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Empirical metronidazole for patients with severe bacterial infection : A systematic review with meta-analysis and trial sequential analysis

Petersen, Marie Warrer ; Perner, Anders ; Jonsson, Andreas Bender ; Bahador, Marjan ; Sjövall, Fredrik LU orcid and Møller, Morten Hylander (2019) In Acta Anaesthesiologica Scandinavica 63(6). p.802-813
Abstract

Background: Metronidazole is the preferred empirical anti-anaerobic agent for patients with suspected anaerobic infection. The balance between benefits and harms of empirical metronidazole is unclear. We aimed to assess patient-important benefits and harms of empirical metronidazole vs placebo/no treatment in adult patients with severe bacterial infection of any origin. Methods: We conducted a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials assessing empirical metronidazole vs placebo/no treatment in adult hospitalized patients with severe bacterial infection. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement,... (More)

Background: Metronidazole is the preferred empirical anti-anaerobic agent for patients with suspected anaerobic infection. The balance between benefits and harms of empirical metronidazole is unclear. We aimed to assess patient-important benefits and harms of empirical metronidazole vs placebo/no treatment in adult patients with severe bacterial infection of any origin. Methods: We conducted a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials assessing empirical metronidazole vs placebo/no treatment in adult hospitalized patients with severe bacterial infection. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. A protocol and statistical analysis plan was published prior to conducting the review. Results: We included a total of nine trials (n = 1753 patients), all of which were adjudicated as having high risk of bias. We found no difference in the primary outcome mortality within 90 days (relative risk 1.56, 95% confidence interval 0.39-6.25). Fewer patients receiving metronidazole had secondary infections (relative risk 0.43, 95% CI: 0.27-0.68). Trial sequential analysis indicated high risk of random errors due to lack of data, and the quality of evidence was very low for all outcomes. Conclusions: There is low quantity and quality of evidence supporting the use of empirical metronidazole in adult patients with severe bacterial infections of any origin, and no firm evidence for benefit or harm.

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author
; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anaerobic infection, intra-abdominal infection, meta-analysis, metronidazole, trial sequential analysis
in
Acta Anaesthesiologica Scandinavica
volume
63
issue
6
pages
802 - 813
publisher
Wiley-Blackwell
external identifiers
  • pmid:30729495
  • scopus:85061195490
ISSN
0001-5172
DOI
10.1111/aas.13327
language
English
LU publication?
no
id
08d4e43e-303a-4269-b58a-cf728478aad4
date added to LUP
2019-02-22 12:55:26
date last changed
2024-03-19 02:01:08
@article{08d4e43e-303a-4269-b58a-cf728478aad4,
  abstract     = {{<p>Background: Metronidazole is the preferred empirical anti-anaerobic agent for patients with suspected anaerobic infection. The balance between benefits and harms of empirical metronidazole is unclear. We aimed to assess patient-important benefits and harms of empirical metronidazole vs placebo/no treatment in adult patients with severe bacterial infection of any origin. Methods: We conducted a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials assessing empirical metronidazole vs placebo/no treatment in adult hospitalized patients with severe bacterial infection. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. A protocol and statistical analysis plan was published prior to conducting the review. Results: We included a total of nine trials (n = 1753 patients), all of which were adjudicated as having high risk of bias. We found no difference in the primary outcome mortality within 90 days (relative risk 1.56, 95% confidence interval 0.39-6.25). Fewer patients receiving metronidazole had secondary infections (relative risk 0.43, 95% CI: 0.27-0.68). Trial sequential analysis indicated high risk of random errors due to lack of data, and the quality of evidence was very low for all outcomes. Conclusions: There is low quantity and quality of evidence supporting the use of empirical metronidazole in adult patients with severe bacterial infections of any origin, and no firm evidence for benefit or harm.</p>}},
  author       = {{Petersen, Marie Warrer and Perner, Anders and Jonsson, Andreas Bender and Bahador, Marjan and Sjövall, Fredrik and Møller, Morten Hylander}},
  issn         = {{0001-5172}},
  keywords     = {{anaerobic infection; intra-abdominal infection; meta-analysis; metronidazole; trial sequential analysis}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{802--813}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Anaesthesiologica Scandinavica}},
  title        = {{Empirical metronidazole for patients with severe bacterial infection : A systematic review with meta-analysis and trial sequential analysis}},
  url          = {{http://dx.doi.org/10.1111/aas.13327}},
  doi          = {{10.1111/aas.13327}},
  volume       = {{63}},
  year         = {{2019}},
}