Efficacy and safety of Tanreqing injection in ventilator-associated pneumonia: A systematic review and meta-analysis

Abstract

Introduction

Ventilator-associated pneumonia (VAP), a prevalent complication of mechanical ventilation, severely impacts patients' quality of life and increases mortality. This systematic review aimed to assess the effectiveness and safety of Tanreqing injection—an injectable herbal preparation with antibacterial, anti-inflammatory, and immunomodulatory properties—as an adjunctive therapy for VAP.

Methods

We searched seven databases up to October 6, 2024, to identify randomized controlled trials (RCTs) of Tanreqing injection plus routine treatment versus routine treatment alone for treating VAP. Two reviewers independently performed literature screening and data extraction. The risk of bias of the included studies was assessed using the Cochrane Risk of Bias Tool 2. Effects were measured using risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs).

Results

Twenty-two RCTs involving 1,536 patients were included (7, 12, and 3 RCTs with low, moderate, and high risk of bias, respectively). Compared with the control, Tanreqing injection significantly reduced the duration of mechanical ventilation (MD −1.72 d, CIs −2.32 to −1.13), mortality (RR 0.34, CIs 0.15 to 0.78), response rate to treatment (RR 1.19, CIs 1.12 to 1.26), white blood cell count (MD −2.14 × 10⁹/L, CIs −2.89 to −1.39), procalcitonin level (MD −0.42 ng/mL, CIs −0.68 to −0.15), C-reactive protein level (MD −15.51 mg/L, CIs −20.68 to −10.35), duration of antibiotic use (MD −3.67 d, CIs −5.43 to −1.90), and length of intensive care unit (ICU) stay (MD: −3.68 d, CIs −5.26 to −2.09). No adverse events related to Tanreqing injection were reported.

Conclusions

Tanreqing injection, when used as an adjuvant therapy to the routine treatment of VAP, can reduce mechanical ventilation duration, antibiotic use, length of ICU stay, mortality, and inflammation indicator levels. More well-designed RCTs are needed to corroborate these findings because of the ​moderate-to-high risk of bias among the included RCTs.