Safety and efficacy of different antibiotic regimens in patients with ocular toxoplasmosis: systematic review and meta-analysis

Systematic Reviews

John E. Feliciano-Alfonso¹  Andrés Vargas-Villanueva²  Laura Triviño-Blanco²  Alejandra de-la-Torre²  María Alejandra Marín-Noriega²  Natalia Carvajal-Saiz²  Juliana Muñoz-Ortiz³ 

[1]Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia

[2]NeURos Research Group, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia

[3]NeURos Research Group, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia

[4]Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia

关键词: Toxoplasmosis;    ocular;    Toxoplasma gondii;    Uveitis;    Anti-bacterial agents;    Therapeutics;   

DOI  :  10.1186/s13643-021-01758-7

来源: Springer

【 摘 要 】

BackgroundOcular toxoplasmosis (OT) is the most common cause of posterior uveitis, which leads to visual impairment in a large proportion of patients. Antibiotics and corticosteroids lower the risk of permanent visual loss by controlling infection and inflammation. However, there remains disagreement regarding optimal antibiotic therapy for OT. Therefore, this systematic review and meta-analysis were performed to determine the effects and safety of existing antibiotic treatment regimens for OT.MethodsMEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, LILACS, WHO International Clinical Trials Registry Platform portal, ClinicalTrials.gov, and Gray Literature in Europe (“OpenGrey”) were searched for relevant studies; manual searches of reference lists were performed for studies identified by other methods. All published and unpublished randomized controlled trials that compared antibiotic schemes known to be effective in OT at any dosage, duration, and administration route were included. Studies comparing antibiotics with placebo were excluded. This review followed standard methodological procedures recommended by the Cochrane group.ResultsTen studies were included in the narrative summary, of which four were included for quantitative synthesis (meta-analysis). Interventions were organized into three groups: intravitreal clindamycin versus pyrimethamine + sulfadiazine, trimethoprim + sulfamethoxazole versus other antibiotics, and other interventions. The first comparison favored intravitreal clindamycin (Mean difference (MD) = 0.10 logMAR; 95% confidence interval = 0.01 to 0.22). However, this finding lacks clinical relevance. Other outcomes showed no statistically significant differences between the treatment groups. In general, the risk of performance bias was high in evaluated studies, and the quality of the evidence found was low to very low.ConclusionsNo antibiotic scheme was superior to others, and the selection of a treatment regimen depends on multiple factors; therefore, treatment should be chosen based on safety, sulfa allergies, and availability.

【 授权许可】

CC BY