Efficacy of drug treatment for severe melioidosis and eradication treatment of melioidosis: A systematic review and network meta-analysis.
Journal
PLoS neglected tropical diseases
ISSN: 1935-2735
Titre abrégé: PLoS Negl Trop Dis
Pays: United States
ID NLM: 101291488
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
01
12
2022
accepted:
16
05
2023
revised:
23
06
2023
medline:
26
6
2023
pubmed:
12
6
2023
entrez:
12
6
2023
Statut:
epublish
Résumé
This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of all available treatments for severe melioidosis in decreasing hospital mortality and to identify eradication therapies with low disease recurrence rates and minimal risk of adverse drug events (AEs). Relevant randomized controlled trials (RCT) were searched from Medline and Scopus databases from their inception until July 31, 2022. RCTs that compared the efficacy between treatment regimens for severe melioidosis or eradication therapy of melioidosis, measured outcomes of in-hospital mortality, disease recurrence, drug discontinuation, or AEs, were included for review. A two-stage NMA with the surface under the cumulative ranking curve (SUCRA) was used to estimate the comparative efficacy of treatment regimens. Fourteen RCTs were included in the review. Ceftazidime plus granulocyte colony-stimulating factor (G-CSF), ceftazidime plus trimethoprim-sulfamethoxazole (TMP-SMX), and cefoperazone-sulbactam plus TMP-SMX had a lower mortality rate than other treatments and were ranked as the top three most appropriate treatments for severe melioidosis with the SUCRA of 79.7%, 66.6%, and 55.7%, respectively. However, these results were not statistically significant. For eradication therapy, treatment with doxycycline monotherapy for 20 weeks was associated with a significantly higher risk of disease recurrence than regimens containing TMP-SMX (i.e.,TMP-SMX for 20 weeks, TMP-SMX plus doxycycline plus chloramphenicol for more than 12 weeks, and TMP-SMX plus doxycycline for more than 12 weeks). According to the SUCRA, TMP-SMX for 20 weeks was ranked as the most efficacious eradication treatment (87.7%) with the lowest chance of drug discontinuation (86.4%), while TMP-SMX for 12 weeks had the lowest risk of AEs (95.6%). Our results found a non-significant benefit of ceftazidime plus G-CSF and ceftazidime plus TMP-SMX over other treatments for severe melioidosis. TMP-SMX for 20 weeks was associated with a lower recurrence rate and minimal risk of adverse drug events compared to other eradication treatments. However, the validity of our NMA may be compromised by the limited number of included studies and discrepancies in certain study parameters. Thus, additional well-designed RCTs are needed to improve the therapy of melioidosis.
Sections du résumé
BACKGROUND
BACKGROUND
This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of all available treatments for severe melioidosis in decreasing hospital mortality and to identify eradication therapies with low disease recurrence rates and minimal risk of adverse drug events (AEs).
METHODOLOGY
METHODS
Relevant randomized controlled trials (RCT) were searched from Medline and Scopus databases from their inception until July 31, 2022. RCTs that compared the efficacy between treatment regimens for severe melioidosis or eradication therapy of melioidosis, measured outcomes of in-hospital mortality, disease recurrence, drug discontinuation, or AEs, were included for review. A two-stage NMA with the surface under the cumulative ranking curve (SUCRA) was used to estimate the comparative efficacy of treatment regimens.
PRINCIPAL FINDINGS
RESULTS
Fourteen RCTs were included in the review. Ceftazidime plus granulocyte colony-stimulating factor (G-CSF), ceftazidime plus trimethoprim-sulfamethoxazole (TMP-SMX), and cefoperazone-sulbactam plus TMP-SMX had a lower mortality rate than other treatments and were ranked as the top three most appropriate treatments for severe melioidosis with the SUCRA of 79.7%, 66.6%, and 55.7%, respectively. However, these results were not statistically significant. For eradication therapy, treatment with doxycycline monotherapy for 20 weeks was associated with a significantly higher risk of disease recurrence than regimens containing TMP-SMX (i.e.,TMP-SMX for 20 weeks, TMP-SMX plus doxycycline plus chloramphenicol for more than 12 weeks, and TMP-SMX plus doxycycline for more than 12 weeks). According to the SUCRA, TMP-SMX for 20 weeks was ranked as the most efficacious eradication treatment (87.7%) with the lowest chance of drug discontinuation (86.4%), while TMP-SMX for 12 weeks had the lowest risk of AEs (95.6%).
