美洛西林联合阿奇霉素治疗小儿肺炎链球菌肺炎疗效的Meta分析

目的：系统评价美洛西林联合阿奇霉素治疗小儿肺炎链球菌肺炎的疗效。方法：在PubMed、EMBase、Web of Science、the Cochrane Library、CNKI、CBM、VIP和万方数据库等中英文数据库检索国内外公开发表的关于美洛西林联合阿奇霉素治疗小儿肺炎链球菌肺炎临床效果的随机对照试验文献，根据Cochrane系统评价手册对所纳入研究进行质量评价。对纳入的文献采用RevMan 5.3软件进行Meta分析。结果：纳入6项RCT，共560例患儿。Meta分析结果显示美洛西林联合阿奇霉素的总有效率优于单用美洛西林（RR=1.27，95%CI 1.13~1.42，P<0.000，1）；退热时间（MD=-1.63，95%CI -1.71~-1.56，P<0.000，01）、咳嗽消失时间（MD=-2.19，95%CI -2.61~-1.78，P<0.000，01）、啰音消失时间（MD=-1.76，95%CI -2.32~-1.19，P<0.000，01）、X线表现消失时间（MD=-1.76，95%CI -2.33~-1.20，P<0.000，01）均比单用美洛西林时间更短，不良反应减少（RR=0.13，95%CI 0.05~0.36），差异有统计学意义（P<0.000，1）。结论：美洛西林联合阿奇霉素治疗小儿肺炎链球菌肺炎的疗效优于单用美洛西林。

Meta-Analysis on Efficacy of Meloxicillin Combined with Azithromycin in the Treatment of Streptococcus Pneumoniae Pneumonia in Children

Objective: To systematically evaluate the efficacy of meloxicillin combined with azithromycin in the treatment of Streptococcus pneumoniae pneumonia in children. Methods: PubMed, EMBase, Web of Science, the Cochrane Library, CNKI, CBM, VIP and Wanfang database were retrieved to collect the randomized controlled trial (RCT) of meloxicillin combined with azithromycin in the treatment of S. pneumoniae pneumonia in children. Quality of the included literature was evaluated according to the Cochrane evaluation criteria. Meta-analysis was performed on the included literature by using RevMan 5.3 software. Results: Totally 6 RCT were extracted, including 560 children. Meta-analysis showed that the total effective rate of meloxicillin combined with azithromycin was better than that of meloxicillin alone (RR=1.27, 95%CI from 1.13 to 1.42, P<0.000,1), duration of fever (MD=-1.63, 95%CI from -1.71 to -1.56, P<0.000,01), disappearance time of cough (MD=-2.19, 95%CI from -2.61 to -1.78, P<0.000,01), disappearance time of lung rales (MD=-1.76, 95%CI from -2.32 to -1.19, P<0.000,01), disappearance time of X-ray manifestations (MD=-1.76, 95%CI from -2.33 to -1.20, P<0.000,01) were shorter than those of meloxicillin alone, and the incidence of adverse drug reactions was lower than that of meloxicillin alone (RR=0.13, 95%CI from 0.05 to 0.36), with statistically significant difference (P<0.000,1). Conclusion: The efficacy of meloxicillin combined with azithromycin in the treatment of S. pneumoniae pneumonia in children is better than that of meloxicillin alone.