替加环素单药与联合方案治疗多重耐药菌感染疗效对比的系统评价#br#

目的 替加环素是一种广谱的新型四环素类抗生素，长期单独使用可能存在耐药菌出现增多的问题。本文将系统性评价以替加环素为基础的联合治疗方案与替加环素单药方案治疗多重耐药菌感染疗效的对比。方法 通过检索PubMed、Embase、the Cochrane Library、CNKI、维普、万方等数据库及手工检索会议论文，寻找有关替加环素单药和联合治疗方案比较的随机对照研究、队列研究、病例丛和个案报道。检索日期截止到2016年12月31日。英文数据库的检索词为“tigecycline”、“tygacil”、“monotherapy”以及“combination”。中文数据库的检索词为“替加环素”、“单药”及“联合”。相关综述研究也一并手工检索。结果 仅1篇符合筛选条件的相关RCT研究。最终纳入9项对比研究(含1510个事件)和22项非对比性研究(含26个事件)。对比研究显示基于替加环素的联合治疗方案与替加环素单药治疗方案相比疗效上无显著差异。然而26例个案报道中23例显示替加环素联合的治疗方案临床效果会更佳。此外，研究还显示，与替加环素组合的治疗方案中最常见的抗菌药物是多黏菌素、碳青霉烯类、氨基糖苷类和氟喹诺酮类。结论 替加环素为基础的联合方案似乎更优于单药方案，常见有效的联合药物为多黏菌素、碳青霉烯类、氨基糖苷类和氟喹诺酮类。未来需要进行更多的前瞻性、随机对照、双盲研究来探索联合治疗方案和单药治疗方案疗效对比以及何种药物与替加环素的联合会更适宜。

Tigecycline-based combination treatment versus monotherapy for multidrug resistant infectious diseases: A systematic review#br#

Objection Tigecycline (TGC) is a novel glycylcycline that exhibits broad-spectrum antibacterial activities. However, there have been an increasing number of bacterial strains resistant to TGC, partly due to the long-term TGC monotherapy. We systematically reviewed the clinical efficacy of TGC alone or in combination with other antibiotics. Methods PubMed, Embase, the Cochrane Library, and relevant references and conference proceedings were searched for randomised controlled trials, cohort studies, case series, and case reports, according to a set of inclusion criteria, up to December 2016. Results Only one RCT was found in our review. Nine comparative studies (1510 episodes) and 22 non-comparative studies (26 episodes) were finally included for this review. Comparative studies showed no significant differences between TGC-based combinations and TGC monotherapy. However, 23 out of 26 cases demonstrated better clinical efficacy of TGC combination therapy. Additionally, utilization of TGC plus colistin, or a carbapenem, or an aminoglycoside, or a fluoroquinolone seemed more frequently among the combinationregimens. Conclusion Tigecycline-based combination regimens appear to be superior to monotherapy regimens. Common and effective combination drugs are polymyxin, carbapenems, aminoglycosides, and fluoroquinolones. In the future, it requires more prospective, randomized, comparative clinical trials to provide solid evidences with respect to the effectiveness of TGC-based combination and TGC