甲硝唑和克林霉素治疗细菌性阴道病有效性及安全性比较的Meta分析
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摘要
目的比较甲硝唑和克林霉素治疗细菌性阴道病(BV)的有效性及安全性。方法计算机检索PubMed、 Cochrane Library和Embase数据库中自建库至2018年2月1日公开发表的关于甲硝唑和克林霉素治疗BV的随机对照试验(RCT)。采用RevMan 5.3软件进行Meta分析。结果共纳入7项RCT,合计1 039例患者。Meta分析结果显示,甲硝唑和克林霉素治疗BV的治愈率差异无显著意义(RR=0.94, 95%CI:0.86～1.02, P=0.13)。在主要不良反应发生率方面,甲硝唑组恶心发生率高于克林霉素组(RR=10.95, 95%CI:2.56～46.78, P=0.001);而外阴阴道假丝酵母菌病、腹泻发生率两组比较均无显著差异(P> 0.05)。结论甲硝唑和克林霉素治疗BV的临床疗效相当,但克林霉素恶心发生率低于甲硝唑。
AIM To compare the efficacy and safety of metronidazole and clindamycin in the treatment of bacterial vaginosis(BV). METHODS The PubMed, Cochrane Library and Embase databases were searched by computer. The randomized controlled trials(RCT) about the metronidazole and clindamycin in the treatment of BV were selected from inception to February 1, 2018. Meta-analysis was performed by using RevMan 5.3 software. RESULTS A total of 7 RCT involving 1 039 patients were included. The meta-analysis showed no significant difference in the cure rate of metronidazole and clindamycin in the treatment of BV(RR = 0.94, 95%CI: 0.86-1.02, P = 0.13). In the incidence of major adverse reactions, the incidence of nausea in the metronidazole group was higher than that in the clindamycin group(RR = 10.95, 95% CI: 2.56-46.78, P =0.001). However, there was no significant difference in the incidence of vulvovaginal candidiasis and diarrhea between the two groups(P > 0.05). CONCLUSION The clinical efficacy of metronidazole and clindamycin in the treatment of BV is comparable, but the incidence of clindamycin induced nausea was lower than metronidazole.
AIM To compare the efficacy and safety of metronidazole and clindamycin in the treatment of bacterial vaginosis(BV). METHODS The PubMed, Cochrane Library and Embase databases were searched by computer. The randomized controlled trials(RCT) about the metronidazole and clindamycin in the treatment of BV were selected from inception to February 1, 2018. Meta-analysis was performed by using RevMan 5.3 software. RESULTS A total of 7 RCT involving 1 039 patients were included. The meta-analysis showed no significant difference in the cure rate of metronidazole and clindamycin in the treatment of BV(RR = 0.94, 95%CI: 0.86-1.02, P = 0.13). In the incidence of major adverse reactions, the incidence of nausea in the metronidazole group was higher than that in the clindamycin group(RR = 10.95, 95% CI: 2.56-46.78, P =0.001). However, there was no significant difference in the incidence of vulvovaginal candidiasis and diarrhea between the two groups(P > 0.05). CONCLUSION The clinical efficacy of metronidazole and clindamycin in the treatment of BV is comparable, but the incidence of clindamycin induced nausea was lower than metronidazole.
引文
[1] KENYON C, COLEBUNDERS R, CRUCITTI T. The global epidemiology of bacterial vaginosis:a systematic review[J]. Am J Obstet Gynecol, 2013, 209(6):505-523.
[2] SOBEL JD. Vaginitis[J]. 1997, 337(26):1896-1903.
[3] ESBER A, VICETTI MR, CHERPES TL, et al. Risk of bacterial vaginosis among women with herpes simplex virus type 2infection:a systematic review and meta-analysis[J]. J Infect Dis,2015, 212(1):8-17.
[4] GILLET E, MEYS JF, VERSTRAELEN H, et al. Bacterial vaginosis is associated with uterine cervical human papillomavirus infection:a meta-analysis[J]. BMC Infect Dis, 2011, 11:10.
[5] ATASHILI J, POOLE C, NDUMBE PM, et al. Bacterial vaginosis and HIV acquisition:a meta-analysis of published studies[J]. AIDS, 2008, 22(12):1493-1501.
[6] GILLET E, MEYS JF, VERSTRAELEN H, et al. Association between bacterial vaginosis and cervical intraepithelial neoplasia:systematic review and meta-analysis[J]. PLoS One, 2012, 7(10):e45201.
