Antibiotics for treating osteomyelitis in people with sickle cell disease

 

Abstract

Background

Osteomyelitis (both acute and chronic) is one of the most common infectious complications in people with sickle cell disease. 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 osteomyelitis.

Objectives

To determine whether an empirical antibiotic treatment approach (monotherapy or combination therapy) is effective and safe as compared to pathogen-directed antibiotic treatment and whether this effectiveness and safety is dependent on different treatment regimens, age or setting.

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 11 November 2010), African Index Medicus (11 November 2010), ISI Web of Knowledge (11 November 2010) and World Health Organization International Clinical Trials Registry Platform (11 November 2010).

Date of most recent search of the Haemoglobinopathies Trials Register: 08 December 2010.

Selection criteria

We searched for published or unpublished randomised and quasi-randomised controlled trials.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

This update was unable to find any randomised or quasi-randomised controlled trials on antibiotic treatment approaches for osteomyelitis in people with sickle cell disease.

Authors' conclusions

We were unable to identify any relevant trials on the efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from osteomyelitis. Randomised controlled trials are needed to establish the optimum antibiotic treatment for this condition.

 

Plain language summary

Antibiotics for treating osteomyelitis in people with sickle cell disease

Sickle cell disease affects millions of people throughout the world. Osteomyelitis, a bone infection, is one of the major complications. Antibiotics are given to treat it, but there is no worldwide standard treatment. We did an update of search randomised controlled trials which compared antibiotics (alone or in combination) with other antibiotics. We wanted to know if the different antibiotic treatments were effective, if they were safe, and which doses worked best for osteomyelitis in people with sickle cell disease. This update did not find any trials to include in this review. We conclude that a randomised controlled trial should attempt to answer these questions.

 

摘要

背景

抗生素對患有骨髓炎的鐮刀型貧血症患者之治療

骨髓炎(包括急性與慢性)是一個最常見於鐮刀型貧血症患者的感染合併症, 抗生素治療沒有標準化的方法, 並且在不同的國家治療方式可能不盡相同, 因此, 需要針對患有骨髓炎的鐮刀型貧血症患者, 確立不同抗生素治療方法的療效與安全性.

目標

為了確定經驗上的抗生素治療方法(單獨或綜合性治療), 相對於以致病菌為導向的抗生素治療是否有效與安全, 以及這樣的療效和安全性是否依不同的治療方法, 年齡或處置而定.

搜尋策略

我們搜尋了群組中的異常血紅素症註冊試驗 (The Group's Haemoglobinopathies Trials Register), 當中包含了全面性電子資料庫檢索與手工檢索相關期刊和會議程序手冊摘要之參考文獻. 我們也搜尋了LILACS資料庫(從1982年至2009年1月)和www.clinicaltrials.gov網頁 (2008年6月), 異常血紅素症註冊試驗之最新搜尋日期: 2008年11月14日.

選擇標準

我們搜尋了發表或未發表的隨機和半隨機對照試驗.

資料收集與分析

每位作者刻意獨立地提取資料和利用Cochrane Collaboration 方法學評估試驗品質, 但是沒有發現符合條件的隨機對照試驗.

主要結論

我們無法發現任何針對患有骨髓炎的鐮刀型貧血症患者之抗生素治療方法的隨機或半隨機對照試驗.

作者結論

我們無法確立任何對於患有骨髓炎的鐮刀型貧血症患者之抗生素療法的療效與安全性的相關試驗. 在此狀況下, 隨機試驗需要建立最佳的抗生素治療方法.

翻譯人

本摘要由臺灣大學附設醫院余家嫻翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

全球有百萬人罹患鐮刀型貧血症, 骨髓炎, 一種骨頭感染症, 是其主要的合併症之一, 抗生素被用來治療此症, 但是沒有全球一致的標準治療. 我們搜尋隨機對照試驗, 比較單種或合併型抗生素與他種抗生素. 我們想了解不同的抗生素治療是否具療效, 若這些抗生素是安全的, 何種劑量最適於患有骨髓炎的鐮刀型貧血症患者. 在本篇回顧中我們未發現任何試驗, 我們認為隨機對照試驗應嘗試回答這些疑問.