Comparison of efficacy of treatments for early syphilis: A systematic review and network meta-analysis of randomized controlled trials and observational studies
Parenteral penicillin is the first-line regimen for treating syphilis, but unsuitable for some patients due to penicillin allergy and lacking health resources. Unfortunately, the efficacy of penicillin alternatives remains poorly understood. This study aimed to assess the efficacy of ceftriaxone and...
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| Veröffentlicht in: | PloS one 2017-06, Vol.12 (6), p.e0180001-e0180001 |
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| creator | Liu, Hong-Ye Han, Yan Chen, Xiang-Sheng Bai, Li Guo, Shu-Ping Li, Li Wu, Peng Yin, Yue-Ping |
| description | Parenteral penicillin is the first-line regimen for treating syphilis, but unsuitable for some patients due to penicillin allergy and lacking health resources. Unfortunately, the efficacy of penicillin alternatives remains poorly understood. This study aimed to assess the efficacy of ceftriaxone and doxycycline/tetracycline in treating early syphilis relative to that of penicillin, and thereby to determine which antibiotic is a better replacement for penicillin.
By searching literature from PubMed, Cochrane Central Register of Controlled Trials, Embase, the Web of Science, and ClinicalTrials.gov and systematically screening relevant studies, eligible randomized controlled trials (RCTs) and observational studies on treatments with penicillin, doxycycline/tetracycline, and ceftriaxone for early syphilis were identified and combined in this systematic review. Estimated risk ratios (RRs) and 95% confidence intervals (CIs) were utilized to compare their serological response and treatment failure rates. At 12-month follow up, serological response rates were compared by a direct meta-analysis and network meta-analysis (NMA), while treatment failure rates were compared with a direct meta-analysis.
Three RCTs and seven cohort studies were included in this research. The results of NMA demonstrated that no significant differences existed in serological response rate at 12-month follow-up between any two of the three treatments (doxycycline/tetracycline vs. penicillin RR = 1.01, 95%CI 0.89-1.14; ceftriaxone vs. penicillin RR = 1.00, 95%CI 0.89-1.13; ceftriaxone vs. doxycycline/tetracycline RR = 0.99, 95%CI 0.96-1.03), which was consistent with the outcomes of the direct meta-analysis. In addition, the direct meta-analysis indicated that, at 12-month follow-up, penicillin and ceftriaxone treatment groups had similar treatment failure rates (RR = 0.92, 95%CI 0.12-6.93), while treatment failure rate was significantly lower among penicillin recipients than among doxycycline/tetracycline recipients (RR = 0.58, 95%CI 0.38-0.89).
Ceftriaxone is as effective as penicillin in treating early syphilis with regard to serological response and treatment failure rate. Compared with doxycycline/tetracycline, ceftriaxone appears to be a better choice as the substitution of penicillin. |
| doi_str_mv | 10.1371/journal.pone.0180001 |
| format | Article |
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By searching literature from PubMed, Cochrane Central Register of Controlled Trials, Embase, the Web of Science, and ClinicalTrials.gov and systematically screening relevant studies, eligible randomized controlled trials (RCTs) and observational studies on treatments with penicillin, doxycycline/tetracycline, and ceftriaxone for early syphilis were identified and combined in this systematic review. Estimated risk ratios (RRs) and 95% confidence intervals (CIs) were utilized to compare their serological response and treatment failure rates. At 12-month follow up, serological response rates were compared by a direct meta-analysis and network meta-analysis (NMA), while treatment failure rates were compared with a direct meta-analysis.
Three RCTs and seven cohort studies were included in this research. The results of NMA demonstrated that no significant differences existed in serological response rate at 12-month follow-up between any two of the three treatments (doxycycline/tetracycline vs. penicillin RR = 1.01, 95%CI 0.89-1.14; ceftriaxone vs. penicillin RR = 1.00, 95%CI 0.89-1.13; ceftriaxone vs. doxycycline/tetracycline RR = 0.99, 95%CI 0.96-1.03), which was consistent with the outcomes of the direct meta-analysis. In addition, the direct meta-analysis indicated that, at 12-month follow-up, penicillin and ceftriaxone treatment groups had similar treatment failure rates (RR = 0.92, 95%CI 0.12-6.93), while treatment failure rate was significantly lower among penicillin recipients than among doxycycline/tetracycline recipients (RR = 0.58, 95%CI 0.38-0.89).
