Meta-analysis of trimethoprim-sulfamethoxazole combined with caspofungin in the treatment of Pneumocystis jirovecii pneumonia

Abstract

Abstract: Objective To systematically evaluate the efficacy and safety of trimethoprim-sulfamethoxazole (TMP/SMZ) combined with caspofungin in the treatment of Pneumocystis jirovecii pneumonia (PJP). Methods PubMed, Embase, Cochrane library, CBM, CNKI, Wanfang, VIP were searched for clinical randomized controlled trials of TMP/SMZ combined with caspofungin in the treatment of PJP, and Meta-analysis was performed. The outcome indicators were total effective rate, incidence of adverse reactions Statistical analysis was performed using RevMan 5.4 software. Results A total of 20 studies were included, involving 1 802 PJP patients. Meta-analysis results showed that compared with TMP/SMZ monotherapy, the effective rate of TMP/SMZ combined with caspofungin in the treatment of PJP was significantly improved, [RR =1.29, 95% CI (1.22,1.37),P< 0.00001], and no Increase the incidence of adverse drug reactions [RR =0.91,95% CI(0.79, 1.05),P=0.21>0.05]. Conclusion The effect of TMP/SMZ combined with caspofungin in the treatment of PJP is better than that of TMP/SMZ monotherapy, without increasing adverse drug reactions, and it is recommended for clinical use.

Key words: trimethoprim-sulfamethoxazole, caspofungin, Pneumocystis jirovecii pneumonia (PJP), Meta-analysis

CLC Number:

R519

DUNA Yan, XU Yuan, YANG Changqing, ZHANG Jinping. Meta-analysis of trimethoprim-sulfamethoxazole combined with caspofungin in the treatment of Pneumocystis jirovecii pneumonia[J]. Chinese Journal of Mycology, 2023, 18(1): 1-7.

