| ABSTRACT Objective: The purpose of this study was to systematic review the clinical efficacy and safety of levonidazole in the treatment of anaerobic infections by meta analysis, and to provide reference for clinical rational drug use. Methods:CNKI, VIP, WanFang Data, PubMed, Medline (viaOvidSP), Cochrane Library were electronically searched to collect randomized controlled trials (RCTs) of anaerobic infection treated by levonidazole from their inception to October 1, 2018. Two reviewers independently screened literatures, extracted data and assessed risk of bias of included studies. Then RevMan 5.3 software was used for Meta analysis. Results:A total of 1 557 patients were enrolled in 16 RCTs, among which 779 patients in the experimental group with levonidazole for anaerobic infection, and 778 patients in the control group with ornidazole. The results of Meta analysis showed that the clinical total cure rate of the experimental group was significantly better than that of the control group (92.9% vs. 85.2%), and the difference was statistically significant (OR=2.28, 95%CI 1.60 to 3.25, P<0.000 01); However, there was no significant difference in the clinical cure rate of abdominal anaerobic infection between the two groups (OR=1.73, 95%CI 0.76 to 3.96, P=0.19). The effect of the two groups on bacterial clearance was comparable, and the difference was not statistically significant (P>0.05). The incidence of digestive system, allergic reaction and leukopenia in the experimental group was slightly lower than that in the control group, but the difference was not statistically significant (P>0.05). However, the neurotoxicity of the experimental group was significantly lower than that of the control group, and the difference was statistically significant (P<0.05). Assuming that the other treatment options are the same, the cost effectiveness ratio of the experimental group was significantly higher than that of the control group, which increases the medical burden of the patient. Conclusion:Based on current clinical studies, levonidazole in the treatment of anaerobic infections can improve the clinical cure rate and reduce the incidence of adverse reactions in the nervous system. However, the clinical adverse reactions are almost mild or moderate, no need for treatment, and can be relieved or disappeared after stop. Moreover, the cost effectiveness of ornidazole is much lower than that of levonidazole. Therefore, after comprehensively evaluating the patient's condition, Ornidazole can still be considered for the treatment of anaerobic infection. And then levonidazole can be preferred for patients with basic diseases such as digestive system, nervous system, immune system, malignant tumor, and adverse reaction intolerance. |
