Updated therapeutic options for human brucellosis: A systematic review and network meta-analysis of randomized controlled trials.
<h4>Background</h4>In clinical practice guidelines, there is no consensus about the medications that should be initially offered to patients with brucellosis. To provide informative evidence, we compared and ranked brucellosis medications based on their efficacy and safety.<h4>Meth...
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| Format: | Article |
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Public Library of Science (PLoS)
2024-08-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://doi.org/10.1371/journal.pntd.0012405 |
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| author | Shanjun Huang Jiaying Xu Hao Wang Zhuo Li Ruifang Song Yiting Zhang Menghan Lu Xin Han Tian Ma Yingtong Wang Jiaxin Hao Shanshan Song Qing Zhen Tiejun Shui |
| author_facet | Shanjun Huang Jiaying Xu Hao Wang Zhuo Li Ruifang Song Yiting Zhang Menghan Lu Xin Han Tian Ma Yingtong Wang Jiaxin Hao Shanshan Song Qing Zhen Tiejun Shui |
| author_sort | Shanjun Huang |
| collection | DOAJ |
| description | <h4>Background</h4>In clinical practice guidelines, there is no consensus about the medications that should be initially offered to patients with brucellosis. To provide informative evidence, we compared and ranked brucellosis medications based on their efficacy and safety.<h4>Methods</h4>For this systematic review and network meta-analysis, we searched 4 English databases and 3 Chinese databases, from the date of database inception to December 13, 2023. We included randomized controlled trials (RCTs) involving children and adolescents with brucellosis, comparing different antibiotic regimens. We excluded studies explicitly targeting patients with spondylitis brucellosis, endocarditis brucellosis, and neuro-brucellosis. The primary outcomes were overall failure (efficacy) and side effects (safety). Secondary outcomes were relapse and therapeutic failure. Pairwise meta-analysis was first examined. Data were analyzed using random effects network meta-analysis, with subgroup and sensitivity analyses performed. The Confidence in Network Meta-Analysis (CINeMA) framework was used to assess the certainty of evidence. The protocol was preregistered in PROSPERO (CRD42023491331).<h4>Results</h4>Of the 11,747 records identified through the database search, 43 RCTs were included in the network meta-analysis. Compared with standard therapy (Doxycycline + Rifampicin), Rifampicin + Tetracyclines (RR 4.96; 95% CI 1.47 to 16.70; very low certainty of evidence), Doxycycline + TMP/SMX (RR 0.18; 95% CI 0.06 to 0.52; low certainty of evidence), Doxycycline + Quinolones (RR 0.27; 95% CI 0.11 to 0.71; low certainty of evidence), Streptomycin + Tetracyclines (RR 0.04; 95% CI 0.01 to 0.16; low certainty of evidence), and Single (RR 0.05; 95% CI 0.02 to 0.16; moderate certainty of evidence) were less efficacious. Doxycycline + Gentamicin ranked the best in efficacy (SUCRA values: 0.94), the second is Triple (SUCRA values: 0.87), and the third is Doxycycline + Streptomycin (SUCRA values: 0.78).<h4>Conclusions</h4>Brucellosis medications differ in efficacy and safety. Doxycycline + Gentamicin, Triple, and Doxycycline + Streptomycin have superior efficacy and safety. Treatment of brucellosis should strike a balance between efficacy, safety, and cost. |
| format | Article |
| id | doaj-art-aeca92cf28474ade97b05b2c6cead664 |
| institution | Kabale University |
| issn | 1935-2727 1935-2735 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Neglected Tropical Diseases |
| spelling | doaj-art-aeca92cf28474ade97b05b2c6cead6642024-11-19T05:32:36ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352024-08-01188e001240510.1371/journal.pntd.0012405Updated therapeutic options for human brucellosis: A systematic review and network meta-analysis of randomized controlled trials.Shanjun HuangJiaying XuHao WangZhuo LiRuifang SongYiting ZhangMenghan LuXin HanTian MaYingtong WangJiaxin HaoShanshan SongQing ZhenTiejun Shui<h4>Background</h4>In clinical practice guidelines, there is no consensus about the medications that should be initially offered to patients with brucellosis. To provide informative evidence, we compared and ranked brucellosis medications based on their efficacy and safety.<h4>Methods</h4>For this systematic review and network meta-analysis, we searched 4 English databases and 3 Chinese databases, from the date of database inception to December 13, 2023. We included randomized controlled trials (RCTs) involving children and adolescents with brucellosis, comparing different antibiotic regimens. We excluded studies explicitly targeting patients with spondylitis brucellosis, endocarditis brucellosis, and neuro-brucellosis. The primary outcomes were overall failure (efficacy) and side effects (safety). Secondary outcomes were relapse and therapeutic failure. Pairwise meta-analysis was first examined. Data were analyzed using random effects network meta-analysis, with subgroup and sensitivity analyses performed. The Confidence in Network Meta-Analysis (CINeMA) framework was used to assess the certainty of evidence. The protocol was preregistered in PROSPERO (CRD42023491331).<h4>Results</h4>Of the 11,747 records identified through the database search, 43 RCTs were included in the network meta-analysis. Compared with standard therapy (Doxycycline + Rifampicin), Rifampicin + Tetracyclines (RR 4.96; 95% CI 1.47 to 16.70; very low certainty of evidence), Doxycycline + TMP/SMX (RR 0.18; 95% CI 0.06 to 0.52; low certainty of evidence), Doxycycline + Quinolones (RR 0.27; 95% CI 0.11 to 0.71; low certainty of evidence), Streptomycin + Tetracyclines (RR 0.04; 95% CI 0.01 to 0.16; low certainty of evidence), and Single (RR 0.05; 95% CI 0.02 to 0.16; moderate certainty of evidence) were less efficacious. Doxycycline + Gentamicin ranked the best in efficacy (SUCRA values: 0.94), the second is Triple (SUCRA values: 0.87), and the third is Doxycycline + Streptomycin (SUCRA values: 0.78).<h4>Conclusions</h4>Brucellosis medications differ in efficacy and safety. Doxycycline + Gentamicin, Triple, and Doxycycline + Streptomycin have superior efficacy and safety. Treatment of brucellosis should strike a balance between efficacy, safety, and cost.https://doi.org/10.1371/journal.pntd.0012405 |
| spellingShingle | Shanjun Huang Jiaying Xu Hao Wang Zhuo Li Ruifang Song Yiting Zhang Menghan Lu Xin Han Tian Ma Yingtong Wang Jiaxin Hao Shanshan Song Qing Zhen Tiejun Shui Updated therapeutic options for human brucellosis: A systematic review and network meta-analysis of randomized controlled trials. PLoS Neglected Tropical Diseases |
| title | Updated therapeutic options for human brucellosis: A systematic review and network meta-analysis of randomized controlled trials. |
| title_full | Updated therapeutic options for human brucellosis: A systematic review and network meta-analysis of randomized controlled trials. |
| title_fullStr | Updated therapeutic options for human brucellosis: A systematic review and network meta-analysis of randomized controlled trials. |
| title_full_unstemmed | Updated therapeutic options for human brucellosis: A systematic review and network meta-analysis of randomized controlled trials. |
| title_short | Updated therapeutic options for human brucellosis: A systematic review and network meta-analysis of randomized controlled trials. |
| title_sort | updated therapeutic options for human brucellosis a systematic review and network meta analysis of randomized controlled trials |
| url | https://doi.org/10.1371/journal.pntd.0012405 |
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