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Comparing the quantity and quality of randomised placebo-controlled trials of antibiotics for acute respiratory, urinary, and skin and soft tissue infections: a scoping review

Comparing the quantity and quality of randomised placebo-controlled trials of antibiotics for acute respiratory, urinary, and skin and soft tissue infections: a scoping review
Comparing the quantity and quality of randomised placebo-controlled trials of antibiotics for acute respiratory, urinary, and skin and soft tissue infections: a scoping review

BACKGROUND: The management of acute respiratory infections (ARIs), urinary tract infections (UTIs), and skin and soft tissue infections (SSTIs) should be guided by high quality evidence.

AIM: To compare the quantity and quality of randomised placebo-controlled trials of antibiotics for ARIs, UTIs, and SSTIs.

DESIGN & SETTING: A scoping review of the literature was performed using comprehensive search strategies.

METHOD: PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for published studies from inception until 17 April 2019. Randomised controlled trials (RCTs) that compared participants in primary care or in the community who had uncomplicated acute ARI, UTI, or studies, and were randomised to antibiotic or placebo (or no active treatment), were eligible for inclusion. Two groups of researchers independently screened articles for inclusion, extracted data, and assessed the quality of included studies.

RESULTS: A total of 108 eligible studies were identified: 80 on ARI, eight on UTI, and 20 on SSTI. The quality of studies varied with unclear risk of bias (RoB) prevalent in many domains. There was a gradual improvement in the quality of trials investigating ARIs over time, which could not be assessed in SSTI and UTI studies.

CONCLUSION: This review highlights a sparsity of trials assessing the effectiveness of antibiotics in people with UTIs and SSTIs, compared to trials targeting ARIs. This gap in the evidence needs to be addressed by conducting further high quality trials on the effects of antibiotics in patients with UTI and SSTI.

anti-bacterial agent, primary health care, randomised controlled trials, respiratory tract infections, skin and soft tissues infections, urinary tract infections
1-8
Bakhit, Mina
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Hoffmann, Tammy
01a2745e-b451-4e7e-85dd-db0e51bcc3be
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Ridd, Matthew
2f15120c-d5fa-4f5d-bb86-21356e034df7
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Hummers, Eva
5cdebb96-bf7e-4831-8995-3784967ee742
Clark, Justin
7cfe5f0b-002e-445f-aeeb-347d658d2934
Hilliges, Carmen
2ce27ab9-d570-4fbf-ba02-99d6654f2bd3
Del Mar, Chris
3c48bc4b-f777-44b7-b6b6-12d734b5fac5
Bakhit, Mina
25b9bf96-5632-4562-8be7-55d6487c265f
Hoffmann, Tammy
01a2745e-b451-4e7e-85dd-db0e51bcc3be
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Ridd, Matthew
2f15120c-d5fa-4f5d-bb86-21356e034df7
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Hummers, Eva
5cdebb96-bf7e-4831-8995-3784967ee742
Clark, Justin
7cfe5f0b-002e-445f-aeeb-347d658d2934
Hilliges, Carmen
2ce27ab9-d570-4fbf-ba02-99d6654f2bd3
Del Mar, Chris
3c48bc4b-f777-44b7-b6b6-12d734b5fac5

Bakhit, Mina, Hoffmann, Tammy, Santer, Miriam, Ridd, Matthew, Francis, Nick, Hummers, Eva, Clark, Justin, Hilliges, Carmen and Del Mar, Chris (2020) Comparing the quantity and quality of randomised placebo-controlled trials of antibiotics for acute respiratory, urinary, and skin and soft tissue infections: a scoping review. BJGP Open, 4 (4), 1-8. (doi:10.3399/bjgpopen20X101082).

Record type: Article

Abstract

BACKGROUND: The management of acute respiratory infections (ARIs), urinary tract infections (UTIs), and skin and soft tissue infections (SSTIs) should be guided by high quality evidence.

AIM: To compare the quantity and quality of randomised placebo-controlled trials of antibiotics for ARIs, UTIs, and SSTIs.

DESIGN & SETTING: A scoping review of the literature was performed using comprehensive search strategies.

METHOD: PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for published studies from inception until 17 April 2019. Randomised controlled trials (RCTs) that compared participants in primary care or in the community who had uncomplicated acute ARI, UTI, or studies, and were randomised to antibiotic or placebo (or no active treatment), were eligible for inclusion. Two groups of researchers independently screened articles for inclusion, extracted data, and assessed the quality of included studies.

RESULTS: A total of 108 eligible studies were identified: 80 on ARI, eight on UTI, and 20 on SSTI. The quality of studies varied with unclear risk of bias (RoB) prevalent in many domains. There was a gradual improvement in the quality of trials investigating ARIs over time, which could not be assessed in SSTI and UTI studies.

CONCLUSION: This review highlights a sparsity of trials assessing the effectiveness of antibiotics in people with UTIs and SSTIs, compared to trials targeting ARIs. This gap in the evidence needs to be addressed by conducting further high quality trials on the effects of antibiotics in patients with UTI and SSTI.

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More information

Accepted/In Press date: 9 March 2020
e-pub ahead of print date: 29 September 2020
Published date: October 2020
Additional Information: Funding Information: This study was conducted under the auspices of the Centre for Research Excellence in Minimising Antibiotic Resistance from Acute Respiratory Infections (CREMARA), which is funded by the Australian National Health and Medical Research Council (NHMRC) (grant reference number: 1044904). Mina Bakhit's salary is funded by NHMRC Centre for Research Excellence in Minimising Antibiotic Resistance in the Community (CRE-MARC) (grant reference number: 1153299). The funding body had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Matthew Ridd is funded by a Post-Doctoral Research Fellowship from the National Institute for Health Research (NIHR) (reference number: PDF-2014-07-013). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Publisher Copyright: © 2020. The Authors. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: anti-bacterial agent, primary health care, randomised controlled trials, respiratory tract infections, skin and soft tissues infections, urinary tract infections

Identifiers

Local EPrints ID: 444567
URI: http://eprints.soton.ac.uk/id/eprint/444567
PURE UUID: ec19a7b1-914e-4225-9aa9-448af236f6cf
ORCID for Miriam Santer: ORCID iD orcid.org/0000-0001-7264-5260
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312

Catalogue record

Date deposited: 26 Oct 2020 17:31
Last modified: 09 Jan 2022 04:08

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Contributors

Author: Mina Bakhit
Author: Tammy Hoffmann
Author: Miriam Santer ORCID iD
Author: Matthew Ridd
Author: Nick Francis ORCID iD
Author: Eva Hummers
Author: Justin Clark
Author: Carmen Hilliges
Author: Chris Del Mar

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