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PloS One 2013Current (1999) World Health Organization guidelines recommend giving routine antibiotics (AB) for all children with severe acute malnutrition (SAM), even if they have... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Current (1999) World Health Organization guidelines recommend giving routine antibiotics (AB) for all children with severe acute malnutrition (SAM), even if they have uncomplicated disease with no clinically obvious infections. We examined the evidence behind this recommendation.
METHODS AND FINDINGS
OVID-MEDLINE, EMBASE, COCHRANE, GLOBAL-HEALTH, CINAHL, POPLINE, AFRICA-WIDE-NiPAD, and LILACS were searched for AB efficacy, bacterial resistance, and infection rates in SAM. Following PRISMA guidelines, a systematic review and meta-analysis were performed. Three randomised controlled trials (RCT), five Cochrane reviews, and 37 observational studies were identified. One cohort-study showed no increase in nutritional-cure and mortality in uncomplicated SAM where no AB were used. (p>0.05). However, an unpublished RCT in this setting did show mortality benefits. Another RCT did not show superiority of ceftriaxone over amoxicilllin for these same outcomes, but adressed SAM children with and without complications (p = 0.27). Another RCT showed no difference between amoxicillin and cotrimoxazole efficacies for pneumonia in underweight, but not SAM. Our meta-analysis of 12 pooled susceptibility-studies for all types of bacterial isolates, including 2767 stricly SAM children, favoured amoxicillin over cotrimoxazole for susceptibility medians: 42% (IQR 27-55%) vs 22% (IQR 17-23%) and population-weighted-means 52.9% (range 23-57%) vs 35.4% (range 6.7-42%). Susceptibilities to second-line AB were better, above 80%. Prevalence of serious infections in SAM, pooled from 24 studies, ranged from 17% to 35.2%. No study infered any association of infection prevalence with AB regimens in SAM.
CONCLUSIONS
The evidence underlying current antibiotic recommendations for uncomplicated SAM is weak. Susceptibility-studies favour amoxicillin over cotrimoxazole. However, given that these antibiotics have side-effects, costs, and risks as well as benefits, their routine use needs urgent testing. With reliable monitoring, we believe that there is sufficient equipoise for placebo controlled RCTs, the only robust way to demonstrate true efficacy.
Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Ceftriaxone; Child; Child Nutrition Disorders; Child, Preschool; Humans; Practice Guidelines as Topic
PubMed: 23326395
DOI: 10.1371/journal.pone.0053184 -
PLoS Medicine Oct 2014Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (<2 months) in low- and middle-income... (Meta-Analysis)
Meta-Analysis Review
Treatment of infections in young infants in low- and middle-income countries: a systematic review and meta-analysis of frontline health worker diagnosis and antibiotic access.
BACKGROUND
Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (<2 months) in low- and middle-income countries (LMICs). We aimed to address three questions regarding access to treatment for young infant infections in LMICs: (1) Can frontline health workers accurately diagnose possible bacterial infection (pBI)?; (2) How available and affordable are antibiotics?; (3) How often are antibiotics procured without a prescription?
METHODS AND FINDINGS
We searched PubMed, Embase, WHO/Health Action International (HAI), databases, service provision assessments (SPAs), Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and grey literature with no date restriction until May 2014. Data were identified from 37 published studies, 46 HAI national surveys, and eight SPAs. For study question 1, meta-analysis showed that clinical sign-based algorithms predicted bacterial infection in young infants with high sensitivity (87%, 95% CI 82%-91%) and lower specificity (62%, 95% CI 48%-75%) (six studies, n = 14,254). Frontline health workers diagnosed pBI in young infants with an average sensitivity of 82% (95% CI 76%-88%) and specificity of 69% (95% CI 54%-83%) (eight studies, n = 11,857) compared to physicians. For question 2, first-line injectable agents (ampicillin, gentamicin, and penicillin) had low variable availability in first-level health facilities in Africa and South Asia. Oral amoxicillin and cotrimoxazole were widely available at low cost in most regions. For question 3, no studies on young infants were identified, however 25% of pediatric antibiotic purchases in LMICs were obtained without a prescription (11 studies, 95% CI 18%-34%), with lower rates among infants <1 year. Study limitations included potential selection bias and lack of neonatal-specific data.
