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Evidence summaries

Antibiotic Therapy for Preventing Infections in Patients with Acute Stroke

Preventive antibiotics appears to have no effect on functional outcome or mortality in acute stroke, but appears to significantly reduce the risk of 'overall' infections, especially urinary infections. Level of evidence: "B"

Summary

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).

Clinical comments

Note

Date of latest search:

References

  • Vermeij JD, Westendorp WF, Dippel DW et al. Antibiotic therapy for preventing infections in people with acute stroke. Cochrane Database Syst Rev 2018;1():CD008530. [PubMed]

Primary/Secondary Keywords