Is de-escalation of antimicrobials effective? A systematic review and meta-analysis.

Abstract

BACKGROUND:

De-escalation therapy is a strategy used widely to treat infections while avoiding the use of broad-spectrum antimicrobials. However, there is a paucity of clinical evidence to demonstrate the effectiveness and safety of de-escalation therapy compared to conventional therapy.

METHODS:

A systematic review and meta-analysis was conducted on de-escalation therapy for a variety of infections. A search of the MEDLINE (via PubMed), EMBASE, and Cochrane Library databases up to July 2015 for relevant studies was performed. The primary outcome was relevant mortality, such as 30-day mortality and in-hospital mortality. A meta-analysis was to be conducted for the pooled odds ratio using the random-effects model when possible. Both randomized controlled trials and observational studies were included in the analysis.

RESULTS:

A total of 23 studies were included in the analysis. There was no difference in mortality for most infections, and some studies favored de-escalation over non-de-escalation for better survival. The quality of most studies included was not high.

CONCLUSIONS:

This review and analysis suggests that de-escalation therapy is safe and effective for most infections, although higher quality studies are needed in the future.

• Authors: Goh Ohji, Asako Doi, Shungo Yamamoto, Kentaro Iwata
• Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Int J Infect Dis) Vol. 49 Pg. 71-9 (Aug 2016) ISSN: 1878-3511 [Electronic] Canada
• PMID: 27292606 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Anti-Infective Agents

Topics

• Anti-Infective Agents (therapeutic use)
• Community-Acquired Infections (drug therapy)
• Cross Infection (drug therapy)
• Hospital Mortality
• Humans
• Infections (drug therapy)
• Intensive Care Units
• Pneumonia (drug therapy)
• Pneumonia, Ventilator-Associated (drug therapy)
• Sepsis (drug therapy)