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Moreira MVB, de Freitas LR, Fonseca LM, Moreira MJB, Balieiro CCA, Marques IR, Mari PC. Shorter versus longer-course of antibiotic therapy for urinary tract infections in pediatric population: an updated meta-analysis. Eur J Pediatr 2024; 183:2037-2047. [PMID: 38451294 DOI: 10.1007/s00431-024-05512-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 03/08/2024]
Abstract
Urinary tract infections (UTI) affect between 3% to 7.5% of the febrile pediatric population each year, being one of the most common bacterial infections in pediatrics. Nevertheless, there is no consensus in the medical literature regarding the duration of per oral (p.o.) antibiotic therapy for UTI among these patients. Therefore, our meta-analysis aims to assess the most effective therapy length in this scenario. PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing short (≤ 5 days) with long-course (≥ 7 days) per os (p.o.) antibiotic therapy for children with UTI. Statistical analysis was performed using R Studio version 4.2.1, heterogeneity was assessed with I2 statistics, and the risk of bias was evaluated using the RoB-2 tool. Risk Ratios (RR) with p < 0.05 were considered statistically significant. Seventeen studies involving 1666 pediatric patients were included. Of these, 890 patients (53.4%) were randomized to receive short-course therapy. Patients undergoing short-course therapy showed higher treatment failure rates (RR 1.61; 95% CI 1.15-2.27; p = 0.006). Furthermore, there were no statistically significant differences between groups regarding reinfection (RR 0.73; 95% CI 0.47-1.13; p = 0156) and relapse rates (RR 1.47; 95% CI 0.8-2.71; p = 0.270). Conclusion: In summary, our results suggest that long-course p.o. antibiotic therapy is associated with a lower rate of treatment failure when compared to short-course p.o. antibiotic therapy. There was no statistical difference between both courses regarding reinfection and relapse rates within 15 months. PROSPERO identifier: CRD42023456745. What is Known: • Urinary tract infections (UTIs) are common in children, affecting around 7.5% of those under 18. • The optimal duration of antibiotic treatment for pediatric UTIs has been a subject of debate. What is New: • Short-course therapy (5 or fewer days) was associated with a significantly higher failure rate when compared to long-course therapy. • There was no significant difference in reinfection and relapse rates within 15 months between short and long-course therapy.
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Sudo RYU, Câmara MCC, Kieling SV, Marques IR, Mesquita Y, Piepenbrink BE, Mari PC. Shorter versus longer duration of antibiotic treatment in children with bacterial meningitis: a systematic review and meta-analysis. Eur J Pediatr 2024; 183:61-71. [PMID: 37870611 DOI: 10.1007/s00431-023-05275-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023]
Abstract
The optimal duration of antibiotic treatment for the most common bacterial meningitis etiologies in the pediatric population, namely Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, is not well-established in the literature. Therefore, we aimed to perform an updated meta-analysis comparing shorter versus longer antibiotic treatment in children with meningitis. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) that compared shorter (up to 7 days) versus longer (10 days or double the days of the equivalent short course) duration of antibiotic treatment in children with meningitis and reported the outcomes of treatment failure, death, neurologic sequelae, non-neurologic complications, hearing impairment, nosocomial infection, and relapse. Heterogeneity was examined with I2 statistics. RevMan 5.4.1 was used for statistical analysis and RoB-2 (Cochrane) for risk of bias assessment. Of 684 search results, 6 RCTs were included, with a cohort of 1333 children ages 3 weeks to 15.5 years, of whom 49.51% underwent a short antibiotic course. All RCTs included monotherapy with ceftriaxone, except one, which added vancomycin as well. No differences were found comparing the short and long duration of therapy concerning treatment failure, relapse, mortality, and neurologic complications at discharge and at follow-up. Conclusion: Because no statistically significant differences were found between groups for the analyzed outcomes, the results of this meta-analysis support shorter therapy. However, generalizing these results to complicated meningitis and infections caused by other pathogens should be made with caution. (PROSPERO identifier: CRD42022369843). What is Known: • Current recommendations on the duration of antibiotic therapy for bacterial meningitis are mostly based on clinical practice. • Defining an optimal duration of antibiotic therapy is essential for antimicrobial stewardship achievement, improving patient outcomes, and minimizing adverse effects. What is New: • There are no differences between shorter versus longer antibiotic treatment duration in regard to treatment failure, relapse, mortality, neurologic complications, and hearing impairment at discharge and at follow-up.
