Interventions for treating melioidosis

  • Review
  • Intervention

Authors


Abstract

Background

Melioidosis is an infectious disease that occurs in tropical regions, particularly in Thailand. It is caused by the bacterium Burkholderia pseudomallei and is a serious condition which can be fatal. Beta-lactam antibiotics have dramatically reduced the risk of death, but mortality still remains high.

Objectives

To summarize reliable evidence on the effects of treatment regimens on death and relapse.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register (August 2004), CENTRAL (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to August 2004), EMBASE (1980 to August 2004), BIOSIS (up to August 2004), Health Star (up to August 2004), and reference lists of articles. We also contacted pharmaceutical companies and researchers in the field.

Selection criteria

Randomized and quasi-randomized controlled trials comparing antibiotic regimens in people with melioidosis.

Data collection and analysis

We independently assessed the eligibility of studies and the risk of bias in the trials. Adverse effects information was collected from the trials.

Main results

Nine trials, all from Thailand, involving a total of 872 participants were included. For intravenous therapy in the acute phase, we identified six trials with a total of 619 participants. Chloramphenicol, doxycycline, and co-trimoxazole (trimethoprim-sulphamethoxazole) combination regimens were associated with a mortality of 50% or more (two studies). Participants randomized to regimens including ceftazidime were more likely to survive (risk ratio [RR] 0.46; 95% confidence interval [CI] 0.30 to 0.71). When ceftazidime-containing regimens were compared with beta-lactam or alternative beta-lactamase inhibitor regimens such as co-amoxiclav (amoxycillin-clavulanic acid) and cefoperazone-sulbactam, or with imipenem, mortality rates were similar (RR 1.06; 95% CI 0.81 to 1.39). For oral therapy in the maintenance phase, we found three trials of 253 participants. They compared the conventional regimen (chloramphenicol, doxycycline, and trimethoprim-sulphamethoxazole) with other regimens (amoxycillin-clavulanic acid, ciprofloxacin-azithromycin, and doxycycline alone). There were fewer deaths with the conventional regimen, but no statistically significant differences demonstrated.

Authors' conclusions

Regimens for the acute phase of illness should contain ceftazidime or imipenem. It is not yet clear if combinations of treatments in the early phase reduce relapse. For oral therapy after the acute phase of treatment, trials suggest that conventional four drug regimens can be used for treatment.

摘要

治療類鼻疽的介入措施

研究背景

類鼻疽是一種發生在熱帶地區的感染疾病,尤其在泰國特別常見。它是由 Burkholderia pseudomallei菌所引起的感染,而且是一種嚴重的疾病,是可能致死的。Betalactam類抗生素可以大幅減少死亡的風險,但死亡率仍然居高不下。

研究目的

針對關於各種治療方案對類鼻疽死亡率及復發率影響的可靠證據做出總結。

检索策略

我們搜尋了the Cochrane Infectious Diseases Group Specialized Register (2004年8月)、CENTRAL (The Cochrane Library 2004年,第3期)、MEDLINE (1966年到2004年8月)、EMBASE (1980年到2004年8月)、BIOSIS (直到2004年8月)、Health Star (直到2004年8月),以及文獻的參考資料。同時也和藥廠及此領域的研究者連絡。

标准/纳入排除标准

以患有類鼻疽的的病患為研究對象,比較各種抗生素療法的隨機及半隨機對照試驗。

数据收集与分析

我們個別評估研究的可用性及試驗的方法品質。並從試驗中收集和不良反應的相關資訊。

主要结果

9個試驗,全部來自泰國,總共包含872位參與者。針對急性期的靜脈注射治療,我們找到6篇相關的試驗,總共包含619位參與者。Chloramphenicol、doxycycline及cotrimoxazole (trimethoprimsulphamethoxazole)的合併療法,死亡率為50%以上(2篇研究)。被隨機分配至包含ceftazidime的療法的參與者,有較高的存活率(relative risk [RR] 0.46; 95% confidence interval [CI] 0.30 to 0.71)。當以包含ceftazidime的療法和betalactam抗生素或替代的betalactamase抑制劑,例如 coamoxiclav (amoxycillinclavulanic acid)及cefoperazonesulbactam比較,或是和imipenem比較時,在死亡率上是很相似的(RR 1.06; 95% CI 0.81 to 1.39)。針對維持期的口服治療,我們找到了3個試驗,包含253位參與者。這些試驗以傳統療法(chloramphenicol、doxycycline及trimethoprimsulphamethoxazole)和其他療法(單獨使用amoxycillinclavulanic acid、ciprofloxacinazithromycin及doxycycline)比較。傳統療法的病患死亡數較少,但其間沒有統計學上的差異。

作者结论

針對類鼻疽急性期的治療應該包含ceftazidime或imipenem。目前仍不清楚,在發病初期使用合併療法是否能減少復發。急性期後的口服治療,試驗結果顯示,應該使用四個藥物和併使用的傳統療法。

Plain language summary

Interventions for treating melioidosis

Plain language summary pending.

概要

治療類鼻疽的介入措施 結論未定

翻译注解

Ancillary