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Int J Infect Dis. 2016 Aug;49:71-9. doi: 10.1016/j.ijid.2016.06.002. Epub 2016 Jun 9.

Is de-escalation of antimicrobials effective? A systematic review and meta-analysis.

Author information

1
Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo 650-0017, Japan.
2
Division of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Japan.
3
Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo 650-0017, Japan. Electronic address: kentaroiwata1969@gmail.com.

Abstract

BACKGROUND:

De-escalation therapy is a strategy used widely to treat infections while avoiding the use of broad-spectrum antimicrobials. However, there is a paucity of clinical evidence to demonstrate the effectiveness and safety of de-escalation therapy compared to conventional therapy.

METHODS:

A systematic review and meta-analysis was conducted on de-escalation therapy for a variety of infections. A search of the MEDLINE (via PubMed), EMBASE, and Cochrane Library databases up to July 2015 for relevant studies was performed. The primary outcome was relevant mortality, such as 30-day mortality and in-hospital mortality. A meta-analysis was to be conducted for the pooled odds ratio using the random-effects model when possible. Both randomized controlled trials and observational studies were included in the analysis.

RESULTS:

A total of 23 studies were included in the analysis. There was no difference in mortality for most infections, and some studies favored de-escalation over non-de-escalation for better survival. The quality of most studies included was not high.

CONCLUSIONS:

This review and analysis suggests that de-escalation therapy is safe and effective for most infections, although higher quality studies are needed in the future.

KEYWORDS:

De-escalation therapy; Meta-analysis; Systematic review

PMID:
27292606
DOI:
10.1016/j.ijid.2016.06.002
[Indexed for MEDLINE]
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