BMJ：人布氏菌病联合用药方案疗效有差异
以色列Rabin医学中心Skalsky等报告，他们进行的一项元分析表明，目前推荐的人布氏菌病治疗方案的疗效存在显著差异。较好的治疗方案是包括氨基糖苷类抗生素的2种或3种药的联合方案。相关论文发表于《英国医学杂志》（BMJ）上。
布氏菌病是全世界最常见的动物源性感染性疾病。全球每年出现50多万例新发病例，但地区分布不均匀。布鲁菌病的年发病率波动于0.3例/100万人(英国和美国的多数地区)至>1例/1000人(流行地区)。布氏菌病在流行地区造成极大的卫生负担，且该负担在不断增大。
布氏菌病的治疗目的是缩短病程，预防复发，减少并发症(如骶髂关节炎、脊椎炎、脑炎、心内膜炎、附睾睾丸炎和流产)。由于单药治疗复发率高，所以现在常用两药联合疗法。但目前推荐的治疗方案并不一致。为确定各种治疗方案的疗效差异，作者系统检索文献，对相关随机对照研究进行了元分析。
结果共有30项研究(77个治疗组)被纳入元分析。总的说来，多西环素-利福平方案的失败率较多西环素-链霉素方案高，主要是由于前者的复发率较高[相对危险(RR)为2.80。菌血症患者与有并发症的布氏菌病患者的转归一致。
多西环素-链霉素方案的失败率较多西环素-利福平-氨基糖苷类抗生素三药联合方案高(RR为2.50)。庆大霉素的疗效不比链霉素差。喹诺酮类抗生素加利福平的疗效较多西环素加利福平或链霉素差(RR为1.83)。如果疗程相同，单药治疗的失败率较联合疗法高(RR为2.56)。治疗≥6周较短疗程方案的疗效好。（中国医学论坛报 蒋文）
生物谷推荐原始出处：
（BMJ），doi:10.1136/bmj.39497.500903.25，Keren Skalsky, Mical Paul
Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials
Keren Skalsky, student , Dafna Yahav, resident, Jihad Bishara, head of unit , Silvio Pitlik, head of department , Leonard Leibovici, head of department , Mical Paul, senior physician
1 Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva 49100, Israel, 2 Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 3 Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv 69978, Israel
Objectives To determine and quantify differences in efficacy between treatment regimens for brucellosis.
Design Systematic review and meta-analysis of randomised controlled trials assessing different antibiotic regimens and durations of treatment for human brucellosis.
Data sources PubMed, CENTRAL, Lilacs, conference proceedings, and bibliographies with no restrictions on language, study year, or publication status.
Review methods Search, application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality independently performed in duplicate. Primary outcomes were relapse and overall failure resulting from primary failure or relapse. Relative risks with 95% confidence intervals were calculated and pooled with a fixed effect model.
Results 30 trials and 77 treatment arms were included. Overall failure was significantly higher with doxycycline-rifampicin compared to doxycycline-streptomycin, mainly due to a higher rate of relapse (relative risk 2.80, 95% confidence interval 1.81 to 4.36; 13 trials, without heterogeneity). Results were consistent among patients with bacteraemia and complicated brucellosis. Doxycycline-streptomycin resulted in a significantly higher rate of failure than doxycycline-rifampicin-aminoglycoside (triple drug regimen) (2.50, 1.26 to 5.00; two trials). Gentamicin was not inferior to streptomycin (1.45, 0.52 to 4.00 for failure; two trials). Quinolones combined with rifampicin were significantly less effective than doxycycline combined with rifampicin or streptomycin (1.83, 1.11 to 3.02, for failure; five trials). Monotherapy was associated with a higher risk of failure than combined treatment when administered for a similar duration (2.56, 1.55 to 4.23; five trials). Treatment for six weeks or more offered an advantage over shorter treatment durations.
Conclusions There are significant differences in effectiveness between currently recommended treatment regimens for brucellosis. The preferred treatment should be with dual or triple regimens including an aminoglycoside.
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