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Antibiotic prophylaxis for leptospirosis

  1. David M Brett-Major1,*,
  2. Robert J Lipnick2

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 17 FEB 2009

DOI: 10.1002/14651858.CD007342.pub2


How to Cite

Brett-Major DM, Lipnick RJ. Antibiotic prophylaxis for leptospirosis. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007342. DOI: 10.1002/14651858.CD007342.pub2.

Author Information

  1. 1

    NAVMED MPT&E, Military Tropical Medicine Course, Bethesda, MD, USA

  2. 2

    Armed Forces Health Surveillance Center, Communications, Standards, & Training Division, Silver Spring, MD, USA

*David M Brett-Major, Military Tropical Medicine Course, NAVMED MPT&E, 8901 Wisconsin Avenue, Bethesda, MD, 20889-5611, USA. dmbrettmajor@gmail.com. David.Brett-Major@med.navy.mil.

Publication History

  1. Publication Status: New
  2. Published Online: 8 JUL 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Leptospira infection is a global zoonosis with significant health impact for agricultural workers and those persons whose work or recreation takes them into endemic areas.

Objectives

This systematic review assessed the current literature for evidence for or against use of antibiotic prophylaxis against Leptospira infection (leptospirosis).

Search methods

The authors searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and SCI-Expanded as well as relevant professional society meeting abstracts until January 2009.

Selection criteria

Prospective, randomised clinical trials studying antibiotic prophylaxis against leptospirosis were selected.

Data collection and analysis

Data collection abstracted participant demographics and outcomes as well as features of trial design and quality. Trial results were analysed to independently determine outcomes, while multiple trial data was pooled when relevant.

Main results

Three trials were included, all of which evaluated doxycyline use. Trial quality suffered from a lack of intention-to-treat analysis and variability across trials in methodology and targeted outcomes. One trial assessed post-exposure prophylaxis in an indigenous population after a flood without apparent efficacy in reduction of clinical or laboratory identified Leptospira infection. Two trials assessed pre-exposure prophylaxis, one among deployed soldiers and another in an indigenous population. Despite an odds ratio of 0.05 (95% CI 0.01 to 0.36) for laboratory-identified infection among deployed soldiers on doxycyline in one of these two trials, pooled data showed no statistically significant reduction in Leptospira infection among participants (Odds ratio 0.28 (95% CI 0.01 to 7.48). Minor adverse events (predominantly nausea and vomiting) were more common among those on doxycycline with an odds ratio of 11 (95% CI 2.1 to 60).

Authors' conclusions

Regular use of weekly oral doxycycline 200 mg increases the odds for nausea and vomiting with unclear benefit in reducing Leptospira seroconversion or clinical consequences of infection.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Use of antibiotics may or may not prevent leptospirosis

This is a systematic review of clinical research testing whether taking the antibiotic can prevent infection from a water-borne bacteria called Leptospira. Data from different trials had conflicting results, and these trials targeted different kinds of people - travellers and people who live in at risk areas, encompassing soldiers, farmers, and students. Taken together, the data does not support the practice in all cases, though short term travellers with a potential for high risk exposure may be helped. People who took doxycycline were more likely to have stomach pain, nausea, and vomiting but the medication had to be stopped in only a few participants.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

抗生素預防鉤端螺旋體病

鉤端螺旋體感染是一種全球性的寄生蟲疾病,嚴重影響了農民以及到疫區工作或休閒民眾的健康。

目標

本次系統性回顧文獻評估了當前支持或反對針對鉤端螺旋體感染的資料。

搜尋策略

作者搜尋截至2009年1月的The Cochrane HepatoBiliary Group Controlled Trials Register, The Cochrane Library的Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, SCIExpanded和相關專業協會會議摘要。

選擇標準

研究針對鉤端螺旋體病使用預防性抗生素的前瞻性隨機臨床試驗。

資料收集與分析

收集有關受試者的資本資料,試驗結果和特徵,試驗品質的資料。分析試驗結果獨立判斷結果,以級同時合併相關多項試驗資料的結果。

主要結論

共包括3個試驗,3個試驗均評估使用doxycyline的結果。由於缺少意向治療分析以及試驗在方法論和目標結果上的變異性,導致試驗品質較低。一個試驗評估在洪水過後,使用doxycyline預防鉤端螺旋體病暴露後對土著人的療效,但是沒有明顯減少臨床或實驗室確定的鉤端螺旋體感染。2個試驗評估暴露前使用doxycyline預防,一個試驗針對士兵,另外一個試驗針對土著人。儘管在2個試驗中,一個試驗是對士兵使用doxycyline來預防實驗室確定的感染,得到的Odds ratio 是0.05 (95% CI 0.01 0.36),但是合併資料指出受試者的鉤端螺旋體感染率方面並沒有出現統計學上顯著的意義(Odds ratio 0.28 (95% CI 0.01 7.48)。服用doxycyline的人群有較普遍產生輕微的不良反應(主要是噁心和嘔吐),Odds ratio 11 (95% CI 2.1 60)。

作者結論

每週定期口服200 mg 的doxycyline會增加噁心和嘔吐的幾率,但是對降低鉤端螺旋體的血清轉化或臨床上的感染並沒有明確的功效。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

本次文獻系統性回顧了服用抗生素是否對經水傳播的鉤端螺旋體具有預防作用的臨床試驗。各種不同的試驗得到了互相矛盾的資料,這些試驗針對不同種類的人旅行者和住在風險區域的人群,囊括了士兵,農民和學生。總體而言,儘管可能對於短時間潛在暴露風險較高的遊客有效,但是上述資料並不能支持在所有情況下使用均可使用這種方法。服用doxycyline的人較容易出現胃痛,噁心和嘔吐,但是只有少數受試者因而停止使用藥物。