A Cochrane review [Abstract] 1 included 8 studies with a total of 4488 subjects. Study intervention differed in all 8 studies. Mortality rate in the preventive antibiotic group was not significantly different from that in the control group (17% vs. 16%; RR 1.03, 95% CI 0.87 to 1.21; 8 studies, n=4422). The number of participants with a poor functional outcome (death or dependency) in the preventive antibiotic therapy group was also not significantly different from that in the control group (53% vs. 55%; RR 0.99, 95% CI 0.89 to 1.10; 7 studies, n=4332). However, preventive antibiotic therapy did significantly reduce the incidence of 'overall' infections in participants with acute stroke from 26% to 19% (19% vs. 26%; RR 0.71, 95% CI 0.58 to 0.88; 7 studies, n=4317). This finding was highly significant for urinary tract infections (4% vs. 10%; RR 0.40, 95% CI 0.32 to 0.51; 6 studies, n=4257), whereas no preventive effect for pneumonia was found (10% vs. 11%; RR 0.95, 95% CI 0.80 to 1.13; 6 studies, n=4257). No major side effects of preventive antibiotic therapy were reported.
Comment: The quality of the evidence is downgraded by inconsistency (heterogeneity in patients and interventions).
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