Research mapping and comparative assessment of drug treatment regimens for brucellosis: a systematic review and...

There are different treatment regimens for treating human brucellosis. This study aimed to evaluate the comparative effectiveness and ranking of different treatment regimens for human brucellosis through a systematic review and network meta-analysis (NMA).

A systematic search was conducted in PubMed, ScienceDirect, Web of Science, and Embase to identify randomized controlled trials (RCTs) from their inception until February 1, 2023. Only RCTs comparing different treatment regimens for human brucellosis were included. The risk of bias was assessed using the Cochrane Risk of Bias tool. Consistency and heterogeneity were evaluated using Cochrane's I^2 and Q statistics. Our outcomes of interest include the "recovery" of patients with brucellosis following pharmacological treatment, as well as the "relative ranking" of the effectiveness of the studied treatment regimens compared to one another. Treatment effects were estimated using the relative risk (RR) effect size, while the P-score and Sucra was utilized to rank treatments in the NMA. A random-effects model was applied to account for between-study variability, and results were reported with 95% confidence intervals (CI).

Out of 872 primary studies reviewed, a total of 32 studies were included in our network meta-analysis. The comparative effectiveness (measured by improvement) of the doxycycline (DOX) + streptomycin (SRT) + hydroxychloroquine (HYD) treatment regimen (RR:1.25, 95%CI: 1.07-1.45) is greater than other treatment regimens compared to DOX + rifampin (RIF) (RR:1) Following that, the DOX + STR + RIF and STR + ofloxacin (OFL) + RIF treatment regimens ranked second and third, respectively. The heterogeneity of the designs in our intervention network was estimated to be 37%, indicating low inconsistency within an acceptable range.

The findings highlight the superior efficacy of triple-drug regimens, particularly those involving aminoglycosides, over dual-drug and monotherapy options. Our results confirm that DOX + STR + HYD is the most effective treatment regimens for human brucellosis. These new findings, when considering practical considerations, could inform the updating of clinical treatment protocols for human brucellosis.