CONCLUSIONS
Trained frontline health workers may screen for pBI in young infants with relatively high sensitivity and lower specificity. Availability of first-line injectable antibiotics appears low in many health facilities in Africa and Asia. Improved data and advocacy are needed to increase the availability and appropriate utilization of antibiotics for young infant infections in LMICs.
REVIEW REGISTRATION
PROSPERO International prospective register of systematic reviews (CRD42013004586). Please see later in the article for the Editors' Summary.
Topics: Anti-Bacterial Agents; Bacterial Infections; Child; Community Health Workers; Developing Countries; Humans
PubMed: 25314011
DOI: 10.1371/journal.pmed.1001741 -
Infection and Drug Resistance 2020is a spiral-shaped gram-negative bacteria associated with peptic ulcer, gastritis and gastric cancer. The global burden and occurrence of infection remains prevalent... (Review)
Review
BACKGROUND
is a spiral-shaped gram-negative bacteria associated with peptic ulcer, gastritis and gastric cancer. The global burden and occurrence of infection remains prevalent and worldwide. Despite this, the trend of the bacterial resistance is not recently studied which can help in the adoption of global, regional and local prevention strategies.
OBJECTIVE
The aim of the study was to systematically review the existing published literature that presents the estimate of antibiotic resistance.
METHODS
A protocol was primarily registered in PROSPERO International prospective register of systematic reviews and has given a registration number CRD42017068710. It was registered after checking whether there was similar study being conducted. A database search (PubMed/Medline and Google scholar) was used to collect relevant articles. A standardized form was prepared for the extraction of relevant data from studies which fulfilled the eligibility criteria. A National Institute for Health research (NIH)-based quality assessment tool was utilized to assess the quality of studies included in the study.
RESULTS
Our searching process has retrieved a total of 288 publications which later resulted in 38 articles for full-text review. Among the 38 articles reviewed in full text, 14 studies were included which fulfilled the inclusion criteria. -pooled overall prevalence rate of antibiotic resistance was found to be 4.55% (95% confidence interval (CI): 3.96-5.22%) to amoxicillin, 27.22% (95% CI: 25.89-28.58%) to clarithromycin, 39.66% (95% CI: 38.20-41.15%) to metronidazole, and 22.48% (95% CI: 21.24-23.76%) to levofloxacin.
CONCLUSION
The primary antibiotic resistance pattern of is increasing worldwide. Thus, implementation of local drug susceptibility surveillance program, rational prescribing and use of antibiotics are necessary.
PubMed: 32547126
DOI: 10.2147/IDR.S250200 -
Frontiers in Microbiology 2016To evaluate the variations in the detection of Porphyromonas gingivalis and/or Aggregatibacter actinomycetemcomitans before and after systemic administration of...
Detection of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans after Systemic Administration of Amoxicillin Plus Metronidazole as an Adjunct to Non-surgical Periodontal Therapy: A Systematic Review and Meta-Analysis.
OBJECTIVE
To evaluate the variations in the detection of Porphyromonas gingivalis and/or Aggregatibacter actinomycetemcomitans before and after systemic administration of amoxicillin plus metronidazole in association with non-surgical periodontal therapy (NSPT).
BACKGROUND
The adjunctive use of antibiotics has been advocated to improve the clinical outcomes of NSPT. However, no systematic review has investigated the microbiological benefit of this combination.
MATERIALS AND METHODS
An electronic search was conducted up to December 2015. Randomized clinical trials comparing the number of patients testing positive for P. gingivalis and/or A. actinomycetemcomitans before and after NSPT with (test group) or without (control group) amoxicillin plus metronidazole were included. The difference between groups in the variation of positive patients was calculated using the inverse variance method with a random effects model.
