Urogenital Chlamydia Trachomatis Treatment Failure With Azithromycin: A Meta-Analysis

Abstractbackground: chlamydia trachomatis is one of the most common pathogens transmitted through the genital tract in humans that leads to urogenital infection. objective: given the high prevalence of chlamydia infection and its adverse effects on the health of women and men, the present metaanalysis was conducted to determine the rate of treatment failure with azithromycin.materials and methods: databases including medline, isi web of science, pubmed, embase, scopus, proquest, and science direct were searched for articles published between 1991 and 2018. the quality of the selected articles was assessed using the cochrane risk of bias assessment tool. heterogeneity was determined using the i2 and cochrane qtest. subgroup analysis and metaregression were used to compare the prevalence rates on different levels of the variables. results: a total of 21 articles that met the inclusion criteria were ultimately assessed. the pooled estimate of azithromycin failure rate was 11.23% (ci 95%: 8.23%14.24%). also, the azithromycin failure rate was 15.87% (ci 95%: 10.20%21.54%) for the treatment of urethritis, 7.41% (ci 95%: 0.60%14.22%) for cervicitis, and 7.14% (ci 95%: 10.90%3.39%) for genital chlamydia. the pooled estimate of failure rate difference was 2.37% (ci 95%: 0.68%4.06%), which shows that azithromycin has a higher failure rate in the treatment of chlamydia compared to doxycycline and other examined medications. the metaregression results showed that the patient's age contributes significantly to the heterogeneity for azithromycin treatment failure rate ( beta; = 0.826; p = 0.017).conclusion: azithromycin has a higher failure rate than doxycycline and other studied medications in treating urogenital chlamydia infections. key words: azithromycin, chlamydia trachomatis, urogenital, treatment failure, metaanalysis. abstractbackground: chlamydia trachomatis is one of the most common pathogens transmitted through the genital tract in humans that leads to urogenital infection. objective: given the high prevalence of chlamydia infection and its adverse effects on the health of women and men, the present metaanalysis was conducted to determine the rate of treatment failure with azithromycin.materials and methods: databases including medline, isi web of science, pubmed, embase, scopus, proquest, and science direct were searched for articles published between 1991 and 2018. the quality of the selected articles was assessed using the cochrane risk of bias assessment tool. heterogeneity was determined using the i2 and cochrane qtest. subgroup analysis and metaregression were used to compare the prevalence rates on different levels of the variables. results: a total of 21 articles that met the inclusion criteria were ultimately assessed. the pooled estimate of azithromycin failure rate was 11.23% (ci 95%: 8.23%14.24%). also, the azithromycin failure rate was 15.87% (ci 95%: 10.20%21.54%) for the treatment of urethritis, 7.41% (ci 95%: 0.60%14.22%) for cervicitis, and 7.14% (ci 95%: 10.90%3.39%) for genital chlamydia. the pooled estimate of failure rate difference was 2.37% (ci 95%: 0.68%4.06%), which shows that azithromycin has a higher failure rate in the treatment of chlamydia compared to doxycycline and other examined medications. the metaregression results showed that the patient's age contributes significantly to the heterogeneity for azithromycin treatment failure rate ( beta; = 0.826; p = 0.017).conclusion: azithromycin has a higher failure rate than doxycycline and other studied medications in treating urogenital chlamydia infections.

شکست درمان با آزیترومایسین در کلامیدیا تراکوماتیس اوروژنیتال: مرور سیستماتیک و متاآنالیز

مقدمه: کلامیدیا تراکوماتیس یکی از شایع‌ترین پاتوژن‌های منتقله از راه دستگاه تناسلی در انسان است که منجر به بروز عفونت اوروژنیتال می گردد. هدف: با توجه به شیوع بالای این عفونت کلامیدیا و پیامدهای نامطلوب آن بر سلامت زنان و مردان، این مطالعه متاآنالیز با هدف تعیین میزان شکست درمان با آزیترومایسین انجام گرفت.موارد و روش ها: پایگاه های اطلاعاتیMEDLINE ، ISI Web of Science، PubMed، EMBASE، Scopus، ProQuest و Science Direct برای مقالاتی که از سال 1991 تا 2018 منتشر شده بود مورد بررسی قرار گرفتند. برای ارزیابی کیفیت مطالعات انتخاب شده، از Cochrane Risk of Bias Assessment Tool استفاده شد. از 12 و کوکران کیوتست برای تعیین هتروژنیسیتی استفاده شد. برای مقایسه شیوع در سطوح مختلف متغیرها از روش Subgroup analysis and metaregression استفاده شده است.نتایج: 21 مطالعه که معیارهای ورود را دارا بودند در نهایت تجزیه و تحلیل شد. برآورد تلفیقی میزان شکست آزیترومایسین 23/11% بود. همچنین درصد شکست آزیترومایسین در درمان اورتریت (87/15%)، سرویسیت (41/7%) و ژنیتال کلامیدیا (14/7%) بود. برآورد تلفیقی تفاوت میزان شکست 37/2% بود که نشان می دهد شکست درمان آزیترومایسین در درمان کلامیدیا نسبت به داکسی سیکلین و سایر داروهای مورد بررسی در مطالعه بیشتر می باشد. نتایج متارگرسیون حاکی از آن بود که سن بیماران در ایجاد هتروژنیسیتی برای درصد شکست درمان آزیترومایسین تاثیر معنی داری داشت (826/0, szlig;= 017/0p= ).نتیجه گیری: شکست درمان با آزیترومایسین در عفونت های کلامیدیایی اوروژنیتال نسبت به داکسی سیکلین و سایر داروهای مورد بررسی در مطالعه بیشتر می باشد.