Ceftriaxone is as effective as penicillin in treating early syphilis with regard to serological response and treatment failure rate. Compared with doxycycline/tetracycline, ceftriaxone appears to be a better choice as the substitution of penicillin.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0180001</identifier><identifier>PMID: 28658325</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Allergies ; Alternatives ; Analysis ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Biology and Life Sciences ; Ceftriaxone ; Ceftriaxone - administration & dosage ; Ceftriaxone - therapeutic use ; Clinical trials ; Computer and Information Sciences ; Confidence intervals ; Dermatology ; Dosage and administration ; Doxycycline ; Drug therapy ; Drug Therapy, Combination ; Effectiveness ; Failure analysis ; Failure rates ; HIV ; Hospitals ; Human immunodeficiency virus ; Humans ; Hypersensitivity ; Infectious diseases ; Medical equipment ; Medical laboratories ; Medicine and Health Sciences ; Mens health ; Meta-analysis ; Molecular biology ; Observational studies ; Observational Studies as Topic ; Patients ; Penicillin ; Penicillins ; Penicillins - therapeutic use ; Physical Sciences ; Public health ; Randomized Controlled Trials as Topic ; Research and Analysis Methods ; Sexually transmitted diseases ; Skin diseases ; STD ; Studies ; Syphilis ; Syphilis - drug therapy ; Tetracycline - administration & dosage ; Tetracycline - therapeutic use ; Treatment Outcome</subject><ispartof>PloS one, 2017-06, Vol.12 (6), p.e0180001-e0180001</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Liu et al 2017 Liu et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-7d2e0b191201d592d181a0d60afb446f0873d839e37bba1dee9e19a263b27b503</citedby><cites>FETCH-LOGICAL-c692t-7d2e0b191201d592d181a0d60afb446f0873d839e37bba1dee9e19a263b27b503</cites><orcidid>0000-0003-3414-1867</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489196/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489196/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28658325$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>De Socio, Giuseppe Vittorio</contributor><creatorcontrib>Liu, Hong-Ye</creatorcontrib><creatorcontrib>Han, Yan</creatorcontrib><creatorcontrib>Chen, Xiang-Sheng</creatorcontrib><creatorcontrib>Bai, Li</creatorcontrib><creatorcontrib>Guo, Shu-Ping</creatorcontrib><creatorcontrib>Li, Li</creatorcontrib><creatorcontrib>Wu, Peng</creatorcontrib><creatorcontrib>Yin, Yue-Ping</creatorcontrib><title>Comparison of efficacy of treatments for early syphilis: A systematic review and network meta-analysis of randomized controlled trials and observational studies</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Parenteral penicillin is the first-line regimen for treating syphilis, but unsuitable for some patients due to penicillin allergy and lacking health resources. Unfortunately, the efficacy of penicillin alternatives remains poorly understood. This study aimed to assess the efficacy of ceftriaxone and doxycycline/tetracycline in treating early syphilis relative to that of penicillin, and thereby to determine which antibiotic is a better replacement for penicillin.
By searching literature from PubMed, Cochrane Central Register of Controlled Trials, Embase, the Web of Science, and ClinicalTrials.gov and systematically screening relevant studies, eligible randomized controlled trials (RCTs) and observational studies on treatments with penicillin, doxycycline/tetracycline, and ceftriaxone for early syphilis were identified and combined in this systematic review. Estimated risk ratios (RRs) and 95% confidence intervals (CIs) were utilized to compare their serological response and treatment failure rates. At 12-month follow up, serological response rates were compared by a direct meta-analysis and network meta-analysis (NMA), while treatment failure rates were compared with a direct meta-analysis.
Three RCTs and seven cohort studies were included in this research. The results of NMA demonstrated that no significant differences existed in serological response rate at 12-month follow-up between any two of the three treatments (doxycycline/tetracycline vs. penicillin RR = 1.01, 95%CI 0.89-1.14; ceftriaxone vs. penicillin RR = 1.00, 95%CI 0.89-1.13; ceftriaxone vs. doxycycline/tetracycline RR = 0.99, 95%CI 0.96-1.03), which was consistent with the outcomes of the direct meta-analysis. In addition, the direct meta-analysis indicated that, at 12-month follow-up, penicillin and ceftriaxone treatment groups had similar treatment failure rates (RR = 0.92, 95%CI 0.12-6.93), while treatment failure rate was significantly lower among penicillin recipients than among doxycycline/tetracycline recipients (RR = 0.58, 95%CI 0.38-0.89).
