Comparing the quantity and quality of randomised placebo-controlled trials of antibiotics for acute respiratory, urinary, and skin and soft tissue infections: a scoping review.

Mina Bakhit,Nick Francis,Tammy Hoffmann,Eva Hummers,Justin Clark,Matthew Ridd,Miriam Santer,Carmen Hilliges,Chris Del Mar

doi:10.3399/bjgpopen20x101082

Abstract

BackgroundThe management of acute respiratory infections (ARIs), urinary tract infections (UTIs), and skin and soft tissue infections (SSTIs) should be guided by high quality evidence.AimTo compare the quantity and quality of randomised placebo-controlled trials of antibiotics for ARIs, UTIs, and SSTIs.Design & settingA scoping review of the literature was performed using comprehensive search strategies.MethodPubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for published studies from inception until 17 April 2019. Randomised controlled trials (RCTs) that compared participants in primary care or in the community who had uncomplicated acute ARI, UTI, or studies, and were randomised to antibiotic or placebo (or no active treatment), were eligible for inclusion. Two groups of researchers independently screened articles for inclusion, extracted data, and assessed the quality of included studies.ResultsA total of 108 eligible studies were identified: 80 on ARI, eight on UTI, and 20 on SSTI. The quality of studies varied with unclear risk of bias (RoB) prevalent in many domains. There was a gradual improvement in the quality of trials investigating ARIs over time, which could not be assessed in SSTI and UTI studies.ConclusionThis review highlights a sparsity of trials assessing the effectiveness of antibiotics in people with UTIs and SSTIs, compared to trials targeting ARIs. This gap in the evidence needs to be addressed by conducting further high quality trials on the effects of antibiotics in patients with UTI and SSTI.

Highlights

Widespread antibiotic resistance threatens a post-antibiotic era.[1,2] Reducing antibiotic use is widely recognised as a key component to tackling the global antibiotic resistance crisis
acute respiratory infections (ARIs), SSTIs, and uncomplicated urinary tract infections (UTIs) are the three most common infections seen in primary care, with ARIs accounting for 41%–46%, SSTIs accounting for 16%–18%, and UTIs accounting for 9%–23% of antibiotics prescribed outside hospitals.[5,6]
Randomised controlled trials (RCTs) were included that compared antibiotic-exposed participants to placebo controls among patients managed in primary care or in the community, who had uncomplicated acute infections of either the respiratory tract, urinary tract, or skin and soft tissue

Summary

Introduction

Widespread antibiotic resistance threatens a post-antibiotic era.[1,2] Reducing antibiotic use is widely recognised as a key component to tackling the global antibiotic resistance crisis. The authors decided to explore this impression by conducting a scoping review of the literature on studies of the effectiveness of antibiotics versus placebo (or no treatment) for these infections, and compare the quantity and quality of the RCTs addressing this question for these groups of infections. Aim: To compare the quantity and quality of randomised placebo-c ontrolled trials of antibiotics for ARIs, UTIs, and SSTIs. Design & setting: A scoping review of the literature was performed using comprehensive search strategies. Randomised controlled trials (RCTs) that compared participants in primary care or in the community who had uncomplicated acute ARI, UTI, or studies, and were randomised to antibiotic or placebo (or no active treatment), were eligible for inclusion.

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Conclusion