替考拉宁与万古霉素治疗革兰阳性菌感染疗效和安全性评价

目的:系统评价替考拉宁与万古霉素治疗G+感染的疗效及不良反应发生情况。方法:应用国际Cochrane协作网系统方法评价替考拉宁与万古霉素治疗G+感染的临床随机对照试验(RCT)。计算机检索Cochrane临床对照试验资料库、MEDLINE(1994-2010.12)和中文科技期刊数据库(1994-2010.12),纳入考拉宁与万古霉素治疗G+感染的RCT。由两名评价者独立提取资料并进行质量评估。试验数据的统计分析采用Cochrane协作网提供的Rev Man5.1软件。结果:最终纳入了10个RCT并对其疗效进行了Meta分析,共纳入758例患者,其中替考拉宁组358例,万古霉素组400例。Meta分析结果显示,替考拉宁组与万古霉素组治疗G+感染临床痊愈率分别为44.1%和39.8%;有效率分别为80.16%和80.00%;细菌清除率分别为86.12%和85.23%;不良反应发生率分别为18.16%和22.92%;其各自的综合OR值分别为0.98(95%CI为0.68～1.40),P=0.45;0.98(95%CI为0.68～1.40),P=0.90;1.05(95%CI为0.65～1.69),P=0.84;0.79(95%CI为0.54～1.15),P=0.22,差异均无统计学意义。结论:现有临床证据表明,替考拉宁与万古霉素治疗G+感染有效性和安全性相比,两药的疗效与不良反应相似。但万古霉素的"红人综合征"不良反应发生率要大一些。

Efficacy and adverse reactions of teicoplanin and vancomycin for treating gram-positive bacterial infections:a Meta-analysis

OBJECTIVE To assess the efficacy and adverse reactions of teicoplanin and vancomycin for treating gram-positive bacterial infections.METHODS A systematic review of randomized controlled trials(RCT) of teicoplanin and vancomycin for treating gram-positive bacterial infections was performed.Trials were identified by searching the Cochrane Library,MEDLINE(1997-12.2010) and CNKI(1997-12.2010).Two authors assessed the quality and reviewed the data independently.Statistical analysis was performed by using Rev Man 5.1.RESULTS Ten trials ranked high quality were included.The efficacy of the treatment of teicoplanin and vancomycin in gram-positive bacterial infections was assessed with Meta-analysis.A total of 758 patients entered the trials.Of them,358 patients were in the teicoplanin group,400 patients were in the vancomycin group.The meta-analysis revealed the following results:the clinical cure rates in the teicoplanin and vancomycin groups for treating bacterial infections of the respiratory and urinary systems were 44.1%and39.8%.respectively;the response rates were 80.16%and 80.00%.respectively;the bacterial clearance rates were 86.12%and85.23%,respectively;the incidence ofadverse reaction rates were 18.16%and 22.92%,respectively;their pooled OR were0.98(95%CI was 0.68-1.40),P=0.45、0.98(95%CI was 0.68-1.40),P=0.90、1.05(95%CI was 0.65-1.69),P=0.84、0.79(95%CI was 0.54-1.15),P=0.22,respectively.The differences were no significant.CONCLUSION The efficacy and adverse reactions of the teicoplanin therapy for gram-positive bacterial infections are similar to those of vancomycin.