1
|
Gillies M, Ranakusuma A, Hoffmann T, Thorning S, McGuire T, Glasziou P, Del Mar C. Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication. CMAJ 2015; 187:E21-E31. [PMID: 25404399 PMCID: PMC4284189 DOI: 10.1503/cmaj.140848] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND When prescribing antibiotics for common indications, clinicians need information about both harms and benefits, information that is currently available only from observational studies. We quantified the common harms of the most frequently prescribed antibiotic, amoxicillin, from randomized placebo-controlled trials. METHODS For this systematic review, we searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials, without language restriction, for any randomized, participant-blinded, placebo-controlled trials of amoxicillin or amoxicillin-clavulanic acid for any indication, in any setting. Our main outcome was any reported adverse event. RESULTS Of 730 studies identified, we included 45 trials: 27 involving amoxicillin, 17 involving amoxicillin-clavulanic acid and 1 involving both. The indications for antibiotic therapy were variable. The risk of bias was low, although only 25 trials provided data suitable for assessment of harms, which suggested under-reporting. Diarrhea was attributed to amoxicillin only in the form of amoxicillin-clavulanic acid (Peto odds ratio [OR] 3.30, 95% confidence interval [CI] 2.23-4.87). The OR for candidiasis (3 trials) was significantly higher (OR 7.77, 95% CI 2.23-27.11). Rashes, nausea, itching, vomiting and abnormal results on liver function tests were not significantly increased. The results were not altered by sensitivity analyses, nor did funnel plots suggest publication bias. The number of courses of antibiotics needed to harm was 10 (95% CI 6-17) for diarrhea with amoxicillin-clavulanic acid and 27 (95% CI 24-42) for candidiasis with amoxicillin (with or without clavulanic acid). INTERPRETATION Diarrhea was caused by use of amoxicillin-clavulanic acid, and candidiasis was caused by both amoxicillin and amoxicillin-clavulanic acid. Harms were poorly reported in most trials, and their true incidence may have been higher than reported. Nevertheless, these rates of common harms associated with amoxicillin therapy may inform decisions by helping clinicians to balance harms against benefits.
Collapse
Affiliation(s)
- Malcolm Gillies
- NPS MedicineWise Ltd. (Gillies), Sydney, New South Wales, Australia; Center for Clinical Epidemiology and Evidence-Based Medicine (Ranakusuma), Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Centre for Research in Evidence-Based Practice (Hoffmann, Thorning, Glasziou, Del Mar) and Faculty of Health Sciences and Medicine (McGuire), Bond University, Gold Coast, Queensland, Australia
| | - Anggi Ranakusuma
- NPS MedicineWise Ltd. (Gillies), Sydney, New South Wales, Australia; Center for Clinical Epidemiology and Evidence-Based Medicine (Ranakusuma), Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Centre for Research in Evidence-Based Practice (Hoffmann, Thorning, Glasziou, Del Mar) and Faculty of Health Sciences and Medicine (McGuire), Bond University, Gold Coast, Queensland, Australia
| | - Tammy Hoffmann
- NPS MedicineWise Ltd. (Gillies), Sydney, New South Wales, Australia; Center for Clinical Epidemiology and Evidence-Based Medicine (Ranakusuma), Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Centre for Research in Evidence-Based Practice (Hoffmann, Thorning, Glasziou, Del Mar) and Faculty of Health Sciences and Medicine (McGuire), Bond University, Gold Coast, Queensland, Australia
| | - Sarah Thorning
- NPS MedicineWise Ltd. (Gillies), Sydney, New South Wales, Australia; Center for Clinical Epidemiology and Evidence-Based Medicine (Ranakusuma), Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Centre for Research in Evidence-Based Practice (Hoffmann, Thorning, Glasziou, Del Mar) and Faculty of Health Sciences and Medicine (McGuire), Bond University, Gold Coast, Queensland, Australia
| | - Treasure McGuire
- NPS MedicineWise Ltd. (Gillies), Sydney, New South Wales, Australia; Center for Clinical Epidemiology and Evidence-Based Medicine (Ranakusuma), Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Centre for Research in Evidence-Based Practice (Hoffmann, Thorning, Glasziou, Del Mar) and Faculty of Health Sciences and Medicine (McGuire), Bond University, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- NPS MedicineWise Ltd. (Gillies), Sydney, New South Wales, Australia; Center for Clinical Epidemiology and Evidence-Based Medicine (Ranakusuma), Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Centre for Research in Evidence-Based Practice (Hoffmann, Thorning, Glasziou, Del Mar) and Faculty of Health Sciences and Medicine (McGuire), Bond University, Gold Coast, Queensland, Australia
| | - Christopher Del Mar
- NPS MedicineWise Ltd. (Gillies), Sydney, New South Wales, Australia; Center for Clinical Epidemiology and Evidence-Based Medicine (Ranakusuma), Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Centre for Research in Evidence-Based Practice (Hoffmann, Thorning, Glasziou, Del Mar) and Faculty of Health Sciences and Medicine (McGuire), Bond University, Gold Coast, Queensland, Australia.
