Tetracyclines

四环素
  • 文章类型: Journal Article
    幼小的农场动物容易受到机会性感染,这可能会由于死亡率和体重增加不良而造成经济损失。抗微生物药物耐药性的发展以及提高治疗效果和安全性的愿望是寻求新的抗菌药物以确保快速恢复且不良事件最少的原因。
    评估DOKSIAVZ500在幼猪呼吸道病变中的功效。
    该研究是在65-70天大的约克郡仔猪中进行的,这些仔猪有细菌呼吸道病变的迹象。用试验药物处理动物3或5天。参考组接受了TETRAMAX500,其化学结构与测试药物相似,作用机制,和活动谱。使用临床检查评估动物的状态,临床血细胞计数,和细菌学测试。
    测试药物和参考药物均具有良好的耐受性,并确保动物在约4天内恢复。恢复伴随着血液学参数和菌群组成的正常化。与疾病发展有关的细菌,猪链球菌,几乎在所有组中完全被淘汰。没有注意到不良事件。治疗后,所有的动物都很容易增加体重和市场质量。
    DOKSIAVZ500是一种高效的疗法,用于治疗由仔猪中的常驻机会菌群引起的呼吸道疾病。它也显示出非劣性与TETRAMAX500在所有与健康相关的参数方面,因此可以推荐用于养猪场的兽医实践。
    UNASSIGNED: Young farm animals are susceptible to opportunistic infections which may cause economic losses due to mortality and poor weight gain. The development of antimicrobial resistance and the desire to improve therapy efficacy and safety are the reasons to seek for new antibacterial drugs ensuring rapid recovery with minimum adverse events.
    UNASSIGNED: To estimate the efficacy of DOKSI AVZ 500 in respiratory pathologies in young pigs.
    UNASSIGNED: The study was conducted in 65-70-day-old Yorkshire piglets with signs of bacterial respiratory pathologies. The animals were treated with the test drug for 3 or 5 days. The reference group received TETRAMAX 500 which is similar to the test drug in terms of chemical structure, mechanism of action, and activity spectrum. The animal\'s status was assessed using clinical examination, clinical blood count, and bacteriological tests.
    UNASSIGNED: Both test and reference drugs were well tolerated and ensured the animal recovery within about 4 days. The recovery was accompanied by normalization of hematological parameters and flora composition. The bacterium associated with the disease development, Streptococcus suis, was virtually completely eliminated in all groups. No adverse events were noted. After the treatment, all the animals readily gained weight and live market quality.
    UNASSIGNED: DOKSI AVZ 500 was a highly efficient therapy for respiratory pathologies caused by the resident opportunistic flora in piglets. It has also shown noninferiority vs. TETRAMAX 500 in terms of all the health-related parameters and thus can be recommended for introduction in veterinary practice in pig farms.
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  • 文章类型: Journal Article
    四环素类药物(TCs)在人类医药和畜牧业中的滥用和不合理使用已成为一个严重的问题,影响生态环境和人类健康。本研究的目的是建立一种灵敏,选择性的全自动固相萃取-超高效液相色谱-串联质谱法测定水中12种TC的方法。使用四种同位素标记的TC内标来校正基体效应。对影响提取效率的几个参数进行了系统的优化,发现的最佳实验条件是1.0L水样,0.5g/LNa2EDTA(pH3.0),用CNWHLB柱提取和富集,用4mL丙酮:甲醇(v/v,1:1).富集因子高达798-1059,但每六个样品仅需要约60分钟。在优化条件下,对于12个TC,该方法的线性范围为0.2至100μg/L,检出限低至0.01-0.15ng/L,回收率在70%-118%之间,相对标准偏差小于15%。该方法可成功用于纯水中12种TCs的测定,自来水,河水,和海水养殖。总之,在河水和海水养殖海水中检测到三个和六个TC,分别,总浓度为0.074-0.520ng/L(平均0.248ng/L)和0.792-58.369ng/L(12.629ng/L),分别。四环素(TC)和土霉素(OTC)是河水中的主要TC,海水养殖海水中多西四环素(DXC)和OTC占优势。
    The abuse and irrational use of tetracyclines (TCs) in human medicine and animal husbandry has become a serious concern, affecting the ecological environment and human health. The aim of this study was to develop a sensitive and selective method using fully automatic solid-phase extraction coupled with ultra-performance liquid chromatography-tandem mass spectrometry for the determination of twelve TCs in water. Four isotope-labeled internal standards for TCs were used to correct matrix effects. Several