PDF(Pubmed)
Abstract：
UNASSIGNED: The escalating resistance of Mycoplasma pneumoniae to macrolides has become a significant global health concern, particularly in low-income and middle-income countries (LMICs). Although tetracyclines and quinolones have been proposed as alternative therapeutic options, concerns regarding age-specific safety issues and the lack of consensus in recommendations across various national guidelines prevail. Thus, the primary objective of this study is to ascertain the most efficacious interventions for second-line treatment of M. pneumoniae infection while considering the age-specific safety issues associated with these interventions.
UNASSIGNED: In this systematic review and network meta-analysis we searched PubMed, Embase, CNKI, and WanFang Data, from inception up to November 11th, 2023. Studies of quinolones or tetracyclines for the treatment of people with M. pneumoniae infection were collected and screened by reading published reports, with any type of study included, and no individual patient-level data requested. A systematic review and direct meta-analysis compared the efficacy of tetracyclines and quinolones regarding time to defervescence (TTD) and the rates of fever disappearance within 24 h and 48 h of antibiotic administration, for managing M. pneumoniae infection. Bayesian network meta-analysis (NMA) was employed to indirectly assess the relative effectiveness of different interventions in people with M. pneumoniae infection and the safety profile of medication in paediatric patients. This study is registered with PROSPERO, CRD42023478383.
UNASSIGNED: The systematic review and direct meta-analysis included a total of 4 articles involving 246 patients, while the NMA encompassed 85 articles involving a substantial cohort of 7095 patients. The NMA measured the effectiveness across all ages and included 7043 patients, with a mean age of 37.80 ± 3.91 years. Of the 85 included studies, 14 (16.5%) were at low risk of bias, 71 (83.5%) were at moderate risk, and no studies were rated as having a high risk of bias. In the direct meta-analysis, no statistically significant differences were found between tetracyclines and quinolones concerning TTD (mean difference: -0.40, 95% CI: -1.43 to 0.63; I2 = 0%), fever disappearance rate within 24 h of antibiotic administration (OR: 0.37, 95% CI: 0.08-1.79; I2 = 58%), and fever disappearance rate within 48 h of antibiotic administration (OR: 1.10, 95% CI: 0.30-3.98; I2 = 59%). However, the comprehensive NMA analysis of clinical response (in 70 studies; n = 6143 patients), shortening of TTD (in 52 studies; n = 4363 patients), shortening length of cough relief or disappearance (in 39 studies; n = 3235 patients), fever disappearance rate at 48 h (in four studies; n = 418 patients) revealed that minocycline exhibited the most favourable outcomes across these various parameters, and the analysis of fever disappearance rate at 24 h (in three studies; n = 145 patients) revealed that levofloxacin may be the most effective, as indicated by the rank probabilities and surface under the cumulative ranking area (SUCRA) value. Moxifloxacin ranked second in clinical response and in shortening the length of cough relief or disappearance, and third in shortening TTD. Notably, when evaluating the occurrence of adverse reactions in paediatric patients (in four studies; n = 239 children), levofloxacin was associated with the highest SUCRA value rankings for the rate of adverse events.
UNASSIGNED: Our findings suggest that tetracyclines and quinolones may be equally effective. Based on the age of participants in the included studies, minocycline may be the most effective intervention for children over eight years of age when all preventive measures are considered, whereas moxifloxacin may benefit people under eight years of age. However, these results should be interpreted with caution, given the limited number of studies and patients included, and the heterogeneity between included studies. Based on a limited number of studies in children, levofloxacin is likely to have one of the highest rates of adverse reactions. The majority of the studies included in the NMA were from the Asian region, and more randomised controlled trials comparing different therapeutic strategies in patients with M. pneumoniae are warranted. This comparative study provides clinical pharmacists and clinicians with important information to enable them to make informed decisions about treatment options, considering drug efficacy and safety.
UNASSIGNED: The Natural Science Foundation of Fujian Province, China.
UNASSIGNED: In this systematic review and network meta-analysis we searched PubMed, Embase, CNKI, and WanFang Data, from inception up to November 11th, 2023. Studies of quinolones or tetracyclines for the treatment of people with M. pneumoniae infection were collected and screened by reading published reports, with any type of study included, and no individual patient-level data requested. A systematic review and direct meta-analysis compared the efficacy of tetracyclines and quinolones regarding time to defervescence (TTD) and the rates of fever disappearance within 24 h and 48 h of antibiotic administration, for managing M. pneumoniae infection. Bayesian network meta-analysis (NMA) was employed to indirectly assess the relative effectiveness of different interventions in people with M. pneumoniae infection and the safety profile of medication in paediatric patients. This study is registered with PROSPERO, CRD42023478383.
