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The efficacy and safety of prophylactic antibiotics for post-acute stroke infection: a systematic review and meta-analysis
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  • Qing Wang,
  • Ziyang Wu,
  • Huilin Tang,
  • Zhan-Miao Yi,
  • Suo-Di Zhai
Qing Wang
Peking University Third Hospital

Corresponding Author:[email protected]

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Ziyang Wu
Peking University Third Hospital
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Huilin Tang
University of Florida College of Pharmacy
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Zhan-Miao Yi
Peking University Third Hospital
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Suo-Di Zhai
Peking University Third Hospital
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Abstract

Background: Infections are common complications after stroke and associated with unfavorable outcomes. We evaluated the efficacy and safety of prophylactic antibiotics for post-acute stroke infection. Methods: We searched PubMed, Embase, the Cochrane Library, SinoMed, China National Knowledge Infrastructure, and WanFangData from inception to February 15th, 2022. We calculated the pooled risk ratio (RR) and mean differences (MDs) with 95% confidence interval (CI), evaluated the risk of bias and conducted sensitivity analysis with RevMan version 5.4.1 and Stata version 14.0 software. The overall quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: Twelve studies (4809 participants) were included in this meta-analysis. There was no significant difference in the mortality rate [RR 1.03 (95% Cl: 0.91-1.16)], pneumonia [RR 0.94 (95% CI: 0.79-1.11)], and the incidence of adverse events between the prophylactic antibiotics and control groups. Prophylactic antibiotics significantly reduced the incidence of infections [RR 0.72 (95% Cl: 0.58-0.89)], and urinary tract infections [RR 0.39 (95% Cl: 0.3-0.49)] in patients with acute stroke. We performed a subgroup analysis and found a decreasing trend in pneumonia in patients with early prophylactic use of antibiotics within 24 hours after admission [RR 0.81 (95%CI: 0.62-1.07)] as compared with those using prophylactic use of antibiotics within 48 hours after admission [RR 0.94 (95%CI: 0.79-1.11)]. Conclusions: Prophylactic antibiotics did not significantly reduce the mortality rate and pneumonia in patients with acute stroke but reduced the incidence of infections and urinary tract infections.
09 Oct 2022Submitted to British Journal of Clinical Pharmacology
10 Oct 2022Submission Checks Completed
10 Oct 2022Assigned to Editor
12 Oct 2022Reviewer(s) Assigned
24 Oct 2022Review(s) Completed, Editorial Evaluation Pending
24 Oct 2022Editorial Decision: Revise Major
05 Dec 20221st Revision Received
06 Dec 2022Submission Checks Completed
06 Dec 2022Assigned to Editor
06 Dec 2022Review(s) Completed, Editorial Evaluation Pending
09 Dec 2022Editorial Decision: Accept
04 Jan 2023Published in British Journal of Clinical Pharmacology. 10.1111/bcp.15646