parameters affecting extraction efficiency were systematically optimized, and the optimum experimental conditions found were 1.0 L water sample with 0.5 g/L Na2EDTA (pH 3.0) extracted and enriched by CNW HLB cartridge and eluted by 4 mL of acetone:methanol (v/v, 1:1). The enrichment factors were up to 798-1059 but only requiring about 60 min per six samples. Under the optimized conditions, the linearity of the method ranged from 0.2 to 100 μg/L for 12 TCs, the detection limits were as low as 0.01-0.15 ng/L, and the recoveries were in the range of 70%-118%, with relative standard deviations less than 15%. The developed method can be successfully utilized for the determination of 12 TCs in pure water, tap water, river water, and mariculture seawater. In summary, three and six TCs were detected in river water and mariculture seawater, respectively, with total concentrations of 0.074-0.520 ng/L (mean 0.248 ng/L) and 0.792-58.369 ng/L (12.629 ng/L), respectively. Tetracycline (TC) and oxytetracycline (OTC) were the dominant TCs in river water, while doxytetracycline (DXC) and OTC were dominant in mariculture seawater.
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  • 文章类型: Journal Article
    抗生素通常被添加到观赏性鱼缸中用于治疗细菌感染或作为预防措施。然而,抗生素的过度使用或亚治疗应用可能潜在地促进细菌中抗生素耐药性的选择,然而,没有研究调查抗生素在零售观赏鱼行业的使用及其对微生物群落的影响。本研究分析了在三个月的时间内每月从10家当地观赏鱼商店收集的运输水中20种抗生素的浓度(也来自零售店的鱼缸)。抗生素浓度与测序的微生物群落组成相关,并评估细菌耐药性选择的风险。结果显示,四环素的检测浓度在样品中最高,其次是氟喹诺酮类和大环内酯类。在三个月内检测到的土霉素浓度(44.3至2,262,064.2ngL-1)表明,大多数采样商店的耐药性选择风险很高。人畜共患病病原体(红球菌的种类,军团菌,和柠檬酸杆菌)与土霉素的浓度呈正相关,四环素,金霉素,和恩诺沙星.这表明在零售店使用抗生素可能会增加选择人畜共患病原体的可能性。这些发现揭示了观赏鱼零售店为抗生素病原体的选择创造有利环境的潜力,从而凸显了行业内加强抗生素管理的迫切需要。
    Antibiotics are routinely added to ornamental fish tanks for treating bacterial infection or as a prophylactic measure. However, the overuse or subtherapeutical application of antibiotics could potentially facilitate the selection of antibiotic resistance in bacteria, yet no studies have investigated antibiotic use in the retail ornamental fish sector and its impact on microbial communities. The present study analyzed the concentrations of twenty antibiotics in the carriage water (which also originates from fish tanks in retail shops) collected monthly from ten local ornamental fish shops over a duration of three months. The antibiotic concentrations were correlated with the sequenced microbial community composition, and the risk of resistance selection in bacteria was assessed. Results revealed that the detected concentrations of tetracyclines were the highest among samples, followed by fluoroquinolones and macrolides. The concentrations of oxytetracycline (44.3 to 2,262,064.2 ng L-1) detected across three months demonstrated a high risk for resistance selection at most of the sampled shops. Zoonotic pathogens (species of Rhodococcus, Legionella, and Citrobacter) were positively correlated with the concentrations of oxytetracycline, tetracycline, chlortetracycline, and enrofloxacin. This suggests that antibiotic use in retail shops may increase the likelihood of selecting for zoonotic pathogens. These findings shed light on the potential for ornamental fish retail shops to create a favorable environment for the selection of pathogens with antibiotics, thereby highlighting the urgent need for enhanced antibiotic stewardship within the industry.
