Introduction The antimicrobial treatment options for patients with intestinal spirochaetosis (caused by Brachyspira pilosicoli and Brachyspira aalborgi ) are not well defined. We aimed to systematically review the literature to explore antimicrobial treatment options to inform future clinical guidelines. Method We systematically searched three bibliographical databases (MEDLINE, EMBASE, SCOPUS and Web of Science) for manuscripts written in English up to January 2024. The primary author conducted an initial abstract screen and two authors conducted independent full-text reviews. We included manuscripts which included primary data for patients with intestinal spirochaetosis who had received antimicrobial treatment and had an outcome measured. Quality and risk of bias was assessed independently by two authors using the Joanna Briggs Institute critical appraisal tools. We used the nine-point synthesis method to synthesise narrative data. Results There were 58 manuscripts included in this review published between 1977 and 2023 (42 case reports, 12 case series, 3 cross-sectional studies, and 1 prospective cohort). In total, there were 270 individuals with intestinal spirochaetosis: 225 patients received oral metronidazole monotherapy, 1 intravenous metronidazole, 2 rectal metronidazole, 5 metronidazole as part of a dual/triple regimen, 17 doxycycline monotherapy, 5 doxycycline (or tetracycline) dual therapy with either a beta-lactam, or neomycin, 4 benzathine penicillin, 1 procaine penicillin/steroids and 3 other antimicrobials including clarithromycin and vancomycin. 230 (85%) of patients in this review had an adequate clinical and or histological response to treatment with a median follow-up period of 30 days (IQR 14–90). The combined treatment response to all metronidazole-based treatment was 195/233 (84%). Conclusion Metronidazole, doxycycline and parenteral penicillin are the most frequently used antimicrobials for the treatment of human intestinal spirochaetosis and treatment response is generally good. More work is needed to understand the pathophysiology and treatment outcomes in patients with symptomatic intestinal spirochaetosis including the development of non-invasive diagnostic tools.

中文翻译：

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人类肠道螺旋体病的抗菌治疗：系统评价


简介 肠道螺旋体病（由毛状短螺旋体和阿尔博吉短螺旋体引起）患者的抗菌治疗选择尚不明确。我们的目的是系统地回顾文献，探索抗菌治疗方案，为未来的临床指南提供信息。方法 我们系统地检索了三个书目数据库（MEDLINE、EMBASE、SCOPUS 和 Web of Science），查找截至 2024 年 1 月以英文撰写的手稿。主要作者进行了初步摘要筛选，两位作者进行了独立的全文评审。我们纳入的手稿包括接受抗菌治疗并测量结果的肠道螺旋体病患者的主要数据。两位作者使用乔安娜·布里格斯研究所的关键评估工具独立评估了质量和偏倚风险。我们使用九点合成法来合成叙事数据。结果 本综述包含 1977 年至 2023 年间发表的 58 篇手稿（42 个病例报告、12 个病例系列、3 个横断面研究和 1 个前瞻性队列）。总共有 270 名肠螺旋体病患者：225 名患者接受口服甲硝唑单药治疗，1 名静脉注射甲硝唑，2 名直肠甲硝唑，5 名甲硝唑作为双/三联疗法的一部分，17 名多西环素单药治疗，5 名多西环素（或四环素）双重治疗β-内酰胺或新霉素、4 种苄星青霉素、1 种普鲁卡因青霉素/类固醇和 3 种其他抗菌药物，包括克拉霉素和万古霉素。本次评价中的 230 名患者 (85%) 对治疗有足够的临床和/或组织学反应，中位随访期为 30 天 (IQR 14-90)。 对所有基于甲硝唑的治疗的综合治疗反应为 195/233 (84%)。结论 甲硝唑、强力霉素和肠外青霉素是治疗肠道螺旋体病最常用的抗菌药物，且治疗效果总体良好。需要更多的工作来了解有症状的肠道螺旋体病患者的病理生理学和治疗结果，包括开发非侵入性诊断工具。