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Affiliation(s)
- Renan Yuji Ura Sudo
- Division of Medicine, Federal University of Grande Dourados, Dourados, MS, Brazil.
| | | | | | - Isabela Reis Marques
- Division of Medicine, Universitat Internacional de Catalunya, Barcelona, CAT, Spain
| | - Yasmin Mesquita
- Division of Medicine, Federal University of Rio de Janeiro, Macaé, RJ, Brazil
| | - Blake Earl Piepenbrink
- Division of Internal Medicine, Primary Care, University of Connecticut, Farmington, CT, USA
| | - Paula Chaves Mari
- Pediatric Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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de Mesquita YLL, Pera Calvi I, Reis Marques I, Almeida Cruz S, Padrao EMH, Carvalho PEDP, da Silva CHA, Cardoso R, Moura FA, Rafalskiy VV. Efficacy and safety of the dual GIP and GLP-1 receptor agonist tirzepatide for weight loss: a meta-analysis of randomized controlled trials. Int J Obes (Lond) 2023; 47:883-892. [PMID: 37460681 DOI: 10.1038/s41366-023-01337-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/05/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Tirzepatide is a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved for type 2 diabetes. We performed a meta-analysis to assess tirzepatide's weight reduction efficacy and safety. METHODS We searched PubMed, Embase, and Cochrane for randomized controlled trials published from inception to July 2022, comparing tirzepatide with placebo for the co-primary endpoints of absolute and percent change in weight. Mean difference (MD) and odds ratio (OR) were calculated for continuous and binary outcomes, respectively. Review Manager 5.4.1 and RStudio were used for the statistical analysis, and RoB-2 (Cochrane) to assess the risk of bias. RESULTS Of 397 search results, 6 studies (4036 participants) ranging from 12 to 72 weeks were included. Pooled analysis showed that tirzepatide 5 mg, 10 mg, and 15 mg were more effective than placebo, with MD in body weight of -7.7 kg (95% CI -11.0, -4.4; p < 0.001), -11.6 kg (95% CI -18.8, -4.3; p = 0.002), and -11.8 kg (95% CI -17.4, -6.2; p < 0.001), respectively, and MD in percent change in weight of -8.1% (95% CI -11.0, -5.2; p < 0.001), -11.9% (95% CI -18.1, -5.6; p < 0.001), and -12.4% (95% CI -17.2, -7.5; p < 0.001), respectively. Tirzepatide also reduced BMI and waist circumference. Adverse events were more common with tirzepatide with respect to nausea (OR 4.2; 95% CI 2.4, 7.5; p < 0.001), vomiting (OR 7.0; 95% CI 4.3, 11.4; p < 0.001), and diarrhea (OR 2.8; 95% CI 1.6, 4.9; p < 0.001) (15 mg dose), when compared with placebo. CONCLUSIONS The results support that tirzepatide leads to substantial weight reduction and constitutes a valuable therapeutic option for weight management, despite an increase in gastrointestinal symptoms. PROTOCOL REGISTRATION CRD42022348576.
