■最初的随机对照试验(RCT)显示,孕妇预防性使用阿奇霉素可改善母婴结局;最近的证据没有显示对新生儿生存有任何益处.关于阿奇霉素在产前和产时预防作用的证据相互矛盾。我们探讨了孕妇预防阿奇霉素是否可以改善母婴结局。
■对于在PROSPERO[CRD42023411093]上注册的系统综述和荟萃分析,我们搜索了七个数据库(PubMed,Scopus,Embase,科克伦图书馆,EBSCOHost,ProQuest,和WebofScience)和临床试验注册,直至2024年4月23日,用于RCT评估产前/产时阿奇霉素对孕妇安慰剂/常规护理的预防。主要结果是新生儿死亡率。产时和产前给药分别进行评估。我们使用随机效应荟萃分析。使用CochraneRoB2工具评估偏倚风险。使用等级方法来评估证据的确定性。
■筛选2161条记录检索到20个随机对照试验(56,381名参与者)。产时阿奇霉素可能对新生儿死亡率影响很小或没有影响[5项随机对照试验,44,436名参与者;风险比(RR):1.02,95%CI0.86-1.20,I2=0%,非常低的确定性],和孕产妇死亡率[3项随机对照试验,44,131名与会者,RR:1.26,0.65-2.42,I2=0%,低确定性]。同样,产前阿奇霉素可能对新生儿死亡率影响很小或没有影响[3个随机对照试验;5304名参与者;RR:0.74,0.35-1.56,I2=43%,非常低的确定性]和孕产妇死亡率[3个随机对照试验;8167名参与者RR:1.62,0.67-3.91,I2=0%,低确定性]。没有关于长期不良结果和抗菌素耐药性的数据。
从低到极低的确定性证据表明,孕妇产时或产前预防阿奇霉素可能不会降低孕产妇或新生儿死亡率。
■无。
UNASSIGNED: Initial randomised controlled trials (RCTs) showed that prophylactic azithromycin in pregnant women improved maternal and neonatal outcomes; however, the recent evidence did not show any benefit to neonatal survival. There is conflicting evidence over the role of azithromycin prophylaxis in antenatal and intrapartum periods. We explored whether azithromycin prophylaxis in pregnant women improves maternal and neonatal outcomes.
UNASSIGNED: For this systematic
review and meta-analysis registered on PROSPERO [CRD42023411093], we searched seven databases (PubMed, Scopus, Embase, Cochrane Library, EBSCOHost, ProQuest, and Web of Science) and clinical trial registries until 04/23/2024, for RCTs evaluating antenatal/intrapartum azithromycin prophylaxis against placebo/routine care in pregnant women. The primary outcome was neonatal mortality. Intrapartum and antenatal administration were assessed separately. We used random-effects meta-analysis. The risk of bias was assessed using the Cochrane RoB 2 tool. The GRADE approach was used to evaluate the certainty of the evidence.
UNASSIGNED: Screening 2161 records retrieved 20 RCTs (56,381 participants). Intrapartum azithromycin may make little or no difference to neonatal mortality [5 RCTs, 44,436 participants; Risk Ratio (RR): 1.02, 95% CI 0.86-1.20, I 2 = 0%, very low certainty], and maternal mortality [3 RCTs, 44,131 participants, RR: 1.26, 0.65-2.42, I 2 = 0%, low certainty]. Similarly, antenatal azithromycin may have little or no effect on neonatal mortality [3 RCTs; 5304 participants; RR: 0.74, 0.35-1.56, I 2 = 43%, very-low certainty] and maternal mortality [3 RCTs; 8167 participants RR: 1.62, 0.67-3.91, I 2 = 0%, low certainty]. There is no data on long-term adverse outcomes and antimicrobial resistance.
UNASSIGNED: Low to very low certainty evidence suggests that intrapartum or antenatal azithromycin prophylaxis in pregnant women might not reduce maternal or neonatal mortality.
UNASSIGNED: None.