Dual versus triple therapy for uncomplicated brucellosis: A retrospective cohort study

Al-Madfaa, Rawan; Alalawi, Mai; Basudan, Lana O.; Alhejaili, Shahad; Eljaaly, Khalid; Madani, Tariq A.; Thabit, Abrar K.

doi:10.3855/jidc.12741

Cited by 9 publications

(8 citation statements)

References 33 publications

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“…A total of 2,537 papers were searched according to the search strategy. After removing duplicates and following the inclusion and exclusion criteria, we finally included 15 papers that were obtained from PubMed, Web of Science, CENTRAL, Embase, CNKI, and SinoMed databases in the meta-analysis (total of 1,466 patients and 35 treatment groups), consisting of 11 randomized controlled trials and 4 cohort studies [ 15 , 21 , 22 , 24 , 25 , 30 – 39 ]. Fig 1 shows the flow chart of the literature screening process.…”

Section: Resultsmentioning

confidence: 99%

“…For acute brucellosis, a combination of doxycycline, rifampicin, and streptomycin can achieve a 100% cure rate [ 21 ]; no cases of relapse after combined treatment with doxycycline and rifampin plus aminoglycosides for osteoarthritic brucellosis [ 22 ]; long-term triple therapy is also effective in patients with spinal bone destruction caused by brucellosis [ 23 ]. However, it has also been found that triple antibiotic therapy has the same clinical effect as dual antibiotic therapy in the treatment of brucellosis [ 24 , 25 ]; despite the higher efficacy of triple antibiotic therapy, the former has a higher rate of side effects compared to the dual antibiotic therapy regimen [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Better efficacy of triple antibiotics therapy for human brucellosis: A systematic review and meta-analysis

Huang,

Wang,

et al. 2023

PLoS Negl Trop Dis

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Background The treatment of brucellosis suffers from a high recurrence rate and drug resistance. Our study researched the differences in efficacy and side effects between triple antibiotics therapy and dual antibiotics therapy in the treatment of brucellosis through a systematic review and meta-analysis. Methods We searched 4 English electronic databases and 2 Chinese electronic databases for randomized controlled trials and cohort studies published through September 2022 on the use of triple antibiotics versus dual antibiotics in the treatment of brucellosis. Overall outcome indicators were therapeutic failure rate, relapse rate, overall therapeutic failure rate, and side effect rate. Relative risk (RR) and 95% confidence intervals (95% CIs) were used as summary statistics. A fixed-effects model was used to combine the overall effect sizes. Results The meta-analysis included 15 studies consisting of 11 randomized controlled trials and 4 cohort studies. Triple antibiotics showed better efficacy than dual antibiotics in a comparison of 3 overall outcome indicators (therapeutic failure rate (RR 0.42; 95% CI 0.30 to 0.59 heterogeneity P = 0.29, I2 = 15%), relapse rate (RR 0.29; 95% CI 0.18 to 0.45 heterogeneity P = 0.88, I2 = 0%), and overall therapeutic failure rate (RR 0.37; 95% CI 0.28 to 0.48 heterogeneity P = 0.35, I2 = 9%)). The incidence of side effects in patients with brucellosis treated with triple antibiotics was not significantly different from that in brucellosis patients treated with dual antibiotics (RR 0.85; 95% CI 0.67 to 1.06 heterogeneity P = 0.1, I2 = 35%). Sensitivity analyses showed robust results and Peter’s test showed no publication bias. The results of subgroup analyses for the research type, drugs, and type of brucellosis were largely consistent with the overall outcome indicators, indicating the reliability and robustness of the overall results. Conclusions In the treatment of brucellosis, triple antibiotics have better efficacy than dual antibiotics and do not increase the incidence of side effects.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Better efficacy of triple antibiotics therapy for human brucellosis: A systematic review and meta-analysis

Huang,

Wang,

et al. 2023

PLoS Negl Trop Dis

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“…Another unique adverse effect that tetracyclines share with fluoroquinolones is photosensitivity [27]. Both tetracyclines and fluoroquinolones are also indicated in brucellosis, a condition that requires a prolonged duration of therapy of at least six weeks [28]. They also share the same drug interaction of potential chelation with divalent and trivalent cations contained in minerals and antacids; though, doxycycline is not significantly affected when co-administered with milk, unlike tetracycline [1].…”

