects described were very variable. Nonetheless no secondary effects obliging discontinuation of treatment were presented in the RD group with only one in the SD group with no differences between the two groups. Recurrences were presented in 5% and 39% in the RD group and in 0 and 17% in the SD group. In total 37 (16%) in the former group and 13 (5%) in the latter group. The Mantel-Haenszel odds ratio with respect to recurrence was 3.81 (CI 95%, 1.82-8.17; p = 0.00009). The total number of cures was 196 (81%) in the RD group and 232 (92%) in the SD group (Mantel-Haenszel odds ratio 0.36; CI 95%, 1.19-0.64; p = 0.0004). The inclusion of the quality index of the trials did not modify the statistical significance achieved.
In human brucellosis the treatment of rifampicin and doxycycline presents a greater number of recurrence and lower number of cure than the classical treatment with streptomycin and tetracycline drugs.
本研究的目的是确定能否通过对已发表的关于利福平与强力霉素对比链霉素与强力霉素或其他四环素类药物（SD）相对疗效的试验进行荟萃分析得出结论。
纳入通过检索1967年至1992年参考数据库MEDLINE并通过人工查阅这些研究或其他综述中引用的文章所确定的比较性和随机试验。采用标准化量表进行质量评估。疗效差异以比值比表示，结果采用Mantel-Haenszel方法进行对比。采用Woolf方法对异质性进行图形分析，并对小子组进行调整。采用Cornfield方法计算每个试验以及合并数据的置信区间。
分析了6项试验，共581例患者，其中544例被视为可评估。利福平与强力霉素（RD）治疗组纳入261例（242例有效）患者，链霉素与强力霉素（SD）组纳入268例（253例有效）。每组观察到5例初始治疗失败，无显著差异。所描述的次要效应差异很大。尽管如此，RD组未出现导致治疗中断的次要效应，SD组仅1例，两组之间无差异。RD组复发率为5%和39%，SD组为0和17%。前一组总计37例（16%），后一组13例（5%）。关于复发的Mantel-Haenszel比值比为3.81（95%CI，1.82 - 8.17；p = 0.00009）。RD组治愈总数为196例（81%），SD组为232例（92%）（Mantel-Haenszel比值比0.36；95%CI，1.19 - 0.64；p = 0.0004）。纳入试验的质量指数并未改变所达到的统计学显著性。
在人类布鲁氏菌病中，与链霉素和四环素类药物的经典治疗相比，利福平与强力霉素治疗的复发率更高，治愈率更低。
