METAANALYSIS OF THE EFFICACY OF THE COMBI NATION OF RIFAMPICIN AND DOXICYCLIN IN THE TREATMENT OF HUMAN BRUCELLOSIS

BACKGROUND: The aim of this study was to determine whether a conclusio n could be obtained through meta-analysis of the published trials on t he relative efficacy of rifampicin and doxicyclin versus streptomycin and doxicyclin or another tetracyclin (SD). METHODS: The comparative a nd randomized trials identified by a search in the reference data base MEDLINE from 1967 to 1992 and through manual review of the articles c ited in these studies or other reviews were included. The evaluation o f quality was performed by a standardized scale. The differences in ef ficacy were expressed as odds ratio and the results were contrasted by the Mantel-Haenszel method. Heterogenecity was graphically analyzed b y the Woolf method with an adjustment being made for small subgroups. The confidence intervals were calculated for each trial and for the co mbined data by the Cornfield method. RESULTS: Six trials including 581 patients of whom 544 were considered evaluable were analyzed. In the RD treatment group 261 (242 valid) patients were included with 268 (25 3 valid) being included in the SD group. Five cases of initial therape utic failure were observed in each group without significant differenc es. The secondary effects described were very variable. Nonetheless no secondary effects obliging discontinuation of treatment were presente d in the RD group with only one in the SD group with no differences be tween the two groups. Recurrences were presented in 5% and 39% in the RD group and in 0 and 17% in the SD group. In total 37 (16%) in the fo rmer group and 13 (5%) in the latter group. The Mantel-Haenszel odds r atio with respect to recurrence was 3.81 (CI 95%, 1.82-8.17; p = 0.000 09). The total number of cures was 196 (81%) in the RD group and 232 ( 92%) in the SD group (Mantel-Haenszel odds ratio 0.36; CI 95%, 1.19-0. 64; p = 0.0004). The inclusion of the quality index of the trials did not modify the statistical significance achieved. CONCLUSIONS: In huma n brucellosis the treatment of rifampicin and doxicyclin presents a gr eater number of recurrence and lower number of cure than the classical treatment with streptomycin and tetracyclin drugs.