CONCLUSION
CONCLUSIONS
Our results found a non-significant benefit of ceftazidime plus G-CSF and ceftazidime plus TMP-SMX over other treatments for severe melioidosis. TMP-SMX for 20 weeks was associated with a lower recurrence rate and minimal risk of adverse drug events compared to other eradication treatments. However, the validity of our NMA may be compromised by the limited number of included studies and discrepancies in certain study parameters. Thus, additional well-designed RCTs are needed to improve the therapy of melioidosis.
Identifiants
pubmed: 37307278
doi: 10.1371/journal.pntd.0011382
pii: PNTD-D-22-01512
pmc: PMC10289671
doi:
Substances chimiques
Trimethoprim, Sulfamethoxazole Drug Combination
8064-90-2
Doxycycline
N12000U13O
Ceftazidime
9M416Z9QNR
Granulocyte Colony-Stimulating Factor
143011-72-7
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0011382Informations de copyright
Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Intensive Care Med. 2016 Oct;42(10):1535-1545
pubmed: 26754759
Antimicrob Agents Chemother. 1992 Jan;36(1):158-62
pubmed: 1590682
Cochrane Database Syst Rev. 2001;(2):CD001263
pubmed: 11405983
Lancet. 2014 Mar 1;383(9919):807-14
pubmed: 24284287
Ann Intern Med. 2015 Jun 2;162(11):777-84
pubmed: 26030634
Trans R Soc Trop Med Hyg. 2000 May-Jun;94(3):301-4
pubmed: 10975006
Trop Med Infect Dis. 2018 Mar 01;3(1):
pubmed: 30274424
Res Synth Methods. 2016 Sep;7(3):329-32
pubmed: 26588593
Clin Infect Dis. 2007 Aug 1;45(3):308-14
pubmed: 17599307
Trop Med Infect Dis. 2018 May 22;3(2):
pubmed: 30274447
Lancet. 1989 Sep 23;2(8665):697-701
pubmed: 2570956
PLoS Negl Trop Dis. 2015 Mar 26;9(3):e0003586
pubmed: 25811783
Am J Trop Med Hyg. 2010 Jun;82(6):1113-7
pubmed: 20519609
Trans R Soc Trop Med Hyg. 1995 Sep-Oct;89(5):546-9
pubmed: 8560537
Am J Trop Med Hyg. 2001 Jan-Feb;64(1-2):24-7
pubmed: 11425157
Clin Infect Dis. 2006 Oct 15;43(8):979-86
pubmed: 16983608
Lancet Infect Dis. 2021 Dec;21(12):1737-1746
pubmed: 34303419
Crit Care. 2011;15(1):R58
pubmed: 21310070
Clin Infect Dis. 1999 Aug;29(2):375-80
pubmed: 10476745
J Med Microbiol. 1990 Feb;31(2):109-14
pubmed: 2304065
Clin Infect Dis. 2001 Jul 1;33(1):29-34
pubmed: 11389491
BMC Infect Dis. 2010 Oct 21;10:302
pubmed: 20964837
Br Med Bull. 2011;99:125-39
pubmed: 21558159
Clin Infect Dis. 1994 Nov;19(5):846-53
pubmed: 7893868
J Antimicrob Chemother. 1994 Jan;33(1):145-9
pubmed: 7512547
Clin Infect Dis. 2005 Oct 15;41(8):1105-13
pubmed: 16163628
Clin Pharmacol Ther. 1999 Oct;66(4):415-24
pubmed: 10546926
J Med Assoc Thai. 1998 Apr;81(4):265-71
pubmed: 9623020
Clin Infect Dis. 2004 Jan 1;38(1):32-7
pubmed: 14679445
Clin Infect Dis. 1999 Aug;29(2):381-7
pubmed: 10476746
Eur J Med Res. 2005 Jan 28;10(1):29-35
pubmed: 15737951
Crit Care Med. 2016 Aug;44(8):1500-5
pubmed: 26963328
J Infect Dis. 1993 Nov;168(5):1181-5
pubmed: 8228352
Clin Infect Dis. 2021 Dec 6;73(11):e3627-e3633
pubmed: 32725199
PLoS Negl Trop Dis. 2020 Sep 28;14(9):e0008659
pubmed: 32986699
Crit Care Med. 2008 Feb;36(2):448-54
pubmed: 18216600
Res Synth Methods. 2012 Jun;3(2):98-110
pubmed: 26062084
Antimicrob Agents Chemother. 2005 Oct;49(10):4020-5
pubmed: 16189075
Trop Med Infect Dis. 2018 Jun 10;3(2):
pubmed: 30274458