Updated therapeutic options for human brucellosis: A systematic review and network meta-analysis of randomized controlled trials

作者：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 · 发表于：PLoS neglected tropical diseases · 年份：2024 · DOI：10.1371/journal.pntd.0012405 · 被引用次数：16 · 研究领域：Brucella: diagnosis, epidemiology, treatment、Burkholderia infections and melioidosis、Zoonotic diseases and public health

BACKGROUND: 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. METHODS: 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). RESULTS: 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 0.5...