Syphilis Treatment: Systematic Review and Meta-Analysis Investigating Nonpenicillin Therapeutic Strategies.

Autor: Callado GY; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil., Gutfreund MC; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil., Pardo I; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil., Hsieh MK; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil., Lin V; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil., Sampson MM; Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, California, USA., Nava GR; Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, California, USA., Marins TA; Faculdade de Medicina, Centro Universitário de Adamantina, Adamantina, São Paulo, Brazil., Deliberato RO; Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.; Biomedical Informatics Division, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Martino MDV; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil., Holubar M; Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, California, USA., Salinas JL; Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, California, USA., Marra AR; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2024 Mar 13; Vol. 11 (4), pp. ofae142. Date of Electronic Publication: 2024 Mar 13 (Print Publication: 2024).
DOI: 10.1093/ofid/ofae142
Abstrakt: Background: Penicillin's long-standing role as the reference standard in syphilis treatment has led to global reliance. However, this dependence presents challenges, prompting the need for alternative strategies. We performed a systematic literature review and meta-analysis to evaluate the efficacy of these alternative treatments against nonneurological syphilis.
Methods: We searched MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Scopus, and Web of Science from database inception to 28 August 2023, and we included studies that compared penicillin or amoxicillin monotherapy to other treatments for the management of nonneurological syphilis. Our primary outcome was serological cure rates. Random-effect models were used to obtain pooled mean differences, and heterogeneity was assessed using the I 2 test.
Results: Of 6478 screened studies, 27 met the inclusion criteria, summing 6710 patients. The studies were considerably homogeneous, and stratified analyses considering each alternative treatment separately revealed that penicillin monotherapy did not outperform ceftriaxone (pooled odds ratio, 1.66 [95% confidence interval, .97-2.84]; I 2 = 0%), azithromycin (0.92; [.73-1.18]; I 2 = 0%), or doxycycline (0.82 [.61-1.10]; I 2 = 1%) monotherapies with respect to serological conversion.
Conclusions: Alternative treatment strategies have serological cure rates equivalent to penicillin, potentially reducing global dependence on this antibiotic.
Competing Interests: Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.
(© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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