International Journal of Reproductive BioMedicine

en شکست درمان با آزیترومایسین در کلامیدیا تراکوماتیس اوروژنیتال: مرور سیستماتیک و متاآنالیز Urogenital chlamydia trachomatis treatment failure with azithromycin: A meta-analysis Review article Review Article مقدمه: کلامیدیا تراکوماتیس یکی از شایع‌ترین پاتوژن‌های منتقله از راه دستگاه تناسلی در انسان است که منجر به بروز عفونت اوروژنیتال میگردد.  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 روشها: پایگاههای 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 کیو-تست برای تعیین هتروژنیسیتی استفاده شد. برای مقایسه شیوع در سطوح مختلف متغیرها از روش Subgroup analysis and meta-regression 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 میدهد شکست درمان آزیترومایسین در درمان کلامیدیا نسبت به داکسیسیکلین و سایر داروهای مورد بررسی در مطالعه بیشتر میباشد. نتایج متارگرسیون حاکی از آن بود که سن بیماران در ایجاد هتروژنیسیتی برای درصد شکست درمان آزیترومایسین تاثیر معنیداری داشت (826/0, ß= 017/0p= ). نتیجه گیری: شکست درمان با آزیترومایسین در عفونتهای کلامیدیایی اوروژنیتال نسبت به داکسیسیکلین و سایر داروهای مورد بررسی در مطالعه بیشتر   میباشد. Abstract Background: 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 meta-analysis 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 Q-Test. Subgroup analysis and meta-regression 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 meta-regression results showed that the patient's age contributes significantly to the heterogeneity for azithromycin treatment failure rate (β = 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, Meta-analysis.  Abstract Background: 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 meta-analysis 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 Q-Test. Subgroup analysis and meta-regression 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 meta-regression results showed that the patient's age contributes significantly to the heterogeneity for azithromycin treatment failure rate (β = 0.826; p = 0.017). Conclusion: Azithromycin has a higher failure rate than doxycycline and other studied medications in treating urogenital chlamydia infections.    آزیترومایسین, کلامیدیا تراکوماتیس, شکست درمان Azithromycin, Chlamydia trachomatis, Urogenital, Treatment failure, Meta-analysis. 603 620 http://ijrm.ir/browse.php?a_code=A-10-1-652&slc_lang=en&sid=1 Farnaz Mohammadzadeh 0000-0002-4597-2677 No Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mahrokh Dolatian mhdolatian@gmail.com 0000-0001-5228-8446 Yes Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Masoumeh Jorjani 0000-0003-4790-4747 No Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Maryam Afrakhteh 0000-0002-1424-1951 No Department of Obstetrics and Gynaecology, Tajrish Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hamid Alavi Majd 0000-0001-7772-2923 No Department of Biostatistics, Paramedical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Fatemeh Abdi 0000-0002-0280-2969 No Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran Reza Pakzad 0000-0002-8215-2918 No Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran