美罗培南与亚胺培南_西司他汀治疗_

美罗培南与亚胺培南_西司他汀治疗_ 中国抗生素杂志2014年10月第39卷第10期. 785 . 文章编号：1001-8689(2014)10-0785-06 美罗培南与亚胺培南/西司他汀治疗重症感染疗效与安 全性的Meta分析 刘茂昌1 葛苗苗2,* 陈渝军1 李石军2 汪洋1 (1 武汉市儿童医院药学部，武汉 430016；2 华中科技大学同济医学院协和医院， 武汉 430022) 摘要：目的 评价碳青霉烯类抗生素美罗培南与亚胺培南/西司他汀在重症感染治疗中的疗效和安全性 。方法 利用计算机检索EMBASE、MEDLINE、Cochrane library和KI等数据库， 纳入比较美罗培南与亚胺培南/西司他汀在相同给药剂量、给药下治疗重症感染疗效和安全性的随机对照试验(RCTs)， 采用RevMan 5.2.6软件对入选试验进行Meta分析。结果 共纳入16个随机对照试验，包括3055例重症感染患者。Meta分析结果显示，美罗培南相比亚胺培南/西司他汀在治疗重症感染中的临床有效率高[RR=1.03，95%CI(1.00，1.06)]。在临床治愈率[RR=1.04，95%CI(1.00，1.10)]与细菌清除率[RR=1.02，95%CI(0.97，1.07)]方面，美罗培南与亚胺培南/西司他汀相当。美罗培南组与药物相关不良反应发生率为11.6%，相比于亚胺培南/西司他汀组的13.6%[RR=0.85，95%CI(0.70，1.02)]，但中枢神经系统不良反应在亚胺培南/西司他汀组发生率较高(P＜0.01)。结论 现有证据表明，美罗培南在重症感染治疗中的临床有效率略优于亚胺培南/西司他汀，中枢神经系统不良反应发生率显著低于亚胺培南/西司他汀。 关键词：美罗培南；亚胺培南/西司他汀； 重症感染；Meta分析 中图分类号：R978.1 文献标志码：A DOI:10.13461/j.cnki.cja.005436 A Meta-analysis of the effi cacy and safety of meropenem with imipenem plus cilastatin in the treatment of severe infections Liu Mao-chang1, Ge Miao-miao2, Chen Yu-jun1, Li Shi-jun2 and Wang Yang1 (1 Wuhan Children’ s Hospital, Wuhan 430016; 2 Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022) Abstract Objective To compare the effectiveness and safety of meropenem with imipenem plus cilastatin in the treatment of severe infections. Methods The date were collected from the EMBASE, MEDLINE, Cochrane library and KI. Randomized controlled trials comparing meropenem with imipenem plus cilastatin administered at the same dosage regimen in patients with severe infections were eligible for inclusion. Meta-analysis was carried out using RevMan 5.2.6 software. Results Sixteen randomized controlled studies comparing meropenem with imipenem p lus cilastatin were analyzed, focusing on the 3,055 patients with severe infections. It was found by Meta-analysis that, meropenem exhibited a high clinical effi cacy rate compared with imipenem plus cilastati n in the treatm ent of severe infections[RR=1.03，95%CI(1.00，1.06)]. The clinical cure rate and bacterial eradication rate did not show any significant difference between the two drugs. Drug-related adverse events occurred in 11.6% and 13.6% of meropenem and imipenem plus cil astatin patients respectively[ RR=0.85，95%CI(0.70,1.02)]. However, the incidence of adverse reaction in central nervous system possessed a higher rate in imipenem plus cilastatin group(P<0.01). Conclusion The available evidence suggests that the clinical effi cacy rate of meropenem in the treatment of severe infections is slightly better than imipenem plus cilastatin. Moreover, meropenem shows signifi cantly lower incidence of adverse reaction in central nervous system than imipenem plus cilastatin. Key Words Meropenem; Imipenem plus cilastatin; Severe infection; Meta-analysis 收稿日期：2013-10-30 作者简介：刘茂昌，男，药师，硕士。研究方向：临床药学。*通迅作者， E-mail：gmmwrh@163.com。