Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis
Introduction Community-acquired pneumonia (CAP), frequently encountered in both outpatient and inpatient settings, is the leading cause of infectious disease-related mortality. While equipoise regarding the optimal duration of antimicrobial therapy to treat CAP remains, recent studies suggest shorte...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-06-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e062428.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832584121409339392 |
|---|---|
| author | Gordon Guyatt Arnav Agarwal Mark Loeb John Basmaji Ya Gao Maryam Ghadimi Layla Bakaa Luis Enrique Colunga Lozano Saad Asif Aninditee Das |
| author_facet | Gordon Guyatt Arnav Agarwal Mark Loeb John Basmaji Ya Gao Maryam Ghadimi Layla Bakaa Luis Enrique Colunga Lozano Saad Asif Aninditee Das |
| author_sort | Gordon Guyatt |
| collection | DOAJ |
| description | Introduction Community-acquired pneumonia (CAP), frequently encountered in both outpatient and inpatient settings, is the leading cause of infectious disease-related mortality. While equipoise regarding the optimal duration of antimicrobial therapy to treat CAP remains, recent studies suggest shorter durations of therapy may achieve optimal outcomes. We have therefore planned a systematic review and meta-analysis evaluating the impact of shorter versus longer durations of antibiotic therapy for patients with CAP.Methods and analysis We searched Ovid MEDLINE, Embase, CINAHL and Cochrane Central Register of Controlled Trials from inception to September 2021 for randomised controlled trials evaluating shorter versus longer duration of antibiotics. Eligible studies will compare durations with a minimum difference of two days of antibiotic therapy, irrespective of antibiotic agent, class, route, frequency or dosage, and will report on any patient-important outcome of benefit or harm. Paired reviewers working independently will conduct title and abstract screening, full-text screening, data extraction and risk of bias (RoB) evaluation using a modified Cochrane RoB 2.0 tool. We will perform random-effects modelling for meta-analyses, with study weights generated using the inverse variance method, and will assess certainty in effect estimates using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) tool will inform assessments of credibility of subgroup effects based on severity of illness, drug class, duration of therapy, setting of CAP acquisition and RoB.Ethics and dissemination The results will be of importance to general practitioners and internists managing CAP, and may directly inform international clinical guidance. Where concerns regarding antimicrobial resistance continue to grow internationally, this evidence summary may motivate new recommendations regarding shorter durations of therapy. We intend to disseminate our findings via national and international conferences, and publication in a peer-reviewed journal.PROSPERO registration number CRD42021283990. |
| format | Article |
| id | doaj-art-b77b2c0b81d84357a5d860d9be542ff9 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-b77b2c0b81d84357a5d860d9be542ff92025-01-27T16:10:13ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2022-062428Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysisGordon Guyatt0Arnav Agarwal1Mark Loeb2John Basmaji3Ya Gao4Maryam Ghadimi5Layla Bakaa6Luis Enrique Colunga Lozano7Saad Asif8Aninditee Das96Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada8Faculty of Medicine, University of Toronto, Toronto, Ontario, Canadamethodologist, infectious disease physicianDivision of Critical Care, Western University, London, Ontario, Canadadoctoral candidateDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, CanadaFaculty of Science, McMaster University, Hamilton, Ontario, CanadaDepartment of Clinical Medicine, Universidad de Guadalajara, Guadalajara, Jalisco, MexicoDepartment of Medicine, McMaster University, Hamilton, Ontario, CanadaDepartment of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, CanadaIntroduction Community-acquired pneumonia (CAP), frequently encountered in both outpatient and inpatient settings, is the leading cause of infectious disease-related mortality. While equipoise regarding the optimal duration of antimicrobial therapy to treat CAP remains, recent studies suggest shorter durations of therapy may achieve optimal outcomes. We have therefore planned a systematic review and meta-analysis evaluating the impact of shorter versus longer durations of antibiotic therapy for patients with CAP.Methods and analysis We searched Ovid MEDLINE, Embase, CINAHL and Cochrane Central Register of Controlled Trials from inception to September 2021 for randomised controlled trials evaluating shorter versus longer duration of antibiotics. Eligible studies will compare durations with a minimum difference of two days of antibiotic therapy, irrespective of antibiotic agent, class, route, frequency or dosage, and will report on any patient-important outcome of benefit or harm. Paired reviewers working independently will conduct title and abstract screening, full-text screening, data extraction and risk of bias (RoB) evaluation using a modified Cochrane RoB 2.0 tool. We will perform random-effects modelling for meta-analyses, with study weights generated using the inverse variance method, and will assess certainty in effect estimates using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) tool will inform assessments of credibility of subgroup effects based on severity of illness, drug class, duration of therapy, setting of CAP acquisition and RoB.Ethics and dissemination The results will be of importance to general practitioners and internists managing CAP, and may directly inform international clinical guidance. Where concerns regarding antimicrobial resistance continue to grow internationally, this evidence summary may motivate new recommendations regarding shorter durations of therapy. We intend to disseminate our findings via national and international conferences, and publication in a peer-reviewed journal.PROSPERO registration number CRD42021283990.https://bmjopen.bmj.com/content/12/6/e062428.full |
| spellingShingle | Gordon Guyatt Arnav Agarwal Mark Loeb John Basmaji Ya Gao Maryam Ghadimi Layla Bakaa Luis Enrique Colunga Lozano Saad Asif Aninditee Das Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis BMJ Open |
| title | Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis |
| title_full | Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis |
| title_fullStr | Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis |
| title_full_unstemmed | Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis |
| title_short | Shorter versus longer durations of antibiotic treatment for patients with community-acquired pneumonia: a protocol for a systematic review and meta-analysis |
| title_sort | shorter versus longer durations of antibiotic treatment for patients with community acquired pneumonia a protocol for a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/12/6/e062428.full |
| work_keys_str_mv | AT gordonguyatt shorterversuslongerdurationsofantibiotictreatmentforpatientswithcommunityacquiredpneumoniaaprotocolforasystematicreviewandmetaanalysis AT arnavagarwal shorterversuslongerdurationsofantibiotictreatmentforpatientswithcommunityacquiredpneumoniaaprotocolforasystematicreviewandmetaanalysis AT markloeb shorterversuslongerdurationsofantibiotictreatmentforpatientswithcommunityacquiredpneumoniaaprotocolforasystematicreviewandmetaanalysis AT johnbasmaji shorterversuslongerdurationsofantibiotictreatmentforpatientswithcommunityacquiredpneumoniaaprotocolforasystematicreviewandmetaanalysis AT yagao shorterversuslongerdurationsofantibiotictreatmentforpatientswithcommunityacquiredpneumoniaaprotocolforasystematicreviewandmetaanalysis AT maryamghadimi shorterversuslongerdurationsofantibiotictreatmentforpatientswithcommunityacquiredpneumoniaaprotocolforasystematicreviewandmetaanalysis AT laylabakaa shorterversuslongerdurationsofantibiotictreatmentforpatientswithcommunityacquiredpneumoniaaprotocolforasystematicreviewandmetaanalysis AT luisenriquecolungalozano shorterversuslongerdurationsofantibiotictreatmentforpatientswithcommunityacquiredpneumoniaaprotocolforasystematicreviewandmetaanalysis AT saadasif shorterversuslongerdurationsofantibiotictreatmentforpatientswithcommunityacquiredpneumoniaaprotocolforasystematicreviewandmetaanalysis AT aninditeedas shorterversuslongerdurationsofantibiotictreatmentforpatientswithcommunityacquiredpneumoniaaprotocolforasystematicreviewandmetaanalysis |