UNASSIGNED: The systematic review and direct meta-analysis included a total of 4 articles involving 246 patients, while the NMA encompassed 85 articles involving a substantial cohort of 7095 patients. The NMA measured the effectiveness across all ages and included 7043 patients, with a mean age of 37.80 ± 3.91 years. Of the 85 included studies, 14 (16.5%) were at low risk of bias, 71 (83.5%) were at moderate risk, and no studies were rated as having a high risk of bias. In the direct meta-analysis, no statistically significant differences were found between tetracyclines and quinolones concerning TTD (mean difference: -0.40, 95% CI: -1.43 to 0.63; I2 = 0%), fever disappearance rate within 24 h of antibiotic administration (OR: 0.37, 95% CI: 0.08-1.79; I2 = 58%), and fever disappearance rate within 48 h of antibiotic administration (OR: 1.10, 95% CI: 0.30-3.98; I2 = 59%). However, the comprehensive NMA analysis of clinical response (in 70 studies; n = 6143 patients), shortening of TTD (in 52 studies; n = 4363 patients), shortening length of cough relief or disappearance (in 39 studies; n = 3235 patients), fever disappearance rate at 48 h (in four studies; n = 418 patients) revealed that minocycline exhibited the most favourable outcomes across these various parameters, and the analysis of fever disappearance rate at 24 h (in three studies; n = 145 patients) revealed that levofloxacin may be the most effective, as indicated by the rank probabilities and surface under the cumulative ranking area (SUCRA) value. Moxifloxacin ranked second in clinical response and in shortening the length of cough relief or disappearance, and third in shortening TTD. Notably, when evaluating the occurrence of adverse reactions in paediatric patients (in four studies; n = 239 children), levofloxacin was associated with the highest SUCRA value rankings for the rate of adverse events.
UNASSIGNED: Our findings suggest that tetracyclines and quinolones may be equally effective. Based on the age of participants in the included studies, minocycline may be the most effective intervention for children over eight years of age when all preventive measures are considered, whereas moxifloxacin may benefit people under eight years of age. However, these results should be interpreted with caution, given the limited number of studies and patients included, and the heterogeneity between included studies. Based on a limited number of studies in children, levofloxacin is likely to have one of the highest rates of adverse reactions. The majority of the studies included in the NMA were from the Asian region, and more randomised controlled trials comparing different therapeutic strategies in patients with M. pneumoniae are warranted. This comparative study provides clinical pharmacists and clinicians with important information to enable them to make informed decisions about treatment options, considering drug efficacy and safety.
UNASSIGNED: The Natural Science Foundation of Fujian Province, China.
摘要：
■肺炎支原体对大环内酯类药物的耐药性不断升级已成为全球健康关注的重要问题。特别是在低收入和中等收入国家(LMICs)。虽然四环素和喹诺酮类药物已被提议作为替代治疗选择，对特定年龄的安全问题的担忧以及在各种国家指南的建议中缺乏共识。因此，本研究的主要目的是确定对肺炎支原体感染二线治疗最有效的干预措施,同时考虑与这些干预措施相关的年龄特异性安全性问题.
■在这篇系统综述和网络荟萃分析中，我们搜索了PubMed，Embase,CNKI,和万方数据，从成立到11月11日，2023年。收集喹诺酮类药物或四环素类药物治疗肺炎支原体感染的研究，并通过阅读已发表的报告进行筛选，包括任何类型的研究，并且不需要个人患者级别的数据。系统评价和直接荟萃分析比较了四环素和喹诺酮类药物在退热时间（TTD）方面的疗效以及抗生素给药24小时和48小时内的发热消失率。用于管理肺炎支原体感染。贝叶斯网络荟萃分析（NMA）用于间接评估不同干预措施对肺炎支原体感染患者的相对有效性以及儿科患者的药物安全性。这项研究在PROSPERO注册，CRD42023478383。
■系统回顾和直接荟萃分析共纳入4篇文章，涉及246例患者，而NMA包含85篇文章，涉及7095名患者的大量队列。NMA测量了所有年龄段的有效性，包括7043名患者，平均年龄为37.80±3.91岁。在纳入的85项研究中，14人(16.5%)存在低偏倚风险，71人（83.5%）处于中等风险，并且没有一项研究被认为存在高偏倚风险.在直接荟萃分析中，关于TTD，四环素和喹诺酮类药物之间无统计学差异（平均差：-0.40，95％CI：-1.43至0.63；I2=0％），抗生素给药24小时内的发热消失率(OR:0.37,95%CI:0.08-1.79;I2=58%),抗生素给药48h内的发热消失率（OR：1.10，95％CI：0.30-3.98；I2=59％）。然而,临床反应的综合NMA分析(在70项研究中；n=6143例患者)，TTD缩短（52项研究；n=4363例），咳嗽缓解或消失的时间缩短（在39项研究中；n=3235例患者），在48小时的发热消失率（在四项研究中，n=418例患者）显示，米诺环素在这些不同的参数中表现出最有利的结果，和24小时发热消失率的分析（在三项研究中，n=145名患者）显示，左氧氟沙星可能是最有效的，如累积排名面积(SUCRA)值下的排名概率和表面所示。莫西沙星在临床反应和缩短咳嗽缓解或消失时间方面排名第二，第三是缩短TTD。值得注意的是,在评估儿科患者不良反应的发生时（在四项研究中；n=239名儿童），左氧氟沙星与不良事件发生率最高的SUCRA值排名相关.
