Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis.
BMJ Open
; 8(2): e020991, 2018 02 06.
Article
en En
| MEDLINE
| ID: mdl-29437689
ABSTRACT
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. REVIEWMETHODS:
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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Enfermedades Cutáneas Infecciosas
/
Absceso
/
Antibacterianos
Tipo de estudio:
Clinical_trials
/
Guideline
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
BMJ Open
Año:
2018
Tipo del documento:
Article
País de afiliación:
China