| |
Collapse
|
2
|
Gough EK, Moodie EEM, Prendergast AJ, Johnson SMA, Humphrey JH, Stoltzfus RJ, Walker AS, Trehan I, Gibb DM, Goto R, Tahan S, de Morais MB, Manges AR. The impact of antibiotics on growth in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials. BMJ 2014; 348:g2267. [PMID: 24735883 PMCID: PMC3988318 DOI: 10.1136/bmj.g2267] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine whether antibiotic treatment leads to improvements in growth in prepubertal children in low and middle income countries, to determine the magnitude of improvements in growth, and to identify moderators of this treatment effect. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, Scopus, the Cochrane central register of controlled trials, and Web of Science. STUDY SELECTION Randomised controlled trials conducted in low or middle income countries in which an orally administered antibacterial agent was allocated by randomisation or minimisation and growth was measured as an outcome. Participants aged 1 month to 12 years were included. Control was placebo or non-antimicrobial intervention. RESULTS Data were pooled from 10 randomised controlled trials representing 4316 children, across a variety of antibiotics, indications for treatment, treatment regimens, and countries. In random effects models, antibiotic use increased height by 0.04 cm/month (95% confidence interval 0.00 to 0.07) and weight by 23.8 g/month (95% confidence interval 4.3 to 43.3). After adjusting for age, effects on height were larger in younger populations and effects on weight were larger in African studies compared with other regions. CONCLUSION Antibiotics have a growth promoting effect in prepubertal children in low and middle income countries. This effect was more pronounced for ponderal than for linear growth. The antibiotic growth promoting effect may be mediated by treatment of clinical or subclinical infections or possibly by modulation of the intestinal microbiota. Better definition of the mechanisms underlying this effect will be important to inform optimal and safe approaches to achieving healthy growth in vulnerable populations.
Collapse
Affiliation(s)
- Ethan K Gough
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Hall A, Hewitt G, Tuffrey V, de Silva N. A review and meta-analysis of the impact of intestinal worms on child growth and nutrition. MATERNAL AND CHILD NUTRITION 2008; 4 Suppl 1:118-236. [PMID: 18289159 DOI: 10.1111/j.1740-8709.2007.00127.x] [Citation(s) in RCA: 250] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
More than a half of the world's population are infected with one or more species of intestinal worms of which the nematodes Ascaris lumbricoides, Trichuris trichiura and the hookworms are the most common and important in terms of child health. This paper: (1) introduces the main species of intestinal worms with particular attention to intestinal nematodes; (2) examines how such worms may affect child growth and nutrition; (3) reviews the biological and epidemiological factors that influence the effects that worms can have on the growth and nutrition of children; (4) considers the many factors that can affect the impact of treatment with anthelmintic drugs; (5) presents the results of a meta-analysis of studies of the effect of treating worm infections on child growth and nutrition; (6) discusses the results in terms of what is reasonable to expect that deworming alone can achieve; (7) describes some important characteristics of an ideal study of the effects of deworming; and (8) comments on the implications for programmes of recommendations concerning mass deworming.
Collapse
Affiliation(s)
- Andrew Hall
- Centre for Public Health Nutrition, University of Westminster, London, UK.
| | | | | | | |
Collapse
|
6
|
Penny ME. The role of the duodenal microflora as a determinant of persistent diarrhoea. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1992; 381:114-20. [PMID: 1421925 DOI: 10.1111/j.1651-2227.1992.tb12383.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
It has been suggested that proliferation of enterobacteriaceae and/or anaerobes in the duodenum of some children with acute diarrhoea determines whether the episode becomes persistent. A review of published studies and the comparison of cultures of duodenal aspirates from Peruvian children with acute and persistent diarrhoea and diarrhoea-free children did not support this hypothesis. Although many children had enterobacteriaceae and/or anaerobes cultured there was no correlation with clinical and nutritional outcome. Age, nutritional status, the environment and the aetiology of the episode were determinants of the duodenal microflora independent of diarrhoea. Culture of the duodenal aspirates did not increase the yield of enteropathogens which were isolated more frequently from stools than from the duodenum. Despite the presence of a single strain or serotype of enterobacteriaceae suggesting that these bacteria were colonizing the duodenum, we were unable to demonstrate any adherence mechanisms in the majority of them. Two of ten bacteria with no other evidence of virulence caused diarrhoea in the RITARD rabbit model.
Collapse
Affiliation(s)
- M E Penny
- Instituto de Investigacion Nutricional, Lima, Peru
| |
Collapse
|
7
|
Pereira SP, Khin-Maung-U, Duncombe VM, Bolin TD, Linklater JM. Comparison of an in vitro faecal hydrogen test with the lactulose breath test: assessment of in vivo hydrogen-producing capability in Burmese village children. ANNALS OF TROPICAL PAEDIATRICS 1992; 12:177-83. [PMID: 1381894 DOI: 10.1080/02724936.1992.11747566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the assessment of carbohydrate malabsorption, it is important to determine if patients with a flat breath hydrogen (H2) response to an absorbable carbohydrate challenge are capable of producing H2. We compared the reliability of a rapid faecal incubation system with the lactulose breath test to assess in vivo H2 production in 64 children. Overall, 70% of subjects were in vivo H2-producers, with breath H2 peaks greater than 10 parts per million within 3 h of ingesting 10 g of the non-absorbable disaccharide lactulose. Faecal specimens from the 64 children had a mean (SE) pH of 5.0 (0.077). Faecal homogenates were incubated with lactulose at both the initially measured faecal pH and at neutral pH. In predicting a normal in vivo H2-producing ability (sensitivity), the faecal H2 test was correct in only 22% (faecal pH) to 44% (pH7) of cases. In predicting an abnormal lactulose breath test result (specificity), faecal homogenate analysis was correct in 53% of cases, at both faecal and neutral pH. These findings indicate that the faecal hydrogen test is unsuitable as a screening test for in vivo H2 production.
Collapse
Affiliation(s)
- S P Pereira
- Gastrointestinal Unit, School of Medicine, University of New South Wales, Sydney, Australia
| | | | | | | | | |
Collapse
|