[7] AMSEL R, TOTTEN PA, SPIEGEL CA, et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations[J]. Am J Med, 1983, 74(1):14-22.
[8] NUGENT RP, KROHN MA, HILLIER SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation[J]. J Clin Microbiol, 1991,29(2):297-301.
[9]中华医学会妇产科学分会感染性疾病协作组.阴道微生态评价的临床应用专家共识[J].中华妇产科杂志, 2016, 51(10):721-723.
[10] PHEIFER TA, FORSYTH PS, DURFEE MA, et al. Nonspecific vaginitis:role of haemophilus vaginalis and treatment with metronidazole[J]. N Engl J Med, 1978, 298(26):1429-1434.
[11] SOBEL R, SOBEL JD. Metronidazole for the treatment of vaginal infections[J]. Expert Opin Pharmacother, 2015, 16(7):1109-1115.
[12]中华医学会妇产科学分会感染性疾病协作组.细菌性阴道病诊治指南(草案)[J].中华妇产科杂志, 2011, 46(4):317.
[13] FISCHBACH F, PETERSEN EE, WEISSENBACHER ER, et al.Efficacy of clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis[J]. Obstet Gynecol, 1993,82(3):405-410.
[14] ANDRES FJ, PARKER R, HOSEIN I, et al. Clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis:a prospective double-blind clinical trial[J].South Med J, 1992, 85(11):1077-1080.
[15] GREAVES WL, CHUNGAFUNG J, MORRIS B, et al.Clindamycin versus metronidazole in the treatment of bacterial vaginosis[J]. Obstet Gynecol, 1988, 72(5):799-802.
[16] MIKAMO H, KAWAZOE K, IZUMI K, et al. Bacteriological epidemiology and treatment of bacterial vaginosis[J]. Chemotherapy, 1996, 42(1):78-84.
[17] NYIRJESY P, MCINTOSH MJ, STEINMETZ JI, et al. The effects of intravaginal clindamycin and metronidazole therapy on vaginal mobiluncus morphotypes in patients with bacterial vaginosis[J]. Sex Transm Dis, 2007, 34(4):197-202.
[18] PAAVONEN J, MANGIONI C, MARTIN MA, et al. Vaginal clindamycin and oral metronidazole for bacterial vaginosis:a randomized trial[J]. Obstet Gynecol, 2000, 96(2):256-260.
[19] SCHMITT C, SOBEL JD, MERIWETHER C. Bacterial vaginosis:treatment with clindamycin cream versus oral metronidazole[J].Obstet Gynecol, 1992, 79(6):1020-1023.
[20] REITER S, KELLOGG SS. Bacterial vaginosis:a primer for clinicians[J]. Postgrad Med, 2019, 131(1):8-18.
[21] MURPHY PB, LE JK. Clindamycin[M]. StatPearls, Treasure Island(FL):StatPearls, 2018:2.
[22] BOHBOT JM, VICAUT E, FAGNEN D, et al. Treatment of bacterial vaginosis:a multicenter, double-blind, double-dummy,randomised phaseⅢstudy comparing secnidazole and metronidazole[J]. Infect Dis Obstet Gynecol, 2010, 2010:705692.
[23] MIZOCK BA. Probiotics[J]. Dis Mon, 2015, 61(7):259-290.
[24] BEIGI RH, AUSTIN MN, MEYN LA, et al. Antimicrobial resistance associated with the treatment of bacterial vaginosis[J].Am J Obstet Gynecol, 2004, 191(4):1124-1129.
[25] HAGGOUD A, M'HAND RA, REYSSET G, et al. Prevalence and characteristics of nim genes encoding 5-nitroimidazole resistance among bacteroides strains isolated in Morocco[J].Microb Drug Resist, 2001, 7(2):177-181.
[26] LEITSCH D. A review on metronidazole:an old warhorse in antimicrobial chemotherapy[J]. Parasitology, 2017:1-12.
[2] SOBEL JD. Vaginitis[J]. 1997, 337(26):1896-1903.
[3] ESBER A, VICETTI MR, CHERPES TL, et al. Risk of bacterial vaginosis among women with herpes simplex virus type 2infection:a systematic review and meta-analysis[J]. J Infect Dis,2015, 212(1):8-17.
[4] GILLET E, MEYS JF, VERSTRAELEN H, et al. Bacterial vaginosis is associated with uterine cervical human papillomavirus infection:a meta-analysis[J]. BMC Infect Dis, 2011, 11:10.