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    文章类型: Journal Article
    围手术期皮炎(POD)是一种常见的,慢性,炎性面部皮肤皮疹,表现为微小丘疹和丘疹脓疱,带有潜在的湿疹样斑块,通常局限于口周,经鼻,和眶周区域。目前尚无食品和药物管理局(FDA)指定的POD治疗方法;但是,广谱抗生素作为一种有效的治疗选择。广谱抗生素对肠道菌群产生负面影响并导致抗生素耐药性。窄谱四环素,比如sarreccine,具有促进细菌耐药性和胃肠道问题的低潜力。
    我们进行了回顾性图表回顾,以评估在一组被诊断为POD的患者中使用sarecycine的疗效。
    使用电子病历完成病历审查。纳入标准包括18至95岁的男性和女性,诊断为POD,用sareccine治疗,并进行了有记录的随访。
    6名患者符合纳入标准,所有这些都显示出改善,没有报道的副作用。六个病人中,4例为女性,2例为男性,患者年龄为26~58岁(平均41岁).疗程为30至180天(中位数=90天)。
    根据结果,与替代的四环素类抗生素相比,使用sareccine治疗POD有许多潜在的益处.需要更大规模的临床研究来评估POD的治疗选择。基于在大规模痤疮研究中的功效和耐受性,sarecycline可能是POD的一种合适的新型治疗选择,应进一步探索。
    UNASSIGNED: Periorificial dermatitis (POD) is a common, chronic, inflammatory facial skin rash that presents as tiny papules and papulopustules with underlying eczematous-like patches, typically confined to the perioral, perinasal, and periorbital areas. There is currently no Food and Drug Administration (FDA)-indicated treatment for POD; however, broad-spectrum antibiotics are efficacious as a treatment option. Broad-spectrum antibiotics negatively impact gut flora and lead to antibiotic resistance. Narrow-spectrum tetracyclines, such as sarecycline, have a low potential for promoting bacterial resistance and gastrointestinal issues.
    UNASSIGNED: We conducted a retrospective chart review in order to evaluate the efficacy of sarecycline in a cohort of patients diagnosed with POD that were treated with sarecycline.
    UNASSIGNED: A review of medical records was completed using an electronic medical record. Inclusion criteria included males and females aged 18 to 95 with a diagnosis of POD, treated with sarecycline with a documented follow-up.
    UNASSIGNED: Six patients met inclusion criteria, all of which had shown improvement with no reported side effects. Of the six patients, four were female and two were male and the patient ages ranged from 26 to 58 years old (mean=41 years). The course of therapy ranged from 30 to180 days (median=90 days).
    UNASSIGNED: Based on the outcomes, there are many potential benefits to treatment of POD with sarecycline over the alternative tetracycline-class antibiotics. There is a need for more large-scale clinical studies evaluating treatment options for POD. Based on the efficacy and tolerability of sarecycline in large- scale acne studies, sarecycline may be an appropriate novel treatment option for POD and should be explored further.
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  • 文章类型: Case Reports
    军团菌,导致社区获得性肺炎的主要病原体之一,会导致军团菌肺炎,以严重肺炎为主要特征的病症。这种疾病,由嗜肺军团菌引起,可以迅速发展为危重肺炎,并且通常与多个器官的损害有关。因此,在临床诊断和治疗方面需要密切关注。Omadacycline,一种属于氨基甲基环素类抗生素的新型四环素衍生物,是衍生自米诺环素的半合成化合物。其主要结构特点,氨甲基改性,允许omadacycline克服细菌耐药性并扩大其对细菌的有效性范围。临床研究表明,奥马环素在体内不代谢,肝肾功能不全患者不需要调整剂量。本文报道了一例最初对莫西沙星经验性治疗无反应的患者,使用奥马环素成功治疗了军团菌肺炎。患者还经历了电解质紊乱,以及肝脏和肾脏的功能障碍,谵妄,和其他相关的精神症状。
    Legionella, one of the main pathogens that causes community-acquired pneumonia, can lead to Legionella pneumonia, a condition characterized predominantly by severe pneumonia. This disease, caused by the bacterium Legionella pneumophila, can quickly progress to critical pneumonia and is often associated with damage to multiple organs. As a result, it requires close attention in terms of clinical diagnosis and treatment. Omadacycline, a new type of tetracycline derivative belonging to the aminomethylcycline class of antibiotics, is a semi-synthetic compound derived from minocycline. Its key structural feature, the aminomethyl modification, allows omadacycline to overcome bacterial resistance and broadens its range of effectiveness against bacteria. Clinical studies have demonstrated that omadacycline is not metabolized in the body, and patients with hepatic and renal dysfunction do not need to adjust their dosage. This paper reports a case of successful treatment of Legionella pneumonia with omadacycline in a patient who initially did not respond to empirical treatment with moxifloxacin. The patient also experienced electrolyte disturbance, as well as dysfunction in the liver and kidneys, delirium, and other related psychiatric symptoms.
