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WITHDRAWN: Antibiotics for preventing leptospirosis.

Abstract

BACKGROUND

Leptospirosis is an infectious disease transmitted by animals. Death occurs in about five per cent of the patients. In clinical practice, doxycycline is widely used for prevention.

OBJECTIVES

To evaluate the effectiveness and safety of any antibiotic regimen versus placebo or other antibiotic regimens in the prophylaxis of leptospirosis.

SEARCH STRATEGY

The sources used were: EMBASE, LILACS, MEDLINE, SCISEARCH, The Cochrane Controlled Trials Register, The Cochrane Hepato-Biliary Group Controlled Trials Register, bibliographies of published papers, and personal communication with authors. There were no language or date restrictions in any of the searches.

STUDIES

All randomised clinical trials in which antibiotics were used as prophylactic regimen for leptospirosis.

PARTICIPANTS

People potentially exposed to leptospirosis, such as people in endemic areas during the rainy season, health professionals and other professionals with high risk of infection.

INTERVENTION

Any antibiotic regimen compared with a control group (placebo or another antibiotic regimen).

OUTCOMES

Infection (primary outcome) and adverse events (secondary outcome).

DATA COLLECTION AND ANALYSIS

Data were independently extracted and methodological quality of each trial was assessed by two reviewers as well as cross-checked. Details of the randomisation (generation and concealment), blinding, and the number of patients lost to follow-up were recorded. The results of each trial were summarised on an intention-to-treat basis in 2 x 2 tables for each outcome.

MAIN RESULTS

Two trials comparing doxycycline with placebo met the inclusion criteria. We did not find trials comparing doxycycline versus other antibiotics, or other antibiotics versus placebo. One of the trials had excellent methodological quality. In the other trial, the allocation concealment process, generation of allocation sequence, and blinding methods were not described.Of the 1022 participants enrolled, 509 were treated with doxycycline and 513 with placebo. Of these, 940 participants were soldiers included in one trial. The patients assigned to the antibiotics group compared with the ones assigned to the placebo group showed: Symptomatic, verified leptospirosis: 0.6% (3/509) versus 4.9% (25/ 513); risk difference (random effects model) -4.1%, 95% confidence interval -5.9% to -2.3%. Number needed-to-treat 24 (95% confidence interval 17 to 43). Adverse effects: 3% (13/469 participants) versus 0.2% (1/471 participants); random effects model 2.6%, 95% confidence interval 1.0% to 4.1%. Number needed-to-harm 39 (95% confidence interval 25 to 100).

AUTHORS' CONCLUSIONS

Prophylaxis of leptospirosis may be achieved by administration of doxycycline to soldiers training in endemic areas with a high risk of exposure to leptospirosis. Whether these findings apply to other scenarios or not remains to be proven.

Authors+Show Affiliations

Brazilian Cochrane Centre, Rua Pedro de Toledo, 598, Sao Paulo, SP, Brazil, 04039-001.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

19588324

Citation

Guidugli, Fábio, et al. "WITHDRAWN: Antibiotics for Preventing Leptospirosis." The Cochrane Database of Systematic Reviews, 2009, p. CD001305.
Guidugli F, Castro AA, Atallah AN. WITHDRAWN: Antibiotics for preventing leptospirosis. Cochrane Database Syst Rev. 2009.
Guidugli, F., Castro, A. A., & Atallah, A. N. (2009). WITHDRAWN: Antibiotics for preventing leptospirosis. The Cochrane Database of Systematic Reviews, (3), CD001305. https://doi.org/10.1002/14651858.CD001305.pub2
Guidugli F, Castro AA, Atallah AN. WITHDRAWN: Antibiotics for Preventing Leptospirosis. Cochrane Database Syst Rev. 2009 Jul 8;(3)CD001305. PubMed PMID: 19588324.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - WITHDRAWN: Antibiotics for preventing leptospirosis. AU - Guidugli,Fábio, AU - Castro,Aldemar A, AU - Atallah,Alvaro N, Y1 - 2009/07/08/ PY - 2009/7/10/entrez PY - 2009/7/10/pubmed PY - 2009/8/15/medline SP - CD001305 EP - CD001305 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: Leptospirosis is an infectious disease transmitted by animals. Death occurs in about five per cent of the patients. In clinical practice, doxycycline is widely used for prevention. OBJECTIVES: To evaluate the effectiveness and safety of any antibiotic regimen versus placebo or other antibiotic regimens in the prophylaxis of leptospirosis. SEARCH STRATEGY: The sources used were: EMBASE, LILACS, MEDLINE, SCISEARCH, The Cochrane Controlled Trials Register, The Cochrane Hepato-Biliary Group Controlled Trials Register, bibliographies of published papers, and personal communication with authors. There were no language or date restrictions in any of the searches. STUDIES: All randomised clinical trials in which antibiotics were used as prophylactic regimen for leptospirosis. PARTICIPANTS: People potentially exposed to leptospirosis, such as people in endemic areas during the rainy season, health professionals and other professionals with high risk of infection. INTERVENTION: Any antibiotic regimen compared with a control group (placebo or another antibiotic regimen). OUTCOMES: Infection (primary outcome) and adverse events (secondary outcome). DATA COLLECTION AND ANALYSIS: Data were independently extracted and methodological quality of each trial was assessed by two reviewers as well as cross-checked. Details of the randomisation (generation and concealment), blinding, and the number of patients lost to follow-up were recorded. The results of each trial were summarised on an intention-to-treat basis in 2 x 2 tables for each outcome. MAIN RESULTS: Two trials comparing doxycycline with placebo met the inclusion criteria. We did not find trials comparing doxycycline versus other antibiotics, or other antibiotics versus placebo. One of the trials had excellent methodological quality. In the other trial, the allocation concealment process, generation of allocation sequence, and blinding methods were not described.Of the 1022 participants enrolled, 509 were treated with doxycycline and 513 with placebo. Of these, 940 participants were soldiers included in one trial. The patients assigned to the antibiotics group compared with the ones assigned to the placebo group showed: Symptomatic, verified leptospirosis: 0.6% (3/509) versus 4.9% (25/ 513); risk difference (random effects model) -4.1%, 95% confidence interval -5.9% to -2.3%. Number needed-to-treat 24 (95% confidence interval 17 to 43). Adverse effects: 3% (13/469 participants) versus 0.2% (1/471 participants); random effects model 2.6%, 95% confidence interval 1.0% to 4.1%. Number needed-to-harm 39 (95% confidence interval 25 to 100). AUTHORS' CONCLUSIONS: Prophylaxis of leptospirosis may be achieved by administration of doxycycline to soldiers training in endemic areas with a high risk of exposure to leptospirosis. Whether these findings apply to other scenarios or not remains to be proven. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/19588324/WITHDRAWN:_Antibiotics_for_preventing_leptospirosis_ L2 - https://doi.org/10.1002/14651858.CD001305.pub2 DB - PRIME DP - Unbound Medicine ER -