Section: Discussionmentioning

confidence: 99%

Long-term gastrointestinal adverse effects of doxycycline

Eljaaly

Alghamdi²,

Almehmadi³

et al. 2023

J Infect Dev Ctries

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Introduction: Doxycycline is an antibiotic with known gastrointestinal (GI) adverse effects. Esophagitis is the most pronounced among these effects, and might be associated with a prolonged duration of therapy. The aim of this study is to evaluate the incidence of esophagitis and other GI side effects in adults who received doxycycline for at least a month. Methodology: This retrospective descriptive study included adults who received oral doxycycline for at least one month between 2016 and 2018. The primary outcome was the frequency of esophagitis. The secondary outcomes were frequency of and discontinuation due to GI adverse effects. Results: A total of 189 subjects were included with a median age of 32 years. The median duration of doxycycline use was 44 days (interquartile range 30-60). Twelve patients (6.3%) reported having GI adverse effects resulting in doxycycline discontinuation in five of them (2.6%), and three patients (1.6%) had esophagitis. The incidence of GI adverse effects was significantly higher in patients who were ≥ 50 years than < 50 years old (8/50 vs. 4/139; p = 0.003) and in those who received a daily dose of 200 mg than 100 mg (12/93 vs. 0/96; p < 0.001). Conclusions: GI adverse events, including esophagitis, are not rare with long-term use of oral doxycycline, particularly in older age and a higher dose of 200 mg/day. Future large and randomized studies are needed to compare the efficacy and safety of different doxycycline doses.

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“…Our study was limited by a few factors. The first was the small number of patients in the BL-D arm, which was attributed to the fact that doxycycline is commonly used for indications other than CAP, such as skin infections, vaginal infections, and brucellosis [ 18 ]. Second, some patients had insufficient data in their electronic medical records to determine clinical cure or failure; hence, they could not be included in the study.…”

Section: Discussionmentioning

confidence: 99%

Doxycycline vs. macrolides in combination with a β-lactam antibiotic for the treatment of community-acquired pneumonia in inpatients

et al. 2022

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Background Hospitalized patients with non-severe community-acquired pneumonia (CAP) are treated with a β-lactam plus either a macrolide or doxycycline. Limited data exist on the effectiveness of the latter combination. Therefore, we aimed to compare the combination of doxycycline vs. macrolide when either is combined with a β-lactam from effectiveness and safety perspectives. Methods This was a retrospective cohort study in CAP inpatients between December 2013 and November 2020. Patients were divided into BL-D (β-lactam plus doxycycline) and BL-M (β-lactam plus a macrolide [azithromycin or clarithromycin]) groups. The primary endpoint was time to clinical stability. Secondary endpoints included length of stay (LOS) and in-hospital mortality. Results Of 197 patients included, 57 were in the BL-D arm and 140 were in the BL-M arm. Patients were similar at baseline, except for the presence of leukocytosis, risk factors for drug resistance, and duration of therapy (P < 0.05 for all comparisons). No difference in clinical cure rate was observed (94.7% vs. 91.4%; P = 0.43). Time to clinical stability and LOS were similar in both groups at 4 (P = 0.82) and 7 days (P = 0.62), respectively. While only three patients died, only one (from the BL-M group) was due to sepsis. Liver enzymes elevation was more prominent in the BL-M group (21.4% vs. 5.3%; P = 0.01). A subgroup analysis showed shorter time to clinical stability with clarithromycin but higher cure rates with azithromycin. Conclusions Data on doxycycline use with a β-lactam are scarce. Our study showed that such regimen was comparable in effectiveness to regimens involving macrolides with a better safety profile.

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Dual versus triple therapy for uncomplicated brucellosis: A retrospective cohort study

Cited by 9 publications

References 33 publications

Better efficacy of triple antibiotics therapy for human brucellosis: A systematic review and meta-analysis

Better efficacy of triple antibiotics therapy for human brucellosis: A systematic review and meta-analysis

Long-term gastrointestinal adverse effects of doxycycline

Doxycycline vs. macrolides in combination with a β-lactam antibiotic for the treatment of community-acquired pneumonia in inpatients

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