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  • 文章类型: Journal Article
    假体关节感染通常通过清创术和植入物保留(DAIR)或带有目标垫片放置的切除关节成形术来管理。两种手术方法都需要长时间的术后抗生素,四环素类抗生素尚未得到很好的研究。在这个回顾性案例系列中,我们纳入了在我们机构接受接受接受DAIR或终点间隔器治疗的葡萄球菌性人工关节感染治疗的患者,这些患者在手术后12周内从IV抗生素转为口服四环素.我们感兴趣的主要结果是初次手术后一年内治疗失败。在我们系列的患者中,88.2%(n=15)接受DAIR的患者和100%(n=7)接受带有目标垫片的切除关节成形术的患者在一年内没有发生事件。这些结果表明,使用口服四环素作为治疗这些感染的长期疗法是有效的并且耐受性良好。
    Prosthetic joint infections are often managed with debridement and implant retention (DAIR) or resection arthroplasty with destination spacer placement. Both surgical approaches require long courses of postoperative antibiotics, for which tetracycline antibiotics have not been well-studied. In this retrospective case series, we included patients at our institution treated for staphylococcal prosthetic joint infection managed with DAIR or destination spacer placement who were switched from IV antibiotics to oral tetracycline within 12 weeks of surgery. Our primary outcome of interest was treatment failure within one year of initial surgery. Among the patients in our series, 88.2% (n = 15) of patients who underwent DAIR and 100% (n = 7) of patients who underwent resection arthroplasty with destination spacer remained event-free for one year. These results demonstrated that the use of oral tetracyclines as long-term therapy in the treatment of these infections was effective and well-tolerated.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    背景:胰腺导管腺癌(PDAC)仍然是对健康的严重威胁,有效的治疗选择有限,特别是由于诊断的晚期阶段及其对化疗的固有抵抗力,使其成为全球癌症相关死亡的主要原因之一。缺乏明确的治疗方向强调了迫切需要创新方法来解决和管理这一致命疾病。在这项研究中,我们使用机器学习(ML)重新调整具有潜在抗癌活性的药物用途。
    方法:我们通过使用对富含药物-药物相互作用信息的药物-靶标相互作用信息进行训练的神经网络来解决该问题。以前没有用于抗癌药物的再利用。我们专注于埃拉环素,一种抗菌药物,选择并评估其抗癌作用。
    结果:埃拉瓦环素能显著抑制BxPC-3细胞的增殖和迁移,诱导细胞凋亡。
    结论:我们的研究强调了使用ML治疗癌症的药物再利用的潜力。伊拉伐环素在抑制癌细胞增殖方面显示出有希望的结果,PDAC中的迁移和诱导凋亡。这些发现表明,我们开发的ML药物再利用模型可以应用于广泛的新的肿瘤治疗,确定潜在的抗癌药物。这突出了潜力,并为确定新的治疗选择提供了有希望的方法。
    BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) remains a serious threat to health, with limited effective therapeutic options, especially due to advanced stage at diagnosis and its inherent resistance to chemotherapy, making it one of the leading causes of cancer-related deaths worldwide. The lack of clear treatment directions underscores the urgent need for innovative approaches to address and manage this deadly condition. In this research, we repurpose drugs with potential anti-cancer activity using machine learning (ML).
    METHODS: We tackle the problem by using a neural network trained on drug-target interaction information enriched with drug-drug interaction information, which has not been used for anti-cancer drug repurposing before. We focus on eravacycline, an antibacterial drug, which was selected and evaluated to assess its anti-cancer effects.
    RESULTS: Eravacycline significantly inhibited the proliferation and migration of BxPC-3 cells and induced apoptosis.
    CONCLUSIONS: Our study highlights the potential of drug repurposing for cancer treatment using ML. Eravacycline showed promising results in inhibiting cancer cell proliferation, migration and inducing apoptosis in PDAC. These findings demonstrate that our developed ML drug repurposing models can be applied to a wide range of new oncology therapeutics, to identify potential anti-cancer agents. This highlights the potential and presents a promising approach for identifying new therapeutic options.
