Monica S Badve1, Zien Zhou2, Craig S Anderson3, Maree L Hackett4. 1. Department of Neurology, The St George hospital, Sydney, Australia; Neurological and Mental Health Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; School of Medicine, The University of Sydney, Sydney, Australia. Electronic address: monica.badve@health.nsw.gov.au. 2. Neurological and Mental Health Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 3. Neurological and Mental Health Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; School of Medicine, The University of Sydney, Sydney, Australia; The George Institute China, Peking University Health Science Center, Beijing, China. 4. Neurological and Mental Health Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; School of Medicine, The University of Sydney, Sydney, Australia; Faculty of Health and Wellbeing, The University of Central Lancashire, Preston, United Kingdom.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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 48hours 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. CONCLUSION: 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.
BACKGROUND: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. METHODS: 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. RESULTS: 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 48hours 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. CONCLUSION: 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.
Authors: Júlia Faura; Alejandro Bustamante; Silvia Reverté; Teresa García-Berrocoso; Mónica Millán; Mar Castellanos; Blanca Lara-Rodríguez; Josep Zaragoza; Oriol Ventura; María Hernández-Pérez; Cecile van Eendenburg; Pere Cardona; Elena López-Cancio; David Cánovas; Joaquín Serena; Marta Rubiera; Antoni Dávalos; Joan Montaner Journal: J Am Heart Assoc Date: 2021-02-26 Impact factor: 5.501
Authors: Júlia Faura; Laura Ramiro; Alba Simats; Feifei Ma; Anna Penalba; Teresa Gasull; Anna Rosell; Joan Montaner; Alejandro Bustamante Journal: Int J Mol Sci Date: 2022-07-22 Impact factor: 6.208