Estimating daily antibiotic harms: an umbrella review with individual study meta-analysis
| Autor: | Kevin R. Brown, Julie Hc Wu, Gary Garber, Kevin L Schwartz, Nick Daneman, Jennifer Lo, Bradley J Langford, Jennifer Curran, Valerie Leung |
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| Rok vydání: | 2021 |
| Předmět: |
Microbiology (medical)
Adult medicine.medical_specialty business.industry medicine.drug_class Antibiotics Context (language use) General Medicine Odds ratio medicine.disease_cause law.invention Anti-Bacterial Agents Infectious Diseases Systematic review Randomized controlled trial law Meta-analysis Superinfection Internal medicine Medicine Humans business Adverse effect Child |
| Zdroj: | Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 28(4) |
| ISSN: | 1469-0691 |
| Popis: | Background There is growing evidence supporting the efficacy of shorter courses of antibiotic therapy for common infections, however the risks of prolonged antibiotic duration are underappreciated. Objectives We sought to estimate the incremental daily risk of antibiotic-associated harms. Methods We searched three major databases to retrieve systematic reviews from 2000 to July 30, 2020 in any language. Eligibility Systematic reviews were required to evaluate shorter versus longer antibiotic therapy with fixed durations between 3 and 14 days. RCTs included for meta-analysis were identified from the systematic reviews. Participants Adult and pediatric patients from any setting. Interventions Primary outcomes were the proportion of patients experiencing adverse drug events, superinfections and antimicrobial resistance. Risk of Bias Assessment: Each RCT was evaluated for quality by extracting the assessment reported by each systematic review. Data Synthesis The daily odds ratio (OR) of antibiotic harm was estimated and pooled using random effects meta-analysis. Results Thirty-five (35) systematic reviews encompassing 71 eligible randomized controlled trials were included. Studies most commonly evaluated duration of therapy for respiratory tract (n=36, 51%) and urinary tract infections (n=29, 41%). Overall, 23,174 patients were evaluated for antibiotic-associated harms. Adverse events (n=20,345), superinfections (n=5,776), and AMR (n=2,330) were identified in 19.9% (n=4,039), 4.8% (n=280), and 10.6% (n=246) of patients, respectively. Each day of antibiotic therapy was associated with 4% increased odds of experiencing an adverse event (OR 1.04, 95% CI [1.02 to 1.07]). Daily odds of severe adverse effects also increased (OR 1.09, 95% CI [1.00 to 1.19). The daily incremental odds of superinfection and AMR were OR 0.98 (0.92 to 1.06) and OR 1.03 (0.98 to 1.07), respectively. Conclusion Each additional day of antibiotic therapy is associated with measurable antibiotic harm, particularly adverse events. These data may provide additional context for clinicians when weighing benefits versus risks of prolonged antibiotic therapy. |
| Databáze: | OpenAIRE |
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