Antibiotics for treating acute chest syndrome in people with sickle cell disease: Cochrane systematic review
The clinical presentation of acute chest syndrome is similar whether due to infectious or non-infectious causes, thus antibiotics are usually prescribed to treat all episodes. Many different pathogens, including bacteria, have been implicated as causative agents of acute chest syndrome. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from acute chest syndrome. This is an update of a Cochrane review first published in 2007, and previously updated in 2013.Objectives
To determine whether an empirical antibiotic treatment approach (used alone or in combination):
1. is effective for acute chest syndrome compared to placebo or standard treatment;
2. is safe for acute chest syndrome compared to placebo or standard treatment;
Further objectives are to determine whether there are important variations in efficacy and safety:
3. for different treatment regimens,
4. by participant age, or geographical location of the clinical trials.
We searched The Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 23 February 2015), African Index Medicus (1982 to 23 February 2015). and the World Health Organization International Clinical Trials Registry Platform Search Portal (23 February 2015).
Date of most recent search of the Haemoglobinopathies Trials Register: 20 January 2015.Selection criteria
We searched for published or unpublished randomised controlled trials.Data collection and analysis
Each author intended to independently extract data and assess trial quality by standard Cochrane Collaboration methodologies, but no eligible randomised controlled trials were identified.Main results
For this update, we were unable to find any randomised controlled trials on antibiotic treatment approaches for acute chest syndrome in people with sickle cell disease.Authors' conclusions
This update was unable to identify randomised controlled trials on efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from acute chest syndrome. Randomised controlled trials are needed to establish the optimum antibiotic treatment for this condition.
Martí-Carvajal Arturo J, Conterno Lucieni O, Knight-Madden Jennifer M
Antibiotics for treating acute chest syndrome in people with sickle cell disease
Sickle cell disease affects millions of people throughout the world. Acute chest syndrome is a major cause of illness and death in people with sickle cell disease. Symptoms include fever, chest pain and a raised white blood cell count. Acute infection of the lung tissue is a major cause of acute chest syndrome. Antibiotics are often given to treat these lung infections, but there is no worldwide standard treatment. We searched for randomised controlled trials which compared antibiotics (alone or in combination) with other antibiotics, placebo or standard treatment. We wanted to know if the different antibiotic treatments were effective, if they were safe, and which doses worked best for acute chest syndrome in people with sickle cell disease. This update was unable to find any trials to include in this review. We conclude that a randomised controlled trial should attempt to answer these questions. Until there is firm evidence, clinicians should treat acute chest syndrome on a case by case basis and according to the diagnosis and the treatment available.
Implications for practice
This updated Cochrane Review found no randomised controlled trials of antibiotics in people with sickle cell disease suffering acute chest syndrome. Therefore, it was not possible to determine the efficacy and safety of the antibiotic treatment approaches (used either alone or in combination) for people with SCD suffering from ACS. Hence, we recommend that until evidence becomes available, clinicians continue to treat patients on a case-by-case basis given the diagnosis and treatments available to them.
Implications for research
This Cochrane Review has identified the need for well-designed, adequately-powered randomised controlled trials to assess the benefits and harms of antibiotic treatment approaches (used either alone or in combination) as a way of improving the survival and decreasing mortality from ACS in people with SCD.
Future trials regarding this issue should be planned according to the recommendations of 'Standard Protocol Items: Recommendations for Interventional Trials' (SPIRIT) (Chan 2013a; Chan 2013b), and reported according to the 'Consolidated Standards of Reporting Trials' (CONSORT) statement for improving the quality of reporting of efficacy and to get better reports of harms in clinical research (Ioannidis 2004; Moher 2010; Turner 2012), and the Foundation of Patient-Centered Outcomes Research (Basch 2012; Gabriel 2012).Get full text at The Cochrane Library
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