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

Publication Date:
2018-02-09
Publisher:
BMJ Publishing
Electronic ISSN:
2044-6055
Topics:
Medicine
Keywords:
Open access, Infectious diseases
Published by:
http://group.bmj.com/
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autor Wang, W., Chen, W., Liu, Y., Siemieniuk, R. A. C., Li, L., Martinez, J. P. D., Guyatt, G. H., Sun, X.
beschreibung 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.
citation_standardnr 6159513
datenlieferant ipn_articles
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insertion_date 2018-02-09
journaleissn 2044-6055
publikationsjahr_anzeige 2018
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publikationsjahr_intervall 7984:2015-2019
publikationsjahr_sort 2018
publisher BMJ Publishing
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relation http://bmjopen.bmj.com/cgi/content/short/8/2/e020991?rss=1
schlagwort Open access, Infectious diseases
search_space articles
shingle_author_1 Wang, W., Chen, W., Liu, Y., Siemieniuk, R. A. C., Li, L., Martinez, J. P. D., Guyatt, G. H., Sun, X.
shingle_author_2 Wang, W., Chen, W., Liu, Y., Siemieniuk, R. A. C., Li, L., Martinez, J. P. D., Guyatt, G. H., Sun, X.
shingle_author_3 Wang, W., Chen, W., Liu, Y., Siemieniuk, R. A. C., Li, L., Martinez, J. P. D., Guyatt, G. H., Sun, X.
shingle_author_4 Wang, W., Chen, W., Liu, Y., Siemieniuk, R. A. C., Li, L., Martinez, J. P. D., Guyatt, G. H., Sun, X.
shingle_catch_all_1 Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
Open access, 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.
Wang, W., Chen, W., Liu, Y., Siemieniuk, R. A. C., Li, L., Martinez, J. P. D., Guyatt, G. H., Sun, X.
BMJ Publishing
2044-6055
20446055
shingle_catch_all_2 Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
Open access, 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.
Wang, W., Chen, W., Liu, Y., Siemieniuk, R. A. C., Li, L., Martinez, J. P. D., Guyatt, G. H., Sun, X.
BMJ Publishing
2044-6055
20446055
shingle_catch_all_3 Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
Open access, 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.
Wang, W., Chen, W., Liu, Y., Siemieniuk, R. A. C., Li, L., Martinez, J. P. D., Guyatt, G. H., Sun, X.
BMJ Publishing
2044-6055
20446055
shingle_catch_all_4 Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
Open access, 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.
Wang, W., Chen, W., Liu, Y., Siemieniuk, R. A. C., Li, L., Martinez, J. P. D., Guyatt, G. H., Sun, X.
BMJ Publishing
2044-6055
20446055
shingle_title_1 Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
shingle_title_2 Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
shingle_title_3 Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
shingle_title_4 Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
timestamp 2025-06-30T23:32:35.934Z
titel Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
titel_suche Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis
topic WW-YZ
uid ipn_articles_6159513