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Affiliation(s)
| | - Izabela Pera Calvi
- Division of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, Kaliningrad Oblast, Russia
| | - Isabela Reis Marques
- Division of Medicine, Universitat Internacional de Catalunya, Barcelona, Catalunya, Spain
| | - Sara Almeida Cruz
- Division of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, Kaliningrad Oblast, Russia
| | | | | | | | - Rhanderson Cardoso
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Filipe Azevedo Moura
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- TIMI study group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
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Godoi A, Reis Marques I, Padrão EMH, Mahesh A, Hespanhol LC, Riceto Loyola Júnior JE, de Souza IAF, Moreira VCS, Silva CH, Miyawaki IA, Oommen C, Gomes C, Silva AC, Advani K, de Sa JR. Glucose control and psychosocial outcomes with use of automated insulin delivery for 12 to 96 weeks in type 1 diabetes: a meta-analysis of randomised controlled trials. Diabetol Metab Syndr 2023; 15:190. [PMID: 37759290 PMCID: PMC10537468 DOI: 10.1186/s13098-023-01144-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Glycaemic control of Type 1 Diabetes Mellitus (T1DM) remains a challenge due to hypoglycaemic episodes and the burden of insulin self-management. Advancements have been made with the development of automated insulin delivery (AID) devices, yet, previous reviews have only assessed the use of AID over days or weeks, and potential benefits with longer time of AID use in this population remain unclear. METHODS We performed a systematic review and meta-analysis of randomised controlled trials comparing AID (hybrid and fully closed-loop systems) to usual care (sensor augmented pumps, multiple daily insulin injections, continuous glucose monitoring and predictive low-glucose suspend) for adults and children with T1DM with a minimum duration of 3 months. We searched PubMed, Embase, Cochrane Central, and Clinicaltrials.gov for studies published up until April 4, 2023. Main outcomes included time in range 70-180 mg/dL as the primary outcome, and change in HbA1c (%, mmol/mol), glucose variability, and psychosocial impact (diabetes distress, treatment satisfaction and fear of hypoglycaemia) as secondary outcomes. Adverse events included diabetic ketoacidosis (DKA) and severe hypoglycaemia. Statistical analyses were conducted using mean differences and odds ratios. Sensitivity analyses were performed according to age, study duration and type of AID device. The protocol was registered in PROSPERO, CRD42022366710. RESULTS We identified 25 comparisons from 22 studies (six crossover and 16 parallel designs) including a total of 2376 participants (721 in adult studies, 621 in paediatric studies, and 1034 in combined studies) which were eligible for analysis. Use of AID devices ranged from 12 to 96 weeks. Patients using AID had 10.87% higher time in range [95% CI 9.38 to 12.37; p < 0.0001, I2 = 87%) and 0.37% (4.77 mmol/mol) lower HbA1c (95% CI - 0.49% (- 6.39 mmol/mol) to - 0.26 (- 3.14 mmol/mol); p < 0·0001, I2 = 77%]. AID systems decreased night hypoglycaemia, time in hypoglycaemia and hyperglycaemia and improved patient distress, with no increase in the risk of DKA or severe hypoglycaemia. No difference was found regarding treatment satisfaction or fear of hypoglycaemia. Among children, there was no difference in glucose variability or time spent in hypoglycaemia between the use of AID systems or usual care. In sensitivity analyses, results remained consistent with the overall analysis favouring AID. CONCLUSION The use of AID systems over 12 weeks, regardless of technical or clinical differences, improved glycaemic outcomes and diabetes distress without increasing the risk of adverse events in adults and children with T1DM.
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Affiliation(s)
- Amanda Godoi
- Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF144YS, UK.