■我们的研究结果表明，四环素和喹诺酮类药物可能同样有效。根据纳入研究的参与者的年龄，在考虑所有预防措施的情况下，米诺环素可能是八岁以上儿童最有效的干预措施，而莫西沙星可能使8岁以下的人受益。然而,这些结果应谨慎解释，鉴于研究和患者数量有限，以及纳入研究之间的异质性。根据对儿童的有限研究，左氧氟沙星可能是不良反应发生率最高的药物之一。NMA中的大多数研究都来自亚洲地区，更多的随机对照试验比较肺炎支原体患者的不同治疗策略是必要的。这项比较研究为临床药剂师和临床医生提供了重要信息，使他们能够就治疗方案做出明智的决定。考虑药物疗效和安全性。
■福建省自然科学基金,中国。
■在这篇系统综述和网络荟萃分析中，我们搜索了PubMed，Embase,CNKI,和万方数据，从成立到11月11日，2023年。收集喹诺酮类药物或四环素类药物治疗肺炎支原体感染的研究，并通过阅读已发表的报告进行筛选，包括任何类型的研究，并且不需要个人患者级别的数据。系统评价和直接荟萃分析比较了四环素和喹诺酮类药物在退热时间（TTD）方面的疗效以及抗生素给药24小时和48小时内的发热消失率。用于管理肺炎支原体感染。贝叶斯网络荟萃分析（NMA）用于间接评估不同干预措施对肺炎支原体感染患者的相对有效性以及儿科患者的药物安全性。这项研究在PROSPERO注册，CRD42023478383。
■系统回顾和直接荟萃分析共纳入4篇文章，涉及246例患者，而NMA包含85篇文章，涉及7095名患者的大量队列。NMA测量了所有年龄段的有效性，包括7043名患者，平均年龄为37.80±3.91岁。在纳入的85项研究中，14人(16.5%)存在低偏倚风险，71人（83.5%）处于中等风险，并且没有一项研究被认为存在高偏倚风险.在直接荟萃分析中，关于TTD，四环素和喹诺酮类药物之间无统计学差异（平均差：-0.40，95％CI：-1.43至0.63；I2=0％），抗生素给药24小时内的发热消失率(OR:0.37,95%CI:0.08-1.79;I2=58%),抗生素给药48h内的发热消失率（OR：1.10，95％CI：0.30-3.98；I2=59％）。然而,临床反应的综合NMA分析(在70项研究中；n=6143例患者)，TTD缩短（52项研究；n=4363例），咳嗽缓解或消失的时间缩短（在39项研究中；n=3235例患者），在48小时的发热消失率（在四项研究中，n=418例患者）显示，米诺环素在这些不同的参数中表现出最有利的结果，和24小时发热消失率的分析（在三项研究中，n=145名患者）显示，左氧氟沙星可能是最有效的，如累积排名面积(SUCRA)值下的排名概率和表面所示。莫西沙星在临床反应和缩短咳嗽缓解或消失时间方面排名第二，第三是缩短TTD。值得注意的是,在评估儿科患者不良反应的发生时（在四项研究中；n=239名儿童），左氧氟沙星与不良事件发生率最高的SUCRA值排名相关.
■我们的研究结果表明，四环素和喹诺酮类药物可能同样有效。根据纳入研究的参与者的年龄，在考虑所有预防措施的情况下，米诺环素可能是八岁以上儿童最有效的干预措施，而莫西沙星可能使8岁以下的人受益。然而,这些结果应谨慎解释，鉴于研究和患者数量有限，以及纳入研究之间的异质性。根据对儿童的有限研究，左氧氟沙星可能是不良反应发生率最高的药物之一。NMA中的大多数研究都来自亚洲地区，更多的随机对照试验比较肺炎支原体患者的不同治疗策略是必要的。这项比较研究为临床药剂师和临床医生提供了重要信息，使他们能够就治疗方案做出明智的决定。考虑药物疗效和安全性。
■福建省自然科学基金,中国。
