Objective To access the effectiveness and safety of levofloxacin in controlling multidrug resistant tuberculosis (MDR-TB). Methods The electronic searches in databases of PubMed, EMbase, The Cochrane Library, CNKI, CBM and VIP, handsearches and other searches were conducted from the date of their establishment to April 2011 for collecting randomized controlled trials (RCTs) on levofloxacin treating MDR-TB. Two researchers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, assessed the quality of the included studies by adopting the Jadad scale, and performed Meta-analysis by using RevMan 5.0 software. Results A total of 31 RCTs involving 2836 cases were included. The results of meta-analysis showed: a) Compared with the placebo group, levofloxacin could increase the sputum negative conversion rate after 3-month taking and at the end of the treatment period; b) Compared with the ofloxacin group, levofloxacin could increase the sputum negative conversion rate after 3 months and at the end of the treatment period; c) levofloxacin replacing either ethambutol or streptomycin could increase the sputum negative conversion rate after 3 months and at the end of the treatment period; d) Compared with the levofloxacin group, gatifloxacin and moxifloxacin could increase the sputum negative conversion rate after 3 months and at the end of the treatment period; e) There was no significant difference in the adverse reaction rate between each of the medication regimens (P=0.19). Conclusion Levofloxacin is more effective for MDR-TB than ofloxacin, ethambutol and streptomycin, but it is inferior to gatifloxacin or moxifloxacin. Its adverse reaction rate is equivalent to other medicines’.
【摘要】 目的 系统评价司帕沙星对比氧氟沙星治疗耐多药肺结核的有效性和安全性。 方法 计算机检索Cochrane图书馆临床对照试验资料库（2010年第2期）和PubMed（1978年-2010年10月）、EMBASE（1974年-2010年10月）、中国学术期刊网络出版总库（1978年-2010年10月）、维普（1989年-2010年10月）、中国生物医学文献数据库（1978年-2010年10月）；手工检索其他相关杂志。检索语种为中文和英文。纳入司帕沙星对比氧氟沙星治疗耐多药肺结核的随机对照试验。按Cochrane系统评价的方法评价纳入研究质量，用RevMan 5.0软件对数据进行Meta分析。 结果 共纳入8篇研究，Meta分析结果显示司帕沙星组与氧氟沙星组相比，痰菌转阴率、病灶显著吸收率、空洞闭合率均高于对照组，差异具有统计学意义（Plt;0.05）。 结论 现有的证据表明，司帕沙星与其他抗结核药物联用治疗难治、耐多药肺结核的疗效优于氧氟沙星的联用方案，但由于纳入的文献数量有限，质量参差不齐，存在潜在的发表偏倚。【Abstract】 Objective To assess the clinical efficacy and safety of sparfloxacin versus ofloxacin in treatment of multi-drug resistant pulmonary tuberculosis (MDR-TB). Methods Literatures were retrieved from PubMed (1978-October, 2010), EMBASE (1974-October 2010), Cochrane library (2nd volume, 2010), China Academic Journal Network Publishing Database (1978-October, 2010), VIP (1989-October, 2010) and CBM (1978 to October, 2010) by computer, and searched some other relevant journals manually. Chinese and English were both used in the search. Randomized controlled trials (RCTs) on sparfloxacin versus ofloxacin in treating pulmonary tuberculosis were included in this study. Meta-analysis was conducted by RevMan 5.0 software. Results The meta-analysis of 8 included RCTs showed that the sputum negative conversion rate, focus absorption rate, cavity closure rate in the sparfloxacin group were significantly higher than the ofloxacin group (P＜0.05). Conclusions The analysis indicates that combined treatment with sparfloxacin has a better effect in treating MDR-TB than with ofloxacin. However, the reliability of this review may be affected by the number and quality of studies included. Large-scale randomized controlled trials of high quality are needed to confirm the conclusions above.
ObjectiveTo overview the systematic reviews on the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients.MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were searched for systematic reviews about the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients from inception to December, 2018. Two reviewers independently screened literature, extracted data, evaluated the reporting and methodological qualities using the PRISMA checklist and the AMSTAR tool. After re-extraction of individual RCT data from included systematic reviews, meta-analysis was performed by Stata10.0 software.ResultsA total of 11 systematic reviews were included. The average methodological quality score was 8.13 in AMSTAR , the reporting quality score was from 19.5 to 25 in PRISMA. Re-performed meta-analysis showed that, the total success rate of operation was 93.3% (95%CI 92.9 to 93.8), the failure rate was 3.7% (95%CI 3.3 to 4.0), the mortality rate was 2.0% (95%CI 1.8 to 2.2), and the loss rate was 1.0% (95%CI 0.8 to 1.2). The cure rates of different surgical methods were all over 80%, among which single lobectomy (98.47%) and compound lobectomy (98.94%) had the higher cure rates than others. For the time of different surgical interventions, cure rate could be improved obviously in patients receiving surgery treatment after 1 months (OR=1.58, 95%CI 1.29 to 1.94, P=0.000 12), 1-8months (OR=1.66, 95%CI 1.30 to 2.12, P=0.000 05) and 9-24 months (OR=1.48, 95%CI 1.15 to 1.90, P=0.002) of anti-tuberculosis therapy compared with 0 month.There were significant differences between two groups.ConclusionCurrent evidence shows that operation is an effective way for severe multidrug-resistant pulmonary tuberculosis. Operative opportunity should be selected after 1-24 months of anti-tuberculosis drug treatment when the operation time depending on whether the tuberculosis has turned negative or not. Operative mode should be decided by the location and the scope of the lesion, which ensures the maximum excision of lesions and retention of lung function.