莫匹罗星软膏治疗脓疱疮的Meta分析

A meta- analysis of mupirocin ointment in treatment of impetigo

目的比较莫匹罗星软膏与安慰剂、其他局部抗菌药物、口服抗菌药物治疗脓疱疮的有效性与安全性。方法计算机检索Pub Med、Elsevier、Cochrane数据库、中国期刊全文数据库、万方、维普数据库(VIP)、中国生物医学文献数据库(CBM)等有关莫匹罗星软膏与安慰剂、其他局部抗菌药物或口服抗菌药物对比治疗脓疱疮的临床随机对照试验。采用Cochrane质量评价标准对纳入研究的方法学质量进行评价,采用Rev Man 5.1软件对入选资料进行Meta分析。结果共36篇文献,包含3 284例脓疱疮患者入选。Meta分析显示,莫匹罗星软膏的有效率显著高于安慰剂[RR=2.21,95%CI(1.59,3.05),P<0.000 01],与夫西地酸乳膏相比差异无显著意义[RR=1.01,95%CI(0.98,1.04),P=0.50],与利福霉素、新霉素、金霉素、杆菌素、新孢霉素无显著差异(P>0.05),显著优于四环素(P=0.000 4),显著优于口服红霉素[RR=1.07,95%CI(1.02,1.13),P=0.007],与双氯青霉素、头孢氨苄、氨苄西林无显著差异[RR=1.09,95%CI(0.94,1.28),P=0.25]。莫匹罗星软膏的不良反应发生率低于口服红霉素[RR=0.41,95%CI(0.25,0.69),P=0.000 7],高于夫西地酸乳膏[OR=5.27,95%CI(2.06,13.53),P=0.000 5]。在微生物学可评估患者中,莫匹罗星软膏对金黄色葡萄球菌的清除率与夫西地酸乳膏无显著差异,[RR=1.05,95%CI(0.99,1.12),P=0.09],显著高于四环素软膏[RR=1.16,95%CI(1.08,1.26),P=0.000 1]。结论莫匹罗星软膏治疗脓疱疮优于安慰剂、其他局部抗菌药物和口服红霉素,不良反应相对较少。

AIM To compare the effectiveness and safety of mupirocin ointment with placebo, the topical antibacterial agents and oral antibacterial agents in the treatment of impetigo. METHODS A literature search in PubMed, Elsevier, Cochrane library, CNKI, Wan Fang, CBM and VIP databases were performed to retrieve clinical trial documents. The randomized controlled trials about the experimental group for mupirocin ointment; the control group for placebo, topical antibacterial agents or oral antibacterial agents were included. Methodological qualities of included literatures were conducted by Cochrane. The included literatures were analyzed by the software of RevMan5.1. RESULTS Thirty-six literatures were included which contained three thousand two hundred and eighty-four patients. The efficiency of mupirocin ointment was better than placebo [RR = 2.21, 95%CI （1.59, 3.05）, P 〈 0.000 01] and tetracycline [RR = 1.09, 95%CI （1.04, 1.15）, P = 0.000 4] and oral erythromycin [RR = 1.07, 95%CI （1.02, 1.13）, P = 0.007]. But there were no statistical differences with fusidic acid [RR = 1.01, 95%CI （0.98, 1.04）, P = 0.50] and other oral antibacterial agents [RR = 1.09, 95%CI （0.94, 1.28）, P = 0.25]. The adverse reaction rates of mupirocin ointment was lower than oral erythromycin [RR = 0.41, 95%C1 （0.25, 0.69）, P = 0.000 7], and higher than other topical antibacterial agents [OR = 5.27, 95%CI （2.06, 13.53） , P = 0.000 5]. There were no significant differences between Mupirocin ointment and fusidic acid in the eradication of the Staphylococcus aurous [RR -- 1.05, 95%CI （0.99, 1.12）, P = 0.09], but mupirocin ointment was better than tetracycline ointment [RR = 1.16, 95%CI （1.08, 1.26）, P = 0.000 1 ]. CONCLUSION Mupirocin ointment is better than placebo, other topical ant/microbial drugs and oral erythromycin in treatment of impetigo with relatively few adverse reactions.