ศึกษาเปรียบเทียบประสิทธิผลของยา Azithromycin และ Doxycycline ที่ให้ร่วมกับยา Ceftriaxone  ในการรักษาโรคหนองในแท้และหนองในเทียม : การทบทวนวรรณกรรมอย่างเป็นระบบ

Pimchanok Paduka

Authors

Pimchanok Paduka Office of Disease Prevention and Control Region 6 Chonburi

Keywords:

Gonorrhoea, Non-gonococcal infection, Azithromycin, Doxycycline, Ceftriaxone, Systematic review

Abstract

This study aimed to perform a literature review relating to the effectiveness between Ceftriaxone with Azithromycin and Ceftriaxone with Doxycycline regimens on the treatment of gonorrhoea and non-gonococcal urethritis infection. This study was a systematic review using data from randomized controlled trials that were published in electronic databases between 2011 and 2023. The studies were searched in PubMed, ScienceDirect, Google Scholar, ThaiJo, Chulalongkorn University Intellectual Repository (CUIR), and National Research Council of Thailand (NRCT) using the relevant keywords. The quality of studies was evaluated using the Cochrane Collaboration’ s tool for assessing risk for bias. A total of 137 publications were gathered and screened. Only 4 of them were included to the analysis.

The results indicated that Ceftriaxone together with either Doxycycline or Azithromycin significantly had clinical efficacy in the treatment of urogenital chlamydial infection. However, 100 mg of Doxycycline twice daily provided higher clinical cure rate and microbiological cure rate than 1 g of Azithromycin single dose in the patients with chlamydial infection. The results from this systematic review showed higher efficacy in clinical cure and microbiological cure in patients using 100 mg of Doxycycline twice daily than 1 g of Azithromycin single dose. Therefore, the regimen of Ceftriaxone plus Doxycycline should be considered as the first-line therapy in the treatment of chlamydial infection.

References

กองระบาดวิทยา กรมควบคุมโรค. ระบบรายงานการเฝ้าระวังโรค ๕๐๖ [อินเทอร์เน็ต]. กรุงเทพฯ: กองระบาดวิทยา กรมควบคุมโรค กระทรวงสาธารณสุข; 2565. [เข้าถึงเมื่อ 1 ตุลาคม 2565]. เข้าถึงได้จาก: http://doe.moph.go.th/ surdata/index.php

Rossaphorn.k, Supachoke K. Treatment guidelines for Gonococcal, 2019 Division of AIDS and STIs, Department of Disease Control [Internet]. Bangkok: AKSORN GRPHIC AND DESIGN PUBLISHING; 2019 [cited 2023 Mar 15]. Available from: http://utoapp.moph.go.th/e_doc/views/uploads/5e4cbc41b41a702413010285f714b066770cc26dc5677-779.pdf

St Cyr S, Barbee L, Workowski KA, Bachmann LH, Pham C, Schlanger K, et al. Update to CDC’s treatment guidelines for gonococcal infection, 2020 [Internet]. [cited 2022 Oct 1]. Available from: https://doi.org/10.15585/mmwr.mm6950a6

สถาบันวิจัยและประเมินผลเทคโนโลยีทางการแพทย์. คู่มือการประเมินคุณภาพเอกสารงานวิจัย. [อินเทอร์เน็ต]. 2562. [เข้าถึงเมื่อ 15 มีนาคม 2566]. เข้าถึงได้จาก: http://www.imrta.dms.moph.go.th/imrta/images/doc20190110.pdf

Schwebke JR, Rompalo A, Taylor S, Seña AC, Martin DH, Lopez LM, et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens - a randomized clinical trial. Clin Infect Dis 2011;52(2):163-70.

Manhart LE, Gillespie CW, Lowens MS, Khosropour CM, Colombara DV, Golden MR, et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: A randomized controlled trial. Clin Infect Dis 2013;56(7):934-42.

Dombrowski JC, Wierzbicki MR, Newman LM, Powell JA, Miller A, Dithmer D, et al. Doxycycline Versus Azithromycin for the treatment of rectal chlamydia in men who have sex with men: A randomized controlled trial. Clin Infect Dis 2021;73(5):824-31.

Lau A, Kong FYS, Fairley CK, Templeton DJ, Amin J, Phillips S, et al. Azithromycin or Doxycycline for asymptomatic rectal Chlamydia trachomatis. N Engl J Med 2021;384(25):2418-27.

Aoki T, Mizushima D, Takano M, Ando N, Uemura H, Yanagawa Y, et al. Efficacy of 1 g Ceftriaxone monotherapy compared to dual therapy with Azithromycin or Doxycycline for treating extragenital gonorrhea among men Who have sex with men. Clin Infect Dis 2021;73(8):1452-58.

Singh AE, Gratrix J, Martin I, Friedman DS, Hoang L, Lester R, et al. Gonorrhea treatment failures with oral and injectable expanded spectrum cephalosporin monotherapy vs dual therapy at 4 canadian sexually transmitted infection clinics, 2010-2013. Sex Transm Dis 2015;42(6):331-6.

Savaris RF, Teixeira LM, Torres TG, Edelweiss MI, Moncada J, Schachter J. Comparing Ceftriaxone Plus Azithromycin or Doxycycline for pelvic inflammatory disease. [Internet]. 2007 [cited 2023 Aug 7]; 110(1):53-60. Available from: https://journals.lww.com/greenjournal/Abstract/2007/07000/Comparing_Ceftriaxone_Plus_Azithromycin_or.11.aspx