Antibiotics for treating acute chest syndrome in people with sickle cell disease

  • Review
  • Intervention

Authors


Abstract

Background

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.

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.

Search methods

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 15 September 2009) and the web site: www.clinicaltrials.gov (15 September 2009).

Date of most recent search of the Haemoglobinopathies Trials Register: 26 August 2009.

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We searched for published or unpublished randomised controlled trials.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

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.

Plain language summary

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.