References

[1] ASAI N, MOTOJIMA S, OHKUNI Y, et al. Early diagnosis and treatment are crucial for the survival of Pneumocystis pneumonia patients without human immunodeficiency virus infection[J]. J Infect Chemother, 2012, 18(6):898-905.
[2] 张会云,王勇强.非艾滋病PJ肺炎患者治疗研究进展[J].内科,2018,13(5):766-768.
[3] 赵铁梅,佘丹阳,解立新,等.非艾滋病免疫功能抑制患者肺孢子菌肺炎的临床特点及诊治探讨[J].中华医院感染学杂志,2014,24(6):1384-1386.
[4] 蔡瑞, 朱立冬. 卡泊芬净联合复方磺胺甲噁唑治疗艾滋病合并肺孢子菌肺炎临床观察[J].世界最新医学信息文摘,2018, 18(89):24-25.
[5] 柴晓青. 艾滋病合并肺孢子菌肺炎23例临床治疗效果观察[J].中国保健营养(下旬刊),2013, 23(7):3637-3638.
[6] 丁玲,王玥媛,刘梦颖,等.复方磺胺甲(口恶)唑单药或联合卡泊芬净治疗耶氏肺孢子菌肺炎患者的疗效与安全性分析[J].药学服务与研究,2021,21(5):342-346.
[7] 李爱新, 汪雯, 张彤, 等. 卡泊芬净联合复方磺胺甲噁唑治疗艾滋病合并肺孢子菌肺炎临床观察[J].临床荟萃,2017, 32(2):163-166.
[8] 刘海霞, 程云霞. 复方新诺明联合卡泊芬净治疗耶氏肺孢子菌肺炎的临床疗效[J].中国现代药物应用,2015, 9(17):90-91.
[9] 罗育勤, 谭娟霞, 陈燕霞. 卡泊芬净联合复方磺胺甲噁唑治疗艾滋病合并肺孢子菌肺炎临床观察[J].医学美学美容,2021, 30(14):26-27.
[10] 吕明, 王雨琪, 宋慧. TMP-SMZ联合卡泊芬净治疗艾滋病合并肺孢子菌肺炎的效果分析[J].国际感染病学(电子版),2019, 8(2):119.
[11] 马秀珍,余花,莫晨玲.卡泊芬净联合复方磺胺甲(噁)唑治疗艾滋病合并肺孢子菌肺炎效果分析[J].青海医药杂志,2015, 45(3):8-11.
[12] 努斯来提·阿不都米吉提, 张永平, 古丽尼格尔. 卡泊芬净联合复方磺胺甲噁唑治疗艾滋病合并肺孢子菌肺炎临床疗效分析[J].健康女性,2021, 2021(13):76.
[13] 唐伯莹.卡泊芬净联合复方磺胺甲唑治疗艾滋病合并重症肺孢子菌肺炎的临床观察[J].中国实用医药,2021,16(36):164-167.
[14] 王敏毅.复方磺胺甲噁唑联合卡泊芬净治疗HIV感染合并肺孢子菌肺炎的临床疗效及其对免疫功能的影响[J].临床合理用药杂志,2021,14(33):128-130.
[15] 王治国,刘学明,陈南芳.卡泊芬净联合复方新诺明治疗系统性红斑狼疮合并肺孢子菌肺炎疗效观察[J].临床合理用药杂志,2019,12(19):59-60,62.
[16] 相巧丽,魏月霞,姚彦芬.卡泊芬净联合小剂量复方新诺明治疗肺孢子菌肺炎疗效观察[J].临床合理用药杂志,2015,8(22):69-70.
[17] 杨凯,郭静微.卡泊芬净联合复方磺胺甲噁唑治疗获得性免疫缺陷综合征合并肺孢子菌肺炎的疗效观察[J].中国医院用药评价与分析,2018,18(8):1068-1069,1072.
[18] 昝映婷.卡泊芬净联合复方磺胺甲噁唑治疗艾滋病合并肺孢子菌肺炎的应用研究[J]. 健康女性,2021,13(47):147.
[19] 张军营,温鲁艳,王少芳,等. 卡泊芬净治疗肺孢子菌肺炎疗效及LDH和PaO₂的变化研究[J].医药论坛杂志,2021,42(5):42-45.
[20] 张天宁,毛志军,王勇,等.卡泊芬净联合复方磺胺甲噁唑治疗艾滋病合并肺孢子菌肺炎的临床价值研究[J]. 临床医药文献电子杂志,2018,5(83):47.
[21] HUANG Y, HE X, CHEN H, et al. No statistically apparent difference in antifungal effectiveness observed among trimethoprim/sulfamethoxazole plus clindamycin or caspofungin, and trimethoprim/sulfamethoxazole monotherapy in HIV-infected patients with moderate to severe Pneumocystis pneumonia:results of an observational multicenter cohort study[J]. Infect Dis Ther, 2022, 11(1):543-557.
[22] JIN F, LIU X H, CHEN W C, et al. High initial (1, 3) Beta-d-Glucan concentration may be a predictor of satisfactory response of caspofungin combined with TMP/SMZ for HIV-negative patients with moderate to severe Pneumocystis jirovecii pneumonia[J]. Int J Infect Dis, 2019, 88:141-148.DOI:10.1016/j.ijid.2019.08.015.
[23] TIAN Q, SI J, JIANG F, et al. Caspofungin combined with TMP/SMZ as a first-line therapy for moderate-to-severe PCP in patients with human immunodeficiency virus infection[J]. HIV Medicine, 2021, 22(4):307-313.
[24] 刘晓东,熊梦瑶,朱旭,等.卡泊芬净药物不良反应的分析[J].中国临床药理学杂志,2018,34(13):1574-1576.
[25] 王冠儒,宋再伟,姜丹,等.卡泊芬净用于侵袭性真菌病的药物经济学系统评价[J].中国医院药学杂志,2022,42(5):544-548.