Ceftriaxone is as effective as penicillin in treating early syphilis with regard to serological response and treatment failure rate. Compared with doxycycline/tetracycline, ceftriaxone appears to be a better choice as the substitution of penicillin.</description><subject>Allergies</subject><subject>Alternatives</subject><subject>Analysis</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Biology and Life Sciences</subject><subject>Ceftriaxone</subject><subject>Ceftriaxone - administration & dosage</subject><subject>Ceftriaxone - therapeutic use</subject><subject>Clinical trials</subject><subject>Computer and Information Sciences</subject><subject>Confidence intervals</subject><subject>Dermatology</subject><subject>Dosage and administration</subject><subject>Doxycycline</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Effectiveness</subject><subject>Failure analysis</subject><subject>Failure rates</subject><subject>HIV</subject><subject>Hospitals</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Hypersensitivity</subject><subject>Infectious diseases</subject><subject>Medical equipment</subject><subject>Medical laboratories</subject><subject>Medicine and Health Sciences</subject><subject>Mens health</subject><subject>Meta-analysis</subject><subject>Molecular biology</subject><subject>Observational studies</subject><subject>Observational Studies as Topic</subject><subject>Patients</subject><subject>Penicillin</subject><subject>Penicillins</subject><subject>Penicillins - therapeutic use</subject><subject>Physical Sciences</subject><subject>Public health</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Research and Analysis Methods</subject><subject>Sexually transmitted diseases</subject><subject>Skin diseases</subject><subject>STD</subject><subject>Studies</subject><subject>Syphilis</subject><subject>Syphilis - drug therapy</subject><subject>Tetracycline - administration & dosage</subject><subject>Tetracycline - therapeutic use</subject><subject>Treatment Outcome</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk12L1DAUhoso7rr6D0QDgujFjEn67YUwDH4MLCz4dRvS5nQma9qMSTrr-Gv8qZ7udJep7IUU2kPyvO85OemJoqeMzlmcszeXtnedNPOt7WBOWUEpZfeiU1bGfJZxGt8_ik-iR95fUprGRZY9jE54kaVFzNPT6M_StlvptLcdsQ2BptG1rPdDHBzI0EIXPGmsIyCd2RO_32600f4tWWDsA7Qy6Jo42Gm4IrJTpINwZd0P0kKQM4kV7r32g5_DXdvq36BIbbvgrDEYBqel8ddKW3lwO_SzqCI-9EqDfxw9aBCAJ-P3LPr24f3X5afZ-cXH1XJxPquzkodZrjjQipWMU6bSkitWMElVRmVTJUnW0CKPVRGXEOdVJZkCKIGVkmdxxfMqpfFZ9PzguzXWi7G5XqBjkib4KpBYHQhl5aXYOt1KtxdWanG9YN1aSIfNMCDyJI-xDFXlvMAQS8i5oqypq6RiharQ692Yra9aUDV22UkzMZ3udHoj1nYn0qQoWZmhwavRwNmfPfggWu1rMEZ2YPtD3UWSsbxE9MU_6N2nG6m1xAPorrGYtx5MxSIpc84w65B2fgeFj4JW461Co3F9Ing9EQw3D7_CWvbei9WXz__PXnyfsi-P2A1IEzbemn74efwUTA5g7az3DprbJjMqhkG66YYYBkmMg4SyZ8cXdCu6mZz4L0JPHAY</recordid><startdate>20170628</startdate><enddate>20170628</enddate><creator>Liu, Hong-Ye</creator><creator>Han, Yan</creator><creator>Chen, Xiang-Sheng</creator><creator>Bai, Li</creator><creator>Guo, Shu-Ping</creator><creator>Li, Li</creator><creator>Wu, Peng</creator><creator>Yin, Yue-Ping</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-3414-1867</orcidid></search><sort><creationdate>20170628</creationdate><title>Comparison of efficacy of treatments for early syphilis: A systematic review and network meta-analysis of randomized controlled trials and observational studies</title><author>Liu, Hong-Ye ; Han, Yan ; Chen, Xiang-Sheng ; Bai, Li ; Guo, Shu-Ping ; Li, Li ; Wu, Peng ; Yin, Yue-Ping</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-7d2e0b191201d592d181a0d60afb446f0873d839e37bba1dee9e19a263b27b503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Allergies</topic><topic>Alternatives</topic><topic>Analysis</topic><topic>Anti-Bacterial Agents - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Hong-Ye</au><au>Han, Yan</au><au>Chen, Xiang-Sheng</au><au>Bai, Li</au><au>Guo, Shu-Ping</au><au>Li, Li</au><au>Wu, Peng</au><au>Yin, Yue-Ping</au><au>De Socio, Giuseppe Vittorio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of efficacy of treatments for early syphilis: A systematic review and network meta-analysis of randomized controlled trials and observational studies</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-06-28</date><risdate>2017</risdate><volume>12</volume><issue>6</issue><spage>e0180001</spage><epage>e0180001</epage><pages>e0180001-e0180001</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Parenteral penicillin is the first-line regimen for treating syphilis, but unsuitable for some patients due to penicillin allergy and lacking health resources. Unfortunately, the efficacy of penicillin alternatives remains poorly understood. This study aimed to assess the efficacy of ceftriaxone and doxycycline/tetracycline in treating early syphilis relative to that of penicillin, and thereby to determine which antibiotic is a better replacement for penicillin.
By searching literature from PubMed, Cochrane Central Register of Controlled Trials, Embase, the Web of Science, and ClinicalTrials.gov and systematically screening relevant studies, eligible randomized controlled trials (RCTs) and observational studies on treatments with penicillin, doxycycline/tetracycline, and ceftriaxone for early syphilis were identified and combined in this systematic review. Estimated risk ratios (RRs) and 95% confidence intervals (CIs) were utilized to compare their serological response and treatment failure rates. At 12-month follow up, serological response rates were compared by a direct meta-analysis and network meta-analysis (NMA), while treatment failure rates were compared with a direct meta-analysis.
Three RCTs and seven cohort studies were included in this research. The results of NMA demonstrated that no significant differences existed in serological response rate at 12-month follow-up between any two of the three treatments (doxycycline/tetracycline vs. penicillin RR = 1.01, 95%CI 0.89-1.14; ceftriaxone vs. penicillin RR = 1.00, 95%CI 0.89-1.13; ceftriaxone vs. doxycycline/tetracycline RR = 0.99, 95%CI 0.96-1.03), which was consistent with the outcomes of the direct meta-analysis. In addition, the direct meta-analysis indicated that, at 12-month follow-up, penicillin and ceftriaxone treatment groups had similar treatment failure rates (RR = 0.92, 95%CI 0.12-6.93), while treatment failure rate was significantly lower among penicillin recipients than among doxycycline/tetracycline recipients (RR = 0.58, 95%CI 0.38-0.89).
Ceftriaxone is as effective as penicillin in treating early syphilis with regard to serological response and treatment failure rate. Compared with doxycycline/tetracycline, ceftriaxone appears to be a better choice as the substitution of penicillin.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28658325</pmid><doi>10.1371/journal.pone.0180001</doi><orcidid>https://orcid.org/0000-0003-3414-1867</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2017-06, Vol.12 (6), p.e0180001-e0180001 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1914549148 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Allergies Alternatives Analysis Anti-Bacterial Agents - therapeutic use Antibiotics Biology and Life Sciences Ceftriaxone Ceftriaxone - administration & dosage Ceftriaxone - therapeutic use Clinical trials Computer and Information Sciences Confidence intervals Dermatology Dosage and administration Doxycycline Drug therapy Drug Therapy, Combination Effectiveness Failure analysis Failure rates HIV Hospitals Human immunodeficiency virus Humans Hypersensitivity Infectious diseases Medical equipment Medical laboratories Medicine and Health Sciences Mens health Meta-analysis Molecular biology Observational studies Observational Studies as Topic Patients Penicillin Penicillins Penicillins - therapeutic use Physical Sciences Public health Randomized Controlled Trials as Topic Research and Analysis Methods Sexually transmitted diseases Skin diseases STD Studies Syphilis Syphilis - drug therapy Tetracycline - administration & dosage Tetracycline - therapeutic use Treatment Outcome |
| title | Comparison of efficacy of treatments for early syphilis: A systematic review and network meta-analysis of randomized controlled trials and observational studies |
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