RESULTS
The frequency of patients positive for A. actinomycetemcomitans was decreased by 30% (p = 0.002) and by 25% (p = 0.01) in the test group compared to the control group at 3- and 6-month follow-up, respectively. Similar findings were observed when considering the frequency of patients positive for Porphyromonas gingivalis, with a reduction by 28% (p < 0.0001), 32% (p < 0.0001), and 34% (p = 0.03) in the test group compared to the control group at 3-, 6-, and 12-month follow-up, respectively.
CONCLUSION
The systemic administration of amoxicillin plus metronidazole as an adjunct to NSPT significantly decreased the number of patients positive for P. gingivalis and A. actinomycetemcomitans compared with periodontal therapy alone or with a placebo.
PubMed: 27594851
DOI: 10.3389/fmicb.2016.01277 -
The Cochrane Database of Systematic... Dec 2016Various central nervous system-penetrant antibiotics are bactericidal in vitro and in vivo against the causative agent of Lyme neuroborreliosis (LNB), Borrelia... (Review)
Review
BACKGROUND
Various central nervous system-penetrant antibiotics are bactericidal in vitro and in vivo against the causative agent of Lyme neuroborreliosis (LNB), Borrelia burgdorferi. These antibiotics are routinely used clinically to treat LNB, but their relative efficacy is not clear.
OBJECTIVES
To assess the effects of antibiotics for the treatment of LNB.
SEARCH METHODS
On 25 October 2016 we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. We searched clinical trial registers on 26 October 2016. We reviewed the bibliographies of the randomized trials identified and contacted the authors and known experts in the field to identify additional published or unpublished data. There were no language restrictions when searching for studies.
SELECTION CRITERIA
Randomized clinical trials of antibiotic treatment of LNB in adults and children that compared any antibiotic treatment, including combinations of treatments, versus any other treatment, placebo, or no treatment. We excluded studies of entities considered as post-Lyme syndrome.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We identified seven randomized studies involving 450 European participants with LNB for inclusion in this systematic review. We found no trials conducted in the United States. Marked heterogeneity among these studies prevented meta-analysis. None of the studies included a placebo control on the initial antibiotic treatment, and only one was blinded. None were delayed-start studies. All were active comparator studies, and most were not adequately powered for non-inferiority comparison. The trials investigated four antibiotics: penicillin G and ceftriaxone in four studies, doxycycline in three studies, and cefotaxime in two studies. One study tested a three-month course of oral amoxicillin versus placebo following initial treatment with intravenous ceftriaxone. One study was limited to children. The trials measured efficacy using heterogeneous physician- or patient-reported outcomes, or both. In some cases cerebrospinal fluid analysis was included as an indirect biomarker of disease and outcome. None of the studies reported on our proposed primary outcome, 'Improvement in a measure of overall disability in the long term (three or more months).' None of the trials revealed any between-group differences in symptom resolution in response to active treatment. In general, treatment was tolerated well. The quality of adverse event reporting, however, was low.
AUTHORS' CONCLUSIONS
There is mostly low- to very low-quality clinical evidence from a limited number of mostly small, heterogeneous trials with diverse outcome measures, comparing the relative efficacy of central nervous system-penetrant antibiotics for the treatment of LNB. The few existing randomized studies have limited power and lack consistent and well-defined entry criteria and efficacy endpoints. It is not possible to draw firm conclusions on the relative efficacy of accepted antibiotic drug regimens for the treatment of LNB. The majority of people are reported to have good outcomes, and symptoms resolve by 12 months regardless of the antibiotic used. A minority of participants did not improve sufficiently, and some were retreated. These randomized studies provide some evidence that doxycycline, penicillin G, ceftriaxone, and cefotaxime are efficacious in the treatment of European LNB. No evidence of additional efficacy was observed when, in one study, an initial antibiotic treatment with intravenous ceftriaxone was followed by additional longer treatment with oral amoxicillin. There is a lack of evidence identified through our high-quality search strategy on the efficacy of antibiotics for treatment of LNB in the United States.
