磷霉素氨丁三醇治疗泌尿系统感染有效性和安全性的Meta分析

Abstract

目的 采用Meta分析评价磷霉素氨丁三醇治疗泌尿系统感染的有效性和安全性.方法 计算机检索PubMed、Embase、Cochrane图书馆、中国生物医学文献数据库、中国知网、维普和万方数据库,检索时限均为建库至2016年9月10日.由2位作者独立进行文献筛选和资料提取,采用Revman5.3软件进行Meta分析.结果 纳入29项研究共计4 451例患者.Meta分析结果显示,磷霉素氨丁三醇的临床治愈率(RR=1.02,95 ％CI=0.98～1.06,P=0.29)、临床总有效率(RR=1.02,95％CI=0.97～1.04,P=0.16)、细菌清除率(RR=1.02,95％CI=0.99～1.08,P=0.24)及不良反应发生率(RR=0.87,95％CI=0.69～1.08,P=0.20)与其他抗生素相当.亚组分析显示,磷霉素氨丁三醇组不良反应发生率显著低于P内酰胺类药物组(RR=0.56,95％CI=0.34～0.94,P=0.03);此外,在妊娠期女性患者中,磷霉素氨丁三醇组的不良反应发生率显著低于其他抗生素组(RR=0.52,95％CI=0.32～0.85,P=0.01).结论 当前证据表明,磷霉素氨丁三醇治疗泌尿系统感染的疗效与其他抗生素相当,但磷霉素氨丁三醇组不良反应发生率显著低于β-内酰胺类药物组,且在妊娠期女性中其不良反应发生率较其他抗生素更低,其显著优势在于单剂量单次口服,值得临床推广使用.

Objective To evaluate the efficacy and safety of fosfomycin trometamol (FT) in the treatment of urinary tract infection (UTI) in a Meta-analytic approach.Methods Databases such as PubMed,EMbase,Cochrane Library,CBM,CNKI,VIP and WanFang Data from their inception to Sep.10,2016 were searched.Two researchers independently screened literature and extracted data.A Meta-analysis was conducted using RevMan 5.3 software.Results A total of 29 trials involving 4 451 patients were included.The results showed that the efficacy and safety of FT were similar to other antibiotics (clinical cure rate:RR =1.02,95 ％ CI:0.98 ～ 1.06,P =0.29;clinical total effective rate:RR =1.02,95％ CI:0.97 ～ 1.04,P =0.16;microbiological success rate:RR =1.02,95 ％ CI:0.99 ～ 1.08,P =0.24;adverse effect rate:RR =0.87,95 ％ CI:0.69 ～1.08,P=0.20).Subgroup analysis showed that FT group had lower adverse effect rate than β-lactam antibiotics group in overall populations (RR =0.56,95 ％ CI:0.34～0.94,P =0.03) and lower adverse effect rate than other antibiotics group in pregnant patients (RR =0.52,95％CI:0.32～0.85,P=0.01).Conclusion Current evidence indicated that the efficacy of FT is comparable to other antibiotics in treating UTI.Additionally,the adverse effect of FT is significantly lower than β-lactam antibiotics in overall populations and lower than other antibiotics in pregnant patients.Considering its significant advantage lies in a single oral dose and once use,it is worth to be widely used in clinical practice.