| | | | | | | | | | | | | | | | | | | | | | - Cintia Gomes
- Federal University of Santa Maria, Santa Maria, Brazil
| | - Ariadne C Silva
- UniEvangelica University Centre of Anapolis, Anapolis, Brazil
| | | | - Joao Roberto de Sa
- Endocrinology Division, ABC School of Medicine and Federal University of Sao Paulo, Paulista School of Medicine, São Paulo, Brazil
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De Souza IAF, Gomes C, Padrao E, Miyawaki I, Marques IR, Moreira V, Loyola JER, Silva C, Cardoso R, Oprysko C. DIAGNOSTIC PERFORMANCE OF ECG CRITERIA FOR LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH LEFT BUNDLE BRANCH BLOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Miyawaki IA, Gomes CP, Moreira VCS, Marques IR, Souza IAF, Silva CHA, Loyola JER, Huh K, Mcdowell M, Padrao EMH. The single-syringe versus the double-syringe techniques of adenosine administration for supraventricular tachycardia: a systematic review and meta-analysis. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Intravenous double-syringe technique (DST) of adenosine administration consists of an intravenous bolus of adenosine via three-way stopcock followed by an immediate 10-20ml sodium chloride 0.9% flush and is the recommended first-line treatment for stable supraventricular tachycardia (SVT). However, an alternative single-syringe technique (SST) method for adenosine administration has been described. This consists of diluting adenosine with sodium chloride 0.9% to a total volume of 15-20ml and was recently found to be potentially beneficial in several studies.
Purpose
We aimed to perform a meta-analysis of the SST versus the DST of adenosine administration as treatments for SVT.
Methods
We systematically searched EMBASE, PubMed, Cochrane, and ClinicalTrials.gov databases for randomised controlled trials (RCTs) and non-randomised studies of intervention (NRSIs) comparing the DST to SST adenosine administration in patients with SVT. The risk of bias was assessed by RoB-2 for RCTs and ROBINS-I for NRSIs. Outcomes included termination rate, termination rate at first dose, total administered dose, adverse effects, and discharge rate.
Results
We included four studies (three RCTs and one NRSI) with a total of 180 (60.55% female) patients, of whom 100 (55.55%) underwent the SST of adenosine administration. The three RCTs were considered of some concerns due to no pre-specified analysis in all studies and deviation from the intended intervention in one study. The NRSI was considered to carry a serious risk of bias by no analysis method that controlled for confounding, the possible influence of the outcome measure by knowledge of the intervention received, and no pre-specified analysis. No significant difference was found between treatment groups regarding termination rate (p = 0.22, Fig 1a), termination rate restricted to RCTs (p = 0.49, Fig 1b), total administered dose (p = 0.29, Fig 2a) and discharge rate (p = 0.1, Fig 2b). Termination rate at first dose (OR 2.87; CI 1.11-7.41; p = 0.03; I² = 0%, Fig 1c) was significantly increased in patients who received the SST. Major adverse effects were observed in only one study, with one patient suffering extravasation and phlebitis in the DST group.
Conclusion
To our knowledge, this is the first meta-analysis studying SST versus conventional DST for the management of SVT. This study suggests that the SST may be as safe as DST, equally effective for SVT termination, or even potentially more effective with the first dose. The SST would represent a simpler and more rapid approach, obviating the need for syringe switching or three-way stopcock, and reducing the margin of error in adenosine administration. To our knowledge, this is the highest quality evidence to date. Our results demonstrate that the current evidence is sufficient to support both SST and DST. However, favouring one technique over the other is not feasible given the limited sample size.
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Affiliation(s)
- I A Miyawaki
- Federal University of Parana , Curitiba , Brazil
| | - C P Gomes
- Federal University Santa Maria , Santa Maria , Brazil
| | - V C S Moreira
- Albert Einstein Israelite Hospital , Sao Paulo , Brazil
| | - I R Marques
- Universitat Internacional de Catalunya , Barcelona , Spain
| | - I A F Souza
- Petropolis Medical School , Petropolis , Brazil
| | - C H A Silva
- Federal University of Rio Grande do Norte , Natal , Brazil
| | - J E R Loyola
- Santa Casa de Misericórdia de Sao Paulo , Sao Paulo , Brazil
| | - K Huh
- University of Connecticut , Internal Medicine , Storrs , United States of America
| | - M Mcdowell
- University of Illinois at Chicago , Chicago , United States of America
| | - E M H Padrao
- University of Connecticut , Internal Medicine , Storrs , United States of America
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