PMID- 28658325
OWN - NLM
STAT- MEDLINE
DCOM- 20170922
LR  - 20181202
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 6
DP  - 2017
TI  - Comparison of efficacy of treatments for early syphilis: A systematic review and 
      network meta-analysis of randomized controlled trials and observational studies.
PG  - e0180001
LID - 10.1371/journal.pone.0180001 [doi]
AB  - BACKGROUND: Parenteral penicillin is the first-line regimen for treating
      syphilis, but unsuitable for some patients due to penicillin allergy and lacking 
      health resources. Unfortunately, the efficacy of penicillin alternatives remains 
      poorly understood. This study aimed to assess the efficacy of ceftriaxone and
      doxycycline/tetracycline in treating early syphilis relative to that of
      penicillin, and thereby to determine which antibiotic is a better replacement for
      penicillin. METHOD: By searching literature from PubMed, Cochrane Central
      Register of Controlled Trials, Embase, the Web of Science, and ClinicalTrials.gov
      and systematically screening relevant studies, eligible randomized controlled
      trials (RCTs) and observational studies on treatments with penicillin,
      doxycycline/tetracycline, and ceftriaxone for early syphilis were identified and 
      combined in this systematic review. Estimated risk ratios (RRs) and 95%
      confidence intervals (CIs) were utilized to compare their serological response
      and treatment failure rates. At 12-month follow up, serological response rates
      were compared by a direct meta-analysis and network meta-analysis (NMA), while
      treatment failure rates were compared with a direct meta-analysis. RESULT: Three 
      RCTs and seven cohort studies were included in this research. The results of NMA 
      demonstrated that no significant differences existed in serological response rate
      at 12-month follow-up between any two of the three treatments
      (doxycycline/tetracycline vs. penicillin RR = 1.01, 95%CI 0.89-1.14; ceftriaxone 
      vs. penicillin RR = 1.00, 95%CI 0.89-1.13; ceftriaxone vs.
      doxycycline/tetracycline RR = 0.99, 95%CI 0.96-1.03), which was consistent with
      the outcomes of the direct meta-analysis. In addition, the direct meta-analysis
      indicated that, at 12-month follow-up, penicillin and ceftriaxone treatment
      groups had similar treatment failure rates (RR = 0.92, 95%CI 0.12-6.93), while
      treatment failure rate was significantly lower among penicillin recipients than
      among doxycycline/tetracycline recipients (RR = 0.58, 95%CI 0.38-0.89).
      CONCLUSION: Ceftriaxone is as effective as penicillin in treating early syphilis 
      with regard to serological response and treatment failure rate. Compared with
      doxycycline/tetracycline, ceftriaxone appears to be a better choice as the
      substitution of penicillin.
FAU - Liu, Hong-Ye
AU  - Liu HY
AUID- ORCID: http://orcid.org/0000-0003-3414-1867
AD  - Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of
      Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College,
      Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 
      China.
AD  - Department of Dermatology and Venereology, First Affiliated Hospital of Shanxi
      Medical University, Taiyuan, China.
FAU - Han, Yan
AU  - Han Y
AD  - Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of
      Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College,
      Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 
      China.
FAU - Chen, Xiang-Sheng
AU  - Chen XS
AD  - Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of
      Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College,
      Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 
      China.
FAU - Bai, Li
AU  - Bai L
AD  - Department of Dermatology and Venereology, First Affiliated Hospital of Shanxi
      Medical University, Taiyuan, China.
FAU - Guo, Shu-Ping
AU  - Guo SP
AD  - Department of Dermatology and Venereology, First Affiliated Hospital of Shanxi
      Medical University, Taiyuan, China.
FAU - Li, Li
AU  - Li L
AD  - Department of Dermatology and Venereology, First Affiliated Hospital of Shanxi
      Medical University, Taiyuan, China.
FAU - Wu, Peng
AU  - Wu P
AD  - Health Statistics Teaching and Research Section, School of Public Health, Shanxi 
      Medical University, Taiyuan, China.
FAU - Yin, Yue-Ping
AU  - Yin YP
AD  - Reference STD Lab, National Center for STD Control, Chinese CDC, Institute of
      Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College,
      Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 
      China.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170628
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Penicillins)
RN  - 75J73V1629 (Ceftriaxone)
RN  - F8VB5M810T (Tetracycline)
SB  - IM
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Ceftriaxone/administration & dosage/therapeutic use
MH  - Drug Therapy, Combination
MH  - Humans
MH  - Observational Studies as Topic
MH  - Penicillins/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Syphilis/*drug therapy
MH  - Tetracycline/administration & dosage/therapeutic use
MH  - Treatment Outcome
PMC - PMC5489196
EDAT- 2017/06/29 06:00
MHDA- 2017/09/25 06:00
CRDT- 2017/06/29 06:00
PHST- 2017/03/07 00:00 [received]
PHST- 2017/06/07 00:00 [accepted]
PHST- 2017/06/29 06:00 [entrez]
PHST- 2017/06/29 06:00 [pubmed]
PHST- 2017/09/25 06:00 [medline]
AID - 10.1371/journal.pone.0180001 [doi]
AID - PONE-D-17-08041 [pii]
PST - epublish
SO  - PLoS One. 2017 Jun 28;12(6):e0180001. doi: 10.1371/journal.pone.0180001.
      eCollection 2017.