[5] ATASHILI J, POOLE C, NDUMBE PM, et al. Bacterial vaginosis and HIV acquisition:a meta-analysis of published studies[J]. AIDS, 2008, 22(12):1493-1501.
[6] GILLET E, MEYS JF, VERSTRAELEN H, et al. Association between bacterial vaginosis and cervical intraepithelial neoplasia:systematic review and meta-analysis[J]. PLoS One, 2012, 7(10):e45201.
[7] AMSEL R, TOTTEN PA, SPIEGEL CA, et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations[J]. Am J Med, 1983, 74(1):14-22.
[8] NUGENT RP, KROHN MA, HILLIER SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation[J]. J Clin Microbiol, 1991,29(2):297-301.
[9]中华医学会妇产科学分会感染性疾病协作组.阴道微生态评价的临床应用专家共识[J].中华妇产科杂志, 2016, 51(10):721-723.
[10] PHEIFER TA, FORSYTH PS, DURFEE MA, et al. Nonspecific vaginitis:role of haemophilus vaginalis and treatment with metronidazole[J]. N Engl J Med, 1978, 298(26):1429-1434.
[11] SOBEL R, SOBEL JD. Metronidazole for the treatment of vaginal infections[J]. Expert Opin Pharmacother, 2015, 16(7):1109-1115.
[12]中华医学会妇产科学分会感染性疾病协作组.细菌性阴道病诊治指南(草案)[J].中华妇产科杂志, 2011, 46(4):317.
[13] FISCHBACH F, PETERSEN EE, WEISSENBACHER ER, et al.Efficacy of clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis[J]. Obstet Gynecol, 1993,82(3):405-410.
[14] ANDRES FJ, PARKER R, HOSEIN I, et al. Clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis:a prospective double-blind clinical trial[J].South Med J, 1992, 85(11):1077-1080.
[15] GREAVES WL, CHUNGAFUNG J, MORRIS B, et al.Clindamycin versus metronidazole in the treatment of bacterial vaginosis[J]. Obstet Gynecol, 1988, 72(5):799-802.
[16] MIKAMO H, KAWAZOE K, IZUMI K, et al. Bacteriological epidemiology and treatment of bacterial vaginosis[J]. Chemotherapy, 1996, 42(1):78-84.
[17] NYIRJESY P, MCINTOSH MJ, STEINMETZ JI, et al. The effects of intravaginal clindamycin and metronidazole therapy on vaginal mobiluncus morphotypes in patients with bacterial vaginosis[J]. Sex Transm Dis, 2007, 34(4):197-202.
[18] PAAVONEN J, MANGIONI C, MARTIN MA, et al. Vaginal clindamycin and oral metronidazole for bacterial vaginosis:a randomized trial[J]. Obstet Gynecol, 2000, 96(2):256-260.
[19] SCHMITT C, SOBEL JD, MERIWETHER C. Bacterial vaginosis:treatment with clindamycin cream versus oral metronidazole[J].Obstet Gynecol, 1992, 79(6):1020-1023.
[20] REITER S, KELLOGG SS. Bacterial vaginosis:a primer for clinicians[J]. Postgrad Med, 2019, 131(1):8-18.
[21] MURPHY PB, LE JK. Clindamycin[M]. StatPearls, Treasure Island(FL):StatPearls, 2018:2.
[22] BOHBOT JM, VICAUT E, FAGNEN D, et al. Treatment of bacterial vaginosis:a multicenter, double-blind, double-dummy,randomised phaseⅢstudy comparing secnidazole and metronidazole[J]. Infect Dis Obstet Gynecol, 2010, 2010:705692.
[23] MIZOCK BA. Probiotics[J]. Dis Mon, 2015, 61(7):259-290.
[24] BEIGI RH, AUSTIN MN, MEYN LA, et al. Antimicrobial resistance associated with the treatment of bacterial vaginosis[J].Am J Obstet Gynecol, 2004, 191(4):1124-1129.
[25] HAGGOUD A, M'HAND RA, REYSSET G, et al. Prevalence and characteristics of nim genes encoding 5-nitroimidazole resistance among bacteroides strains isolated in Morocco[J].Microb Drug Resist, 2001, 7(2):177-181.
[26] LEITSCH D. A review on metronidazole:an old warhorse in antimicrobial chemotherapy[J]. Parasitology, 2017:1-12.
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