Effectiveness and Safety of Antibiotics for Preventing Pneumonia and Improving Outcome after Acute Stroke: Systematic Review and Meta-analysis

Badve, Monica S, Zhou, Zien, Anderson, Craig and Hackett, Maree orcid iconORCID: 0000-0003-1211-9087 (2018) Effectiveness and Safety of Antibiotics for Preventing Pneumonia and Improving Outcome after Acute Stroke: Systematic Review and Meta-analysis. Journal of Stroke and Cerebrovascular Diseases . ISSN 1052-3057

[thumbnail of Author Accepted Manuscript]
Preview
PDF (Author Accepted Manuscript) - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

189kB
[thumbnail of PRISMA 2009 checklist]
Preview
PDF (PRISMA 2009 checklist) - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

222kB
[thumbnail of Table 1]
Preview
PDF (Table 1) - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

430kB
[thumbnail of Table 2]
Preview
PDF (Table 2) - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

567kB
[thumbnail of Figure 1]
Preview
PDF (Figure 1) - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

213kB
[thumbnail of Figure 2]
Preview
PDF (Figure 2) - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

1MB
[thumbnail of Figure 3]
Preview
PDF (Figure 3) - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

25kB
[thumbnail of Figure 4]
Preview
PDF (Figure 4) - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

26kB
[thumbnail of Figure 5]
Preview
PDF (Figure 5) - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

25kB

Official URL: https://doi.org/10.1016/j.jstrokecerebrovasdis.201...

Abstract

Pneumonia is a common complication after stroke which increases morbidity and mortality. This systematic review was conducted to evaluate the efficacy and safety of antibiotics for the prevention of pneumonia after acute stroke. Medline, EMBASE, and Cochrane databases were searched for randomized controlled trials comparing preventive antibiotics to placebo or no antibiotics after acute stroke. The primary outcome was poststroke pneumonia. Secondary outcomes were all infections, urinary tract infections, death, dependency, length of hospital stay, and adverse events. Treatment effects were summarized using random effects metaanalysis. Six trials (4111 patients) were eligible for inclusion. The median National Institute of Health Stroke Scale score in included trials ranged from 5 to 16.5. The proportion of dysphagia ranged from 26% to 100%. Preventive antibiotics were commenced within 48 hours after acute stroke. Compared to control, preventive antibiotics reduced the risk of poststroke pneumonia (RR .75, 95%CI ·.57-.99), and all infections (RR .58, 95%CI .48-.69). There was no significant difference in the risks of dependency (RR 0.99, 95%CI 0·80-1·11), or mortality (RR .96, 95%CI .78-1.19) between the preventive antibiotics and control groups. Preventive antibiotics did not increase the risk of elevated liver enzymes (RR 1.20, 95% CI .97-1.49). Preventive antibiotics had uncertain effects on the risks of other adverse events. Preventive antibiotics reduced the risk of post-stroke pneumonia. However, there is insufficient evidence to currently recommend routine use of preventive antibiotics after acute stroke. [Abstract copyright: Copyright © 2018. Published by Elsevier Inc.]


Repository Staff Only: item control page