Topics: Amoxicillin; Anti-Bacterial Agents; Borrelia burgdorferi; Cefotaxime; Ceftriaxone; Doxycycline; Humans; Lyme Disease; Lyme Neuroborreliosis; Penicillin G; Randomized Controlled Trials as Topic
PubMed: 27931077
DOI: 10.1002/14651858.CD006978.pub2 -
Therapeutic Advances in Gastroenterology 2022As a novel drug, vonoprazan (VPZ) has been developed as a new strategy against () infections. However, whether VPZ + amoxicillin (AMO) dual therapy has a clear...
BACKGROUND
As a novel drug, vonoprazan (VPZ) has been developed as a new strategy against () infections. However, whether VPZ + amoxicillin (AMO) dual therapy has a clear advantage is still unclear.
OBJECTIVE
To review and meta-analyze the available literature investigating the efficacy and safety of eradication in VPZ dual therapy.
DESIGN
A systematic review and meta-analysis were conducted.
DATA SOURCES AND METHODS
We performed a systematic search in the PubMed, Embase, EIsevier/Science Library, and Cochrane Library databases from 2015 to 2022. Meta-analyses were conducted to evaluate the actual cure rate and the incidence rate of adverse reactions in dual therapy and VPZ + AMO + clarithromycin (CLA) triple therapy; furthermore, eradication rates in CLA-resistant infections and different doses of antibiotics were evaluated in subgroup analysis.
RESULTS
Seven studies with 1490 patients were included in this meta-analysis. According to intention-to-treat analysis, the actual cure rates of VPZ dual and triple therapy were 82.8% and 84.6%, respectively [ = 0.29, odds ratio (OR): 0.86, 95% confidence interval (CI): 0.64-1.14]. And in the per-protocol analysis, the actual cure rates of these two therapies were 84.8% and 87.0%, respectively ( = 0.21, OR: 0.80, 95% CI: 0.57-1.13). The incidence of adverse reactions between VPZ dual and triple therapy was 26.1% 29.6% ( = 0.04, OR: 0.78, 95% CI: 0.61-0.99). In subgroup analysis, the eradication rates in CLA-resistant infections were dual therapy: 85.7% for VPZ 71.0% for triple therapy ( = 0.03, OR: 2.36, 95% CI: 1.10-5.05). And the actual cure rate of VPZ with high-dose antibiotics was lower than with low-dose antibiotics ( = 0.000 in dual therapy; = 0.011 in triple therapy).
CONCLUSION
A combination of VPZ and a low dose of AMO should be prioritized as a treatment option for eradication.
REGISTRATION
PROSPERO registration number CRD42022346100.
PubMed: 36268270
DOI: 10.1177/17562848221125308 -
One Health (Amsterdam, Netherlands) Dec 2021Antimicrobial resistance (AMR) has been recognized as one of the greatest global threats for human and animal health. The present review retrieved up to date information... (Review)
Review
Antimicrobial resistance (AMR) has been recognized as one of the greatest global threats for human and animal health. The present review retrieved up to date information on the epidemiology of AMR in the animal-source food chain in Ethiopia focusing on AMR in bacterial species isolated from food handlers, live animals, foods (animal origin and non-animal origin), and in environmental samples. Accordingly, pooled prevalence of AMR in the different sources was estimated. For data analysis, we used random effect meta-analysis and in order to avoid exclusion of studies with zero prevalence of antimicrobial resistance, Freeman-Tukey double arcsine transformation was applied. We identified 152 eligible studies and retrieved 4097 data records (183 in food handlers, 2055 in foods, 1040 in live animals and 819 for environmental samples) which together reported a total of 86,813 AMR tests with 64 different antimicrobial disks for 81 bacteria species. We present the pooled prevalence of AMR for major bacterium-antibiotic combination in different sample types. The pooled prevalence of AMR in bacteria from food producing live animals was 20%. High estimates of AMR pooled prevalence were found in bacteria identified from milk, food handlers and the environmental samples with 29%, and 28% in meat. In foods of non-animal origin, the prevalence was lower with 13%. In milk, the highest AMR estimate was found for penicillin (69%) followed by amoxicillin (51%). Regarding multi-drug resistance (MDR), the overall pooled prevalence was 74% among AMR positive samples. Microbes reported having a higher MDR pattern were: (96%), (81%) and (77%). The present review revealed a high resistance against commonly used drugs for animal and human treatments and/or prophylaxis. In conclusion, the high estimate of prevalence of AMR observed in bacteria recovered from different sample sources related to the animal-source food chain (food, live animal and environment) can highlight the possible linkage among them. The MDR levels in several bacteria species are a clear indication that the threat is directed to many antimicrobials. Our review demonstrated that the high overall AMR resistance levels call for effective policy and intervention measures, which best address the problem along the food chain through a One Health approach.
