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Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis

OBJECTIVE: To assess the impact of adjunctive antibiotic therapy on uncomplicated skin abscesses. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Medline, Embase, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. STUDY SELECTION: A BMJ Rapid Recommendation...

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Autores principales: Wang, Wen, Chen, Wenwen, Liu, Yanmei, Siemieniuk, Reed Alexander C, Li, Ling, Martínez, Juan Pablo Díaz, Guyatt, Gordon H, Sun, Xin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829937/
https://www.ncbi.nlm.nih.gov/pubmed/29437689
http://dx.doi.org/10.1136/bmjopen-2017-020991
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author Wang, Wen
Chen, Wenwen
Liu, Yanmei
Siemieniuk, Reed Alexander C
Li, Ling
Martínez, Juan Pablo Díaz
Guyatt, Gordon H
Sun, Xin
author_facet Wang, Wen
Chen, Wenwen
Liu, Yanmei
Siemieniuk, Reed Alexander C
Li, Ling
Martínez, Juan Pablo Díaz
Guyatt, Gordon H
Sun, Xin
author_sort Wang, Wen
collection PubMed
description OBJECTIVE: To assess the impact of adjunctive antibiotic therapy on uncomplicated skin abscesses. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Medline, Embase, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. STUDY SELECTION: A BMJ Rapid Recommendation panel provided input on design, important outcomes and the interpretation of the results. Eligible randomised controlled trials (RCTs) included a comparison of antibiotics against no antibiotics or a comparison of different antibiotics in patients with uncomplicated skin abscesses, and reported outcomes prespecified by the linked guideline panel. REVIEW METHODS: Reviewers independently screened abstracts and full texts for eligibility, assessed risk of bias and extracted data. We performed random-effects meta-analyses that compared antibiotics with no antibiotics, along with a limited number of prespecified subgroup hypotheses. We also performed network meta-analysis with a Bayesian framework to compare effects of different antibiotics. Quality of evidence was assessed with The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Fourteen RCTs including 4198 patients proved eligible. Compared with no antibiotics, antibiotics probably lower the risk of treatment failure (OR 0.58, 95% CI 0.37 to 0.90; low quality), recurrence within 1 month (OR 0.48, 95% CI 0.30 to 0.77; moderate quality), hospitalisation (OR 0.55, 95% CI 0.32 to 0.94; moderate quality) and late recurrence (OR 0.64, 95% CI 0.48 to 0.85; moderate quality). However, relative to no use, antibiotics probably increase the risk of gastrointestinal side effects (trimethoprim and sulfamethoxazole (TMP-SMX): OR 1.28, 95% CI 1.04 to 1.58; moderate quality; clindamycin: OR 2.29, 95% CI 1.35 to 3.88; high quality) and diarrhoea (clindamycin: OR 2.71, 95% CI 1.50 to 4.89; high quality). Cephalosporins did not reduce the risk of treatment failure compared with placebo (moderate quality). CONCLUSIONS: In patients with uncomplicated skin abscesses, moderate-to-high quality evidence suggests TMP-SMX or clindamycin confer a modest benefit for several important outcomes, but this is offset by a similar risk of adverse effects. Clindamycin has a substantially higher risk of diarrhoea than TMP-SMX. Cephalosporins are probably not effective.
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spelling pubmed-58299372018-03-01 Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis Wang, Wen Chen, Wenwen Liu, Yanmei Siemieniuk, Reed Alexander C Li, Ling Martínez, Juan Pablo Díaz Guyatt, Gordon H Sun, Xin BMJ Open Infectious Diseases OBJECTIVE: To assess the impact of adjunctive antibiotic therapy on uncomplicated skin abscesses. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Medline, Embase, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. STUDY SELECTION: A BMJ Rapid Recommendation panel provided input on design, important outcomes and the interpretation of the results. Eligible randomised controlled trials (RCTs) included a comparison of antibiotics against no antibiotics or a comparison of different antibiotics in patients with uncomplicated skin abscesses, and reported outcomes prespecified by the linked guideline panel. REVIEW METHODS: Reviewers independently screened abstracts and full texts for eligibility, assessed risk of bias and extracted data. We performed random-effects meta-analyses that compared antibiotics with no antibiotics, along with a limited number of prespecified subgroup hypotheses. We also performed network meta-analysis with a Bayesian framework to compare effects of different antibiotics. Quality of evidence was assessed with The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Fourteen RCTs including 4198 patients proved eligible. Compared with no antibiotics, antibiotics probably lower the risk of treatment failure (OR 0.58, 95% CI 0.37 to 0.90; low quality), recurrence within 1 month (OR 0.48, 95% CI 0.30 to 0.77; moderate quality), hospitalisation (OR 0.55, 95% CI 0.32 to 0.94; moderate quality) and late recurrence (OR 0.64, 95% CI 0.48 to 0.85; moderate quality). However, relative to no use, antibiotics probably increase the risk of gastrointestinal side effects (trimethoprim and sulfamethoxazole (TMP-SMX): OR 1.28, 95% CI 1.04 to 1.58; moderate quality; clindamycin: OR 2.29, 95% CI 1.35 to 3.88; high quality) and diarrhoea (clindamycin: OR 2.71, 95% CI 1.50 to 4.89; high quality). Cephalosporins did not reduce the risk of treatment failure compared with placebo (moderate quality). CONCLUSIONS: In patients with uncomplicated skin abscesses, moderate-to-high quality evidence suggests TMP-SMX or clindamycin confer a modest benefit for several important outcomes, but this is offset by a similar risk of adverse effects. Clindamycin has a substantially higher risk of diarrhoea than TMP-SMX. Cephalosporins are probably not effective. BMJ Publishing Group 2018-02-06 /pmc/articles/PMC5829937/ /pubmed/29437689 http://dx.doi.org/10.1136/bmjopen-2017-020991 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Infectious Diseases
Wang, Wen
Chen, Wenwen
Liu, Yanmei
Siemieniuk, Reed Alexander C
Li, Ling
Martínez, Juan Pablo Díaz
Guyatt, Gordon H
Sun, Xin
Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
title Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
title_full Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
title_fullStr Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
title_full_unstemmed Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
title_short Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
title_sort antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
topic Infectious Diseases
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829937/
https://www.ncbi.nlm.nih.gov/pubmed/29437689
http://dx.doi.org/10.1136/bmjopen-2017-020991
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