Antibiotics for treating community‐acquired pneumonia in people with sickle cell disease Edited (no change to conclusions)

Abstract

Abstract Background

As a consequence of their condition, people with sickle cell disease are at high risk of developing an acute infection of the pulmonary parenchyma called community‐acquired pneumonia. Many different bacteria can cause this infection and antibiotic treatment is generally needed to resolve it. 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 community‐acquired pneumonia. This is an update of a previously published Cochrane Review.

Objectives

To determine the efficacy and safety of the antibiotic treatment approaches (monotherapy or combined) for people with sickle cell disease suffering from community‐acquired pneumonia.

Search methods

We searched The Group's Haemoglobinopathies Trials Register (01 September 2016), which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched LILACS (1982 to 01 September 2016), African Index Medicus (1982 to 20 October 2016) and WHO ICT Registry (20 October 2016).

Selection criteria

We searched for published or unpublished randomized controlled trials.

Data collection and analysis

We intended to summarise data by standard Cochrane methodologies, but no eligible randomized controlled trials were identified.

Main results

We were unable to find any randomized controlled trials on antibiotic treatment approaches for community‐acquired pneumonia in people with sickle cell disease.

Authors' conclusions

The updated review was unable to identify randomized controlled trials on efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from community‐acquired pneumonia. Randomized controlled trials are needed to establish the optimum antibiotic treatment for this condition. The trials regarding this issue should be structured and reported according to the CONSORT statement for improving the quality of reporting of efficacy and improved reports of harms in clinical research. Triallists should consider including the following outcomes in new trials: number of days to become afebrile; mortality; onset of pain crisis or complications of sickle cell disease following community‐acquired pneumonia; diagnosis; hospitalization (admission rate and length of hospital stay); respiratory failure rate; and number of participants receiving a blood transfusion.

There are no trials included in the review and we have not identified any relevant trials up to September 2016. We therefore do not plan to update this review until new trials are published.

Author(s)

Arturo J Martí‐Carvajal, Lucieni O Conterno

Abstract

Plain language summary

Antibiotics for treating pneumonia caught outside of hospital or care homes in people with sickle cell disease

Review question

We reviewed the evidence on the effect and safety of the antibiotic treatment approaches (one drug alone or combined drugs) for people with sickle cell disease with from community‐acquired pneumonia. This is an update of a previously published Cochrane Review.

Background

Sickle cell disease affects millions of people throughout the world. These people can catch pneumonia more easily due to sickle damage to the spleen. The germs causing pneumonia caught in the community vary across the world. They have different sensitivities and resistance levels which are affected by how antibiotics are prescribed in that area.

Search date

The evidence is current to: 01 September 2016.

Study characteristics

We were not able to find any trials to include in this review.

Key results

Trials addressing this issue should be structured and reported according to the CONSORT statement for improving the quality of reporting of efficacy and improved reports of harms in clinical research. Trial investigators should consider including the following outcomes in new trials: number of days to be free of fever, death, onset of pain crisis or complications of sickle cell disease following community‐acquired pneumonia, diagnosis, hospitalization (admission rate and length of hospital stay), respiratory failure rate, and number of participants receiving a blood transfusion. Since no trials have been included in the review up until September 2016, we will still search for trials every two years, but will not publish an updated version of this review until any eligible trials are identified.

Author(s)

Arturo J Martí‐Carvajal, Lucieni O Conterno

Reviewer's Conclusions

Authors' conclusions

Implications for practice

No randomized controlled trials of antibiotics in people with SCD suffering from CAP were found for inclusion in this review. Therefore, it was not possible to determine the efficacy and safety of the antibiotic treatment approaches (monotherapy or combined) for people with CAP suffering from SCD. Hence, we recommend that until evidence becomes available, clinicians continue to treat individuals on a case by case basis given the diagnosis and treatments available to them.

There are no trials included in the review and we have not identified any relevant trials up to September 2016. We therefore do not plan to update this review until new trials are published.

Implications for research

This systematic review has identified the need for well‐designed, adequately‐powered randomized controlled trials to assess the benefits and harms of antibiotic treatment approaches (monotherapy or combined) as a way of improving the survival and decreasing mortality from CAP in people with SCD.

Due to the variability of the clinical practice for treating CAP in this population (inter‐countries and intra‐country), lack of definition of mild CAP in people with SCD, and the immunocompromised state of those individuals, it is not easy to recommend specific outcomes which should be included into RCTs for this clinical entity. For example, some clinical outcomes are not recommended to be included in RCTs for outpatients with mild CAP (mortality, return to “normal” activities of daily living, microbiological response, chest radiography and admission to the hospital) (Gilbert 2008). On the contrary, end points such as patient‐reported outcomes and time‐to‐response are recommended for this clinical issue (Gilbert 2008). Infectious Diseases Society of America has recommended "Design Features of Future Clinical Trials of Antibacterial Agents for Community‐Acquired Pneumonia" (ISDA 2008). However, SCD was not specifically considered in that position paper. CAP has a major impact in people with SCD, more so than in people without that hereditary disease which affects the immune system.

The American Society of Hematology has stated "Due to the complexity of this disease, the numerous side‐effects of treatments, and the potential for hospitalization, patients should be closely monitored and have access to specialized care" (ASH 2008). Therefore, it would be desirable, in order to improve the well‐being and quality of life of that population, to conduct a workshop about this clinical condition in SCD, so that the rules for performing RCTs are defined. This workshop should include haematologists, experts in infectious diseases and methodologists in RCTs from throughout the world.

The trials regarding this issue should be structured and reported according to the CONSORT statement (www.consort‐statement.org) for improving the quality of reporting of efficacy and improved reports of harms in clinical research.

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