PubMed: 34258373
DOI: 10.1016/j.onehlt.2021.100286 -
World Journal of Gastroenterology Mar 2024() infects over half the global population, causing gastrointestinal diseases like dyspepsia, gastritis, duodenitis, peptic ulcers, G-MALT lymphoma, and gastric... (Meta-Analysis)
Meta-Analysis
BACKGROUND
() infects over half the global population, causing gastrointestinal diseases like dyspepsia, gastritis, duodenitis, peptic ulcers, G-MALT lymphoma, and gastric adenocarcinoma. Eradicating is crucial for treating and preventing these conditions. While conventional proton pump inhibitor (PPI)-based triple therapy is effective, there's growing interest in longer acid suppression therapies. Potassium competitive acid blocker (P-CAB) triple and dual therapy are new regimens for eradication. Initially used in Asian populations, vonoprazan (VPZ) has been recently Food and Drug Administration-approved for eradication.
AIM
To assess the efficacy of regimens containing P-CABs in eradicating infection.
METHODS
This study, following PRISMA 2020 guidelines, conducted a systematic review and meta-analysis by searching MEDLINE and Scopus libraries for randomized clinical trials (RCTs) or observational studies with the following command: [("" OR "H pylori") AND ("Treatment" OR "Therapy" OR "Eradication") AND ("Vonaprazan" OR "Potassium-Competitive Acid Blocker" OR "P-CAB" OR "PCAB" OR "Revaprazan" OR "Linaprazan" OR "Soraprazan" OR "Tegoprazan")]. Studies comparing the efficacy of P-CABs-based treatment to classical PPIs in eradicating were included. Exclusion criteria included case reports, case series, unpublished trials, or conference abstracts. Data variables encompassed age, diagnosis method, sample sizes, study duration, intervention and control, and eradication method were gathered by two independent reviewers. Meta-analysis was performed in R software, and forest plots were generated.
RESULTS
A total of 256 references were initially retrieved through the search command. Ultimately, fifteen studies (7 RCTs, 7 retrospective observational studies, and 1 comparative unique study) were included, comparing P-CAB triple therapy to PPI triple therapy. The intention-to-treat analysis involved 8049 patients, with 4471 in the P-CAB intervention group and 3578 in the PPI control group across these studies. The analysis revealed a significant difference in eradication between VPZ triple therapy and PPI triple therapy in both RCTs and observational studies [risk ratio (RR) = 1.17, 95% confidence interval (CI): 1.11-1.22, < 0.0001] and (RR = 1.13, 95%CI: 1.09-1.17, < 0.0001], respectively. However, no significant difference was found between tegoprazan (TPZ) triple therapy and PPI triple therapy in both RCTs and observational studies (RR = 1.04, 95%CI: 0.93-1.16, = 0.5) and (RR = 1.03, 95%CI: 0.97-1.10, = 0.3), respectively.
CONCLUSION
VPZ-based triple therapy outperformed conventional PPI-based triple therapy in eradicating , positioning it as a highly effective first-line regimen. Additionally, TPZ-based triple therapy was non-inferior to classical PPI triple therapy.
