Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review.

2.50
Hdl Handle:
http://hdl.handle.net/10029/5606
Title:
Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review.
Authors:
Hahné, Susan J M; Charlett, André; Purcell, Bernadette; Samuelsson, Susanne; Camaroni, Ivonne; Ehrhard, Ingrid; Heuberger, Sigrid; Santamaria, Maria; Stuart, James M
Abstract:
OBJECTIVE: To review the evidence for effectiveness of treatment with antibiotics before admission in reducing case fatality from meningococcal disease. DESIGN: Systematic review. DATA SOURCES: Cochrane register of trials and systematic reviews, database of abstracts of reviews of effectiveness, health technology assessment, and national research register in England and Wales, Medline, Embase, and CAB Health. INCLUDED STUDIES: Studies describing vital outcome of at least 10 cases of meningococcal disease classified by whether or not antibiotics were given before admission to hospital. RESULTS: 14 observational studies met the review criteria. Oral antibiotic treatment given before admission was associated with reduced mortality among cases (combined risk ratio 0.17, 95% confidence interval 0.07 to 0.44). In seven studies in which all included patients were seen in primary care, the association between parenteral antibiotics before admission and outcome was inconsistent (chi2 for heterogeneity 11.02, P = 0.09). After adjustment for the proportion given parenteral antibiotics before admission, there was no residual heterogeneity. A higher proportion of patients given parenteral antibiotics before admission was associated with reduced mortality after such treatment and vice versa (P = 0.04). CONCLUSION: Confounding by severity is the most likely explanation both for the beneficial effect of oral antibiotics and the harmful effect observed in some studies of parenteral antibiotics. We cannot conclude whether or not antibiotics given before admission have an effect on case fatality. The data are consistent with benefit when a substantial proportion of cases are treated.
Citation:
BMJ 2006, 332(7553):1299-303
Issue Date:
3-Jun-2006
URI:
http://hdl.handle.net/10029/5606
DOI:
10.1136/bmj.332.7553.1299
PubMed ID:
16740557
Type:
Article
Language:
en
ISSN:
1468-5833
Appears in Collections:
Infectious Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorHahné, Susan J M-
dc.contributor.authorCharlett, André-
dc.contributor.authorPurcell, Bernadette-
dc.contributor.authorSamuelsson, Susanne-
dc.contributor.authorCamaroni, Ivonne-
dc.contributor.authorEhrhard, Ingrid-
dc.contributor.authorHeuberger, Sigrid-
dc.contributor.authorSantamaria, Maria-
dc.contributor.authorStuart, James M-
dc.date.accessioned2006-10-26T11:32:13Z-
dc.date.available2006-10-26T11:32:13Z-
dc.date.issued2006-06-03-
dc.identifier.citationBMJ 2006, 332(7553):1299-303en
dc.identifier.issn1468-5833-
dc.identifier.pmid16740557-
dc.identifier.doi10.1136/bmj.332.7553.1299-
dc.identifier.urihttp://hdl.handle.net/10029/5606-
dc.description.abstractOBJECTIVE: To review the evidence for effectiveness of treatment with antibiotics before admission in reducing case fatality from meningococcal disease. DESIGN: Systematic review. DATA SOURCES: Cochrane register of trials and systematic reviews, database of abstracts of reviews of effectiveness, health technology assessment, and national research register in England and Wales, Medline, Embase, and CAB Health. INCLUDED STUDIES: Studies describing vital outcome of at least 10 cases of meningococcal disease classified by whether or not antibiotics were given before admission to hospital. RESULTS: 14 observational studies met the review criteria. Oral antibiotic treatment given before admission was associated with reduced mortality among cases (combined risk ratio 0.17, 95% confidence interval 0.07 to 0.44). In seven studies in which all included patients were seen in primary care, the association between parenteral antibiotics before admission and outcome was inconsistent (chi2 for heterogeneity 11.02, P = 0.09). After adjustment for the proportion given parenteral antibiotics before admission, there was no residual heterogeneity. A higher proportion of patients given parenteral antibiotics before admission was associated with reduced mortality after such treatment and vice versa (P = 0.04). CONCLUSION: Confounding by severity is the most likely explanation both for the beneficial effect of oral antibiotics and the harmful effect observed in some studies of parenteral antibiotics. We cannot conclude whether or not antibiotics given before admission have an effect on case fatality. The data are consistent with benefit when a substantial proportion of cases are treated.en
dc.format.extent135264 bytes-
dc.format.mimetypeapplication/pdf-
dc.language.isoenen
dc.titleEffectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review.en
dc.typeArticleen
dc.format.digYES-

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