厄他培南治疗感染性疾病有效性、安全性和经济性的快速卫生技术评估  

Efficacy,safety,and economics of ertapenem in the treatment of infectious diseases:a rapid health technology assessment

作　　者：秦寅鹏 王超[1] 张瑞霞[1] 郭媛媛[1] 钱玉德 张弋[1] Qin Yinpeng;Wang Chao;Zhang Ruixia;Guo Yuanyuan;Qian Yude;Zhang Yi(Department of Pharmacy,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院药学部,天津300192

出　　处：《药物不良反应杂志》2024年第6期347-354,共8页Adverse Drug Reactions Journal

基　　金：国家卫生健康委员会医院管理研究所医院药学高质量发展研究项目(NIHAYS2329)。

摘　　要：目的采用快速卫生技术评估的方法评价厄他培南治疗感染性疾病的有效性、安全性和经济性。方法检索有关数据库以及卫生技术评估网站(截至2023年7月31日),收集厄他培南和其他抗菌药物治疗感染性疾病有效性与安全性比较的系统评价/meta分析和经济学文献,分别采用系统评价方法学质量评估工具和卫生经济学评价报告标准进行质量评价。将患者分为厄他培南组和对照组(使用其他抗菌药物),比较2组的结局指标(临床治愈率、细菌清除率)和不良反应发生率;经济学研究为成本-效果和成本-结果分析。对有关结果进行定性描述。结果共纳入13篇文献,包括系统评价/meta分析7篇,其中4篇高质量、3篇中等质量;药物经济学文献6篇,其中4篇高质量、2篇中等质量。厄他培南组与对照组对复杂性腹腔感染、社区获得性肺炎、复杂性皮肤及附属器感染的临床治愈率和细菌清除率的差异均无统计学意义(均P>0.05);厄他培南组对严重糖尿病足感染的临床治愈率低于哌拉西林钠他唑巴坦钠组[91.5%(119/130)比97.2%(139/143),P=0.04];厄他培南组对复杂性尿路感染的细菌清除率高于头孢曲松组[98.71%(305/309)比95.45%(273/286),P=0.03]。厄他培南治疗复杂性腹腔感染出现的不良反应(转氨酶和碱性磷酸酶升高或血小板计数升高)发生率高于对照组[8.96%(68/759)比6.49%(50/771),P<0.05];厄他培南治疗复杂感染(社区获得性肺炎、复杂性尿路感染和复杂性腹腔感染)后不良反应发生率高于头孢曲松加或不加甲硝唑组[10.62%(163/1535)比7.89%(91/1153),P=0.02];厄他培南治疗严重糖尿病足感染的腹泻发生率低于哌拉西林钠他唑巴坦钠组[8.14%(24/295)比14.09%(41/291),P=0.02]。使用厄他培南较使用哌拉西林钠他唑巴坦钠、头孢曲松治疗复杂性腹腔感染、严重糖尿病足感染、复杂性尿路感染、社区获得性肺炎等更能节省药物治疗成�Objective To evaluate the efficacy,safety,and economics of ertapenem in the treatment of infectious diseases by means of rapid health technology assessment.Methods The relevant databases and health technology assessment websites(up to July 31,2023)were searched to collect the metaanalyses and economic literature on the efficacy,safety,and economics of ertapenem and other antibacterial drugs in the treatment of infectious diseases.The quality of meta-analyses and economic researches were evaluated by a measurement tool to assess systematic reviews and consolidated health economic evaluation reporting standards,respectively.The patients were divided into ertapenem group and control group(using other antibacterial drugs).The outcome indicators of meta-analysis(clinical cure rate,bacterial clearance rate)and the incidence of adverse reactions were compared between the 2 groups.The economic research were cost-effectiveness analysis and cost-consequence analysis.The relevant results were described qualitatively.Results A total of 13 literature were enrolled,including 7 systematic reviews/meta-analyses(4 of high-quality,3 of medium quality)and 6 pharmacoeconomics literature(4 of high quality,2 of medium quality).There were no significant differences on the clinical cure rate and bacterial clearance rate for complex abdominal infection,community-acquired pneumonia,complex skin and appendage infection between the ertapenem group and the control group(all P>0.05).The clinical cure rate of severe diabetic foot infection in the ertapenem group was lower than that in the piperacillin sodium and tazobactam sodium group[91.5%(119/130)vs.97.2%(139/143),P=0.04].The bacterial clearance rate of complicated urinary tract infection in the ertapenem group was higher than that in the ceftriaxone group[98.71%(305/309)vs.95.45%(273/286),P=0.03].The incidence of adverse reactions(elevated transaminase and alkaline phosphatase or elevated platelet count)in patients with complex abdominal infection in the ertapenem group was higher than tha

关 键 词：碳青霉烯类 感染 有效性 安全性 经济性 卫生技术评估 厄他培南 

分 类 号：R978[医药卫生—药品]