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Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis

The comparative effectiveness and safety of macrolides, quinolones and amoxicillin/clavulanate (A/C) for the treatment of patients with acute bacterial exacerbation of chronic bronchitis (ABECB) was evaluated in the present study. PubMed, Current Contents and the Cochrane Central Register of Controlled Trials were searched to identify relevant randomised controlled trials (RCTs). In total, 19 RCTs (20 comparisons) were included in the present analysis. There was no difference regarding treatment success in intention-to-treat and clinically evaluable patients between macrolides and quinolones, A/C and quinolones or A/C and macrolides. The treatment success in microbiologically evaluable patients was lower for macrolides compared with quinolones (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.31-0.69). Fewer quinolone-recipients experienced a recurrence of ABECB after resolution of the initial episode compared with macrolide-recipients during the 26-week period following therapy. Adverse effects in general were similar between macrolides and quinolones. Administration of A/C was associated with more adverse effects (mainly diarrhoea) than quinolones (OR 1.36, 95% CI 1.01-1.85). Macrolides, quinolones and amoxicillin/clavulanate may be considered equivalent for the treatment of patients with an acute bacterial exacerbation of chronic bronchitis in terms of short-term effectiveness. Quinolones are associated with better microbiological success and fewer recurrences of acute bacterial exacerbation of chronic bronchitis than macrolides, while amoxicillin/clavulanate is associated with more adverse effects than both comparators.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Systemic anti-infective periodontal therapy: a systematic review

BACKGROUND: Periodontal diseases are infections and thus systemically administered antibiotics are often employed as adjuncts for their control. There are conflicting reports as to whether these agents provide a therapeutic benefit.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Increased clinical failures when treating acute otitis media with macrolides: a meta-analysis

The review found that paediatric patients with acute otitis media and treated with macrolide antibiotics compared to first-line antibiotics may be more likely to have clinical failures. The authors' conclusions reflect the evidence presented, but limitations in the quality of many of the included studies mean the conclusions should be considered tentative.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Effectiveness and safety of short vs long duration of antibiotic therapy for acute bacterial sinusitis: a meta-analysis of randomized trials

This generally well-conducted review concluded that short-course antibiotic treatment (median five days) was as effective as longer-course treatment (median 10 days) for patients with acute uncomplicated bacterial sinusitis. This conclusion accurately reflected the results of the review and is likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Dosage intervals of amoxicillin for the treatment of acute middle ear infection

Acute middle ear infection (acute otitis media) is a very common disease in children and may cause pain and hearing loss. Delayed or ineffective treatment may lead to serious complications such as ear drum perforation, sensorineural hearing loss or the disease becoming chronic. Amoxicillin, with or without clavulanate, is the most commonly used antibiotic for treating acute otitis media. Currently, a reduction in the dosing interval to one or two daily doses is being used, in preference to the conventional three or four daily doses, to aid compliance.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Management of Acute Otitis Media: Update

Acute Otitis Media (AOM), a viral or bacterial infection of the ear, is the most common childhood infection for which antibiotics are prescribed in the United States. In 2001, the Southern California Evidence-based Practice Center conducted a systematic review of the evidence comparing treatments of AOM.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: November 2010
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Urinary Tract Infection in Children: Diagnosis, Treatment and Long-term Management

In the past 30–50 years, the natural history of urinary tract infection (UTI) in children has changed as a result of the introduction of antibiotics and improvements in health care. This change has contributed to uncertainty about the most appropriate and effective way to diagnose and treat UTI in children and whether or not investigations and follow-up are justified.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2007
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Chronic Venous Ulcers: A Comparative Effectiveness Review of Treatment Modalities [Internet]

To systematically review whether the use of advanced wound dressings, systemic antibiotics, or venous surgery enhanced the healing of venous ulcers over the use of adequate venous compression.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: December 2013
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Clinical Guidelines for Type 2 Diabetes: Prevention and Management of Foot Problems [Internet]

The aim of the guideline is to provide recommendations to help health care professionals in their management of people with Type 2 diabetes. The guideline is aimed at all health care professionals providing care to people with diagnosed Type 2 diabetes in primary and secondary care, irrespective of location. Depending on the type, stage and severity of clinical problem, the guidelines may also be valuable to those who work in the tertiary sector of diabetes care.

NICE Clinical Guidelines - School of Health and Related Research (ScHARR), University of Sheffield.

