Relapsing fever is an acute infectious disease caused by a variety of relapsing fever-associated spirochetes,for which no optimal treatment has been developed.The purposes of this study were to compare the efficacy an...Relapsing fever is an acute infectious disease caused by a variety of relapsing fever-associated spirochetes,for which no optimal treatment has been developed.The purposes of this study were to compare the efficacy and safety of commonly used antibiotics for the treatment of relapsing fever using a network meta-analysis approach and to explore the advantages of each drug based on the current evidence.This study examined nine published studies involving 1416 patients with relapsing fever treated with penicillin,erythromycin,tetracycline,doxycycline,minocycline or chloramphenicol.The odds ratio(OR)and 95% confidence interval(CI)were used as influence indices for discontinuous data,and the efficacy and safety of drugs were ranked by the surface under the cumulative ranking(SUCRA)curve.The primary outcomes of this study were mortality and cure rates,and the secondary outcomes were the rates of Jarisch-Herxheimer reaction and relapse.Erythromycin(SUCRA,84.5%)was the most effective antibiotic for reducing mortality,whereas tetracycline was the most effective antibiotic for improving the cure rate(SUCRA,69.3%)and reducing the relapse rate(SUCRA,79.7%),and minocycline(SUCRA,66.4%)was the most effective antibiotic for reducing Jarisch-Herxheimer reactions.In addition,our network meta-analysis showed that tetracycline is superior to penicillin for improving the cure rate(OR,5.91;95%CI,2.21-15.81)and reducing the relapse rate(OR,0.16;95%CI,0.04-0.67).展开更多
基金supported by the National Natural Science Foundation of China(32060180,82160304,81560596,81860644 and 31560051)the Natural Foundation of Yunnan Province(2017FE467-001 and 2019FE001-002)the Scientific Research Fund Project of the Yunnan Education Department(2022Y208).
文摘Relapsing fever is an acute infectious disease caused by a variety of relapsing fever-associated spirochetes,for which no optimal treatment has been developed.The purposes of this study were to compare the efficacy and safety of commonly used antibiotics for the treatment of relapsing fever using a network meta-analysis approach and to explore the advantages of each drug based on the current evidence.This study examined nine published studies involving 1416 patients with relapsing fever treated with penicillin,erythromycin,tetracycline,doxycycline,minocycline or chloramphenicol.The odds ratio(OR)and 95% confidence interval(CI)were used as influence indices for discontinuous data,and the efficacy and safety of drugs were ranked by the surface under the cumulative ranking(SUCRA)curve.The primary outcomes of this study were mortality and cure rates,and the secondary outcomes were the rates of Jarisch-Herxheimer reaction and relapse.Erythromycin(SUCRA,84.5%)was the most effective antibiotic for reducing mortality,whereas tetracycline was the most effective antibiotic for improving the cure rate(SUCRA,69.3%)and reducing the relapse rate(SUCRA,79.7%),and minocycline(SUCRA,66.4%)was the most effective antibiotic for reducing Jarisch-Herxheimer reactions.In addition,our network meta-analysis showed that tetracycline is superior to penicillin for improving the cure rate(OR,5.91;95%CI,2.21-15.81)and reducing the relapse rate(OR,0.16;95%CI,0.04-0.67).