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  • 文章类型: Journal Article
    耐碳青霉烯类鲍曼不动杆菌(CRAB)对几乎所有抗生素都具有耐药性。埃拉瓦环素,一种新的治疗选择,有可能治疗CRAB感染,然而,CRAB分离株对埃拉环素产生耐药性的机制尚待阐明.本研究旨在探讨CRAB临床分离株中埃拉环素异质耐药的特征和机制。从2020年到2022年,中国共收集了287株分离株。使用肉汤微量稀释测定埃拉环素和其他临床上可获得的药剂对鲍曼不动杆菌的最小抑制浓度(MIC)。通过人群分析(PAP)确定了埃拉环素异质耐药的频率。通过聚合酶链反应(PCR)和定量实时PCR(qRT-PCR)确定异源抗性分离株中抗性基因的突变和表达水平,分别。反义RNA沉默用于验证埃拉环素异源耐药候选基因的功能。在144个CRAB分离株中,埃拉环素MIC值≤4mg/L,检测到25个埃拉环素异源耐药菌株(17.36%),而碳青霉烯类敏感的鲍曼不动杆菌(CSAB)中未检测到埃拉环素异源耐药菌株。所有埃拉环素异源耐药菌株均含有OXA-23碳青霉烯酶,主要的多位点序列分型(MLST)为ST208(72%)。观察到埃拉环素之间的交叉耐药性,替加环素,耐药亚群中的左氧氟沙星。外排泵抑制剂的添加显着降低了耐药亚群中埃拉环素的MIC,并削弱了CRAB分离株中埃拉环素异质抗性的形成。抗性亚群中adeABC和adeRS的表达水平显著高于埃拉环素抗性亲本菌株(P<0.05)。在40%(10/25)的抗性亚群中鉴定出adeS基因中的ISAba1插入。通过反义RNA沉默降低adeABC或adeRS的表达显着抑制了埃拉环素的异质抗性。总之,这项研究确定了中国CRAB分离株中埃拉环素异株耐药性的出现,这与AdeABC和AdeRS的高表达有关。
    Carbapenem-resistant Acinetobacter baumannii (CRAB) is resistant to almost all antibiotics. Eravacycline, a newer treatment option, has the potential to treat CRAB infections, however, the mechanism by which CRAB isolates develop resistance to eravacycline has yet to be clarified. This study sought to investigate the features and mechanisms of eravacycline heteroresistance among CRAB clinical isolates. A total of 287 isolates were collected in China from 2020 to 2022. The minimum inhibitory concentration (MIC) of eravacycline and other clinically available agents against A. baumannii were determined using broth microdilution. The frequency of eravacycline heteroresistance was determined by population analysis profiling (PAP). Mutations and expression levels of resistance genes in heteroresistant isolates were determined by polymerase chain reaction (PCR) and quantitative real-time PCR (qRT-PCR), respectively. Antisense RNA silencing was used to validate the function of eravacycline heteroresistant candidate genes. Twenty-five eravacycline heteroresistant isolates (17.36%) were detected among 144 CRAB isolates with eravacycline MIC values ≤4 mg/L while no eravacycline heteroresistant strains were detected in carbapenem-susceptible A. baumannii (CSAB) isolates. All eravacycline heteroresistant strains contained OXA-23 carbapenemase and the predominant multilocus sequence typing (MLST) was ST208 (72%). Cross-resistance was observed between eravacycline, tigecycline, and levofloxacin in the resistant subpopulations. The addition of efflux pump inhibitors significantly reduced the eravacycline MIC in resistant subpopulations and weakened the formation of eravacycline heteroresistance in CRAB isolates. The expression levels of adeABC and adeRS were significantly higher in resistant subpopulations than in eravacycline heteroresistant parental strains (P < 0.05). An ISAba1 insertion in the adeS gene was identified in 40% (10/25) of the resistant subpopulations. Decreasing the expression of adeABC or adeRS by antisense RNA silencing significantly inhibited eravacycline heteroresistance. In conclusion, this study identified the emergence of eravacycline heteroresistance in CRAB isolates in China, which is associated with high expression of AdeABC and AdeRS.
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  • 文章类型: Journal Article
    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。
    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.
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