Topics: Humans; Anti-Bacterial Agents; Clarithromycin; Helicobacter pylori; Proton Pump Inhibitors; Drug Therapy, Combination; Helicobacter Infections; Pyrroles; Amoxicillin; Treatment Outcome; Randomized Controlled Trials as Topic; Observational Studies as Topic; Benzene Derivatives; Imidazoles; Sulfonamides
PubMed: 38577188
DOI: 10.3748/wjg.v30.i9.1213 -
Journal of Personalized Medicine Nov 2023The nasal microbiome represents the main environmental factor of the inflammatory process in chronic rhinosinusitis (CRS). Antibiotics and steroids constitute the... (Review)
Review
BACKGROUND
The nasal microbiome represents the main environmental factor of the inflammatory process in chronic rhinosinusitis (CRS). Antibiotics and steroids constitute the mainstay of CRS therapies. However, their impact on microbial communities needs to be better understood. This systematic review summarizes the evidence about antibiotics' and steroids' impact on the nasal microbiota in patients with CRS.
METHODS
The search strategy was conducted in accordance with the PRISMA guidelines for systematic reviews. The authors searched all papers in the three major medical databases (PubMed, Scopus, and Cochrane Library) using the PICO tool (population, intervention, comparison, and outcomes). The search was carried out using a combination of the key terms "Microbiota" or "Microbiome" and "Chronic Rhinosinusitis".
RESULTS
Overall, 402 papers were identified, and after duplicate removal (127 papers), excluding papers off-topic (154) and for other structural reasons (110), papers were assessed for eligibility; finally, only 11 papers were included and summarized in the present systematic review. Some authors used only steroids, other researchers used only antibiotics, and others used both antibiotics and steroids. With regard to the use of steroids as exclusive medical treatment, topical mometasone and budesonide were investigated. With regard to the use of antibiotics as exclusive medical treatments, clarithromycin, doxycycline, roxithromycin, and amoxicillin clavulanate were investigated. Regarding the use of both antibiotics and steroids, two associations were investigated: systemic prednisone combined with amoxicillin clavulanate and topical budesonide combined with azithromycin.
CONCLUSIONS
The impact that therapies can have on the nasal microbiome of CRS patients is very varied. Further studies are needed to understand the role of the nasal microbiome, prevent CRS, and improve therapeutic tools for personalized medicine tailored to the individual patient.
PubMed: 38003898
DOI: 10.3390/jpm13111583 -
Frontiers in Cardiovascular Medicine 2022The aim of this study was to determine the association between fluoroquinolones (FQs) use, the risk of aortic aneurysm or dissection (AAD), and the prognosis of...
OBJECTIVE
The aim of this study was to determine the association between fluoroquinolones (FQs) use, the risk of aortic aneurysm or dissection (AAD), and the prognosis of patients with pre-existing AAD.
MATERIALS AND METHODS
We searched PubMed, EMBASE, CENTRAL, Scopus, and Web of Science on 31 March 2022. Observational studies that evaluated the association of FQs with AAD risk in the general population or FQs with the prognosis of patients with preexisting AAD and presented adjusted effect estimates were included. Two reviewers assessed study eligibility, extracted data, and assessed the risk of bias and certainty of evidence using GRADE.
RESULTS
Of the 13 included studies, 11 focused on the association of FQs with AAD incidence, and only one study investigated the association of FQs with the patient with AAD prognosis. FQ use was associated with an increased risk of AAD within 30 days (RR: 1.42; 95% CI: 1.11-1.81; very low certainty) and 60 days (RR: 1.44; 95% CI: 1.26-1.64; low certainty). Specifically, the association was significant when compared with amoxicillin, azithromycin, doxycycline, or no antibiotic use. Furthermore, patients with preexisting AAD exposure to FQ had an increased risk of all-cause mortality (RR: 1.61; 95% CI: 1.50-1.73; moderate certainty) and aortic-specific mortality (RR: 1.80; 95% CI: 1.50-2.15; moderate certainty), compared to the non-exposed FQ group within a 60-day risk period.
CONCLUSION
FQs were associated with an increased incidence of AAD in the general population and a higher risk of adverse outcomes in patients with preexisting AAD. Nevertheless, the results may be affected by unmeasured confounding factors. This should be considered by physicians contemplating using FQs in patients with aortic dilation and those at high risk of AAD.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021230171].
PubMed: 36017083
DOI: 10.3389/fcvm.2022.949538