哌拉西林-他唑巴坦对比头孢吡肟治疗粒细胞缺乏伴 发热有效性和安全性的系统评价和荟萃分析

Efficacy and safety of piperacillin-tazobactam versus cefepime in the treatment of febrile neutropenia: a systematic review and meta-analysis

目的对比哌拉西林-他唑巴坦与头孢吡肟治疗粒细胞缺乏伴发热(febrile neutropenia,FN)的有效性和安全性,为临床合理选择药物提供循证依据。方法系统检索PubMed、Embase、The Cochrane Library、中国知网、CBM及万方数据库中对比哌拉西林-他唑巴坦与头孢吡肟治疗FN的随机对照试验(RCT),检索时间均为数据库建库到2020年3月30日,使用Stata 15.0软件对结果进行荟萃分析,比较哌拉西林-他唑巴坦与头孢吡肟治疗FN的有效性和安全性。结果共纳入了7宗RCT,共2142例次患者,荟萃分析结果显示头孢吡肟治疗FN的初始治疗有效性以及治疗的有效率均优于哌拉西林-他唑巴坦,且两者不良反应发生率以及全因死亡率差异无统计学意义;亚组分析结果显示两药对儿童FN的有效性差异也无统计学意义。结论头孢吡肟初始经验性治疗成人FN的有效性略优于哌拉西林-他唑巴坦,且不增加不良反应发生率和全因死亡率,哌拉西林-他唑巴坦与头孢吡肟治疗儿童FN的有效性和安全性差异无统计学意义。

Objective To compare the efficacy and safety of piperacillin-tazobactam versus cefepime in the treatment of febrile neutropenia(FN)for improving evidence-based treatment in clinical practice.Methods A systematic search of randomized controlled trial(RCT)which compared piperacillin-tazobactam with cefepime in the treatment of FN in PubMed,Embase,the Cochrane Library,CNKI,CBM,and Wanfang databases from start of the respective database up to March 30,2020.Meta-analysis was performed using Stata 15.0 software to compare the efficacy and safety of piperacillin-tazobactam versus cefepime.Results A total of 7 RCTs were included with 2142 patients.Meta-analysis showed that the initial cefepime treatment was better than piperacillin-tazobactam in the efficacy for FN,while the adverse events and all-cause mortality did not show significant difference between the two groups.However,subgroup analysis showed no significant between-group difference regarding the efficacy in children.Conclusions Initial empirical cefepime therapy is slightly more effective than piperacillin-tazobactam and does not increase the incidence of adverse events and all-cause mortality in FN patients.In children,piperacillin-tazobactam and cefepime did not show significant difference in the effectiveness and safety.