Version: 2003
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Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 4: Antibiotic Prescribing Behavior)

Unnecessary prescribing of antibiotics is a major problem in the US and worldwide, contributing to the problem of antimicrobial resistance (AMR). This review examines the effects of quality improvement strategies on reducing inappropriate prescribing of antibiotics, targeting both prescribing of antibiotics for non-bacterial illnesses (“the antibiotic treatment decision”) and prescribing of broad-spectrum antibiotics when narrow-spectrum agents are indicated (“the antibiotic selection decision”).

Technical Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2006
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Respiratory Tract Infections - Antibiotic Prescribing: Prescribing of Antibiotics for Self-Limiting Respiratory Tract Infections in Adults and Children in Primary Care

Respiratory tract infection (RTI) is defined as any infectious disease of the upper or lower respiratory tract. Upper respiratory tract infections (URTIs) include the common cold, laryngitis, pharyngitis/tonsillitis, acute rhinitis, acute rhinosinusitis and acute otitis media. Lower respiratory tract infections (LRTIs) include acute bronchitis, bronchiolitis, pneumonia and tracheitis. Antibiotics are commonly prescribed for RTIs in adults and children in primary care. General practice consultation rates in England and Wales show that a quarter of the population will visit their GP because of an RTI each year (Ashworth et al. 2005). RTIs are the reason for 60% of all antibiotic prescribing in general practice, and this constitutes a significant cost to the NHS. Annual prescribing costs for acute cough alone exceed £15 million (Lindbaek 2006).

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: July 2008
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Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary Care

This guideline covers bacterial meningitis and meningococcal septicaemia, focusing on management of these conditions in children and young people aged younger than 16 years in primary and secondary care, and using evidence of direct relevance to these age groups where available.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: 2010
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Antibiotics for Early-Onset Neonatal Infection: Antibiotics for the Prevention and Treatment of Early-Onset Neonatal Infection

Early-onset neonatal bacterial infection (infection with onset within 72 hours of birth) is a significant cause of mortality and morbidity in newborn babies. Parent organisations and the scientific literature report that there can be unnecessary delays in recognising and treating sick babies. In addition, concern about the possibility of early-onset neonatal infection is common. This concern is an important influence on the care given to pregnant women and newborn babies. There is wide variation in how the risk of early-onset neonatal infection is managed in healthy babies. The approach taken by the NHS needs to: prioritise the treatment of sick babies, minimise the impact of management pathways on healthy women and babies, use antibiotics wisely to avoid the development of resistance to antibiotics. These drivers have not always been addressed consistently in the NHS, and this guideline was commissioned to ensure they would be addressed in future.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2012
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Caesarean Section

This guidance is a partial update of NICE clinical guideline 13 (published April 2004) and will replace it.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 2011
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Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease

The guideline covers adults and children (from birth) with lower urinary tract dysfunction resulting from neurological disease or injury.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2012
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Comparative effectiveness of antibiotics for uncomplicated urinary tract infections: Network meta-analysis of randomized trials.

BACKGROUND: The efficacies and adverse effects of different antibiotics for uncomplicated urinary tract infections (UTIs) have been studied by standard meta-analytic methods using pairwise direct comparisons of antimicrobial treatments: the effects of one treatment are compared to those of either another treatment or placebo. However, for clinical decisions, we need to know the effectiveness of each possible treatment in comparison with all relevant alternatives, not with just one.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Interventions for ear discharge associated with grommets (ventilation tubes)

More research is needed to find the most effective treatment for discharge from ears in patients who have had grommets fitted.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Management of acute otitis media: update

The authors concluded that immediate antibiotic therapy was more effective than placebo for treating uncomplicated acute otitis media. Comparison of different antibiotic treatments was inconclusive for recurrent otitis media. Further research is needed. The authors' conclusions reflected the evidence, but given significant heterogeneity and concerns regarding the analysis, their conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Antibiotics for reduction of posttonsillectomy morbidity: a meta-analysis

This review assessed the effects of post-operative antibiotics on post-tonsillectomy morbidity. The authors concluded that post-operative antibiotics do not reduce pain, but do hasten return to work and normal activities. It is difficult to assess the robustness of the review findings without further details of the review methods and an assessment of the quality of the included studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Antibiotics for acute maxillary sinusitis

Sinusitis is one of the most common reasons for visiting a doctor and an estimated 20 million cases of acute sinusitis occur every year in the USA alone. There are four pairs of sinuses linked to the bony structures around the nose: maxillary, frontal, ethmoidal and sphenoidal sinuses. In sinusitis, these membrane‐lined air spaces become infected, which causes pain and discharge from the nose. Treatment options include decongestants, steroid drops or sprays, mucus‐clearing drugs (mucolytics), antihistamines and antibiotics and sometimes sinus puncture and irrigation for removal of purulent secretions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Systematic Reviews in PubMed

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