tetano
Editor, Senior Moderator
Clin Microbiol Infect. 2019 Jul 5. pii: S1198-743X(19)30381-7. doi: 10.1016/j.cmi.2019.06.030. [Epub ahead of print]
[h=1]Impact of vaccination on antibiotic usage: a systematic review and meta-analysis.[/h] Buckley BS[SUP]1[/SUP], Henschke N[SUP]2[/SUP], Bergman H[SUP]3[/SUP], Skidmore B[SUP]4[/SUP], Klemm EJ[SUP]5[/SUP], Villanueva G[SUP]3[/SUP], Garritty C[SUP]6[/SUP], Paul M[SUP]7[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Vaccines may reduce antibiotic use and the development of resistance.
[h=4]OBJECTIVES:[/h] To provide a comprehensive, up-to-date assessment of the evidence base relating to the effect of vaccines on antibiotic use.
[h=4]DATA SOURCES:[/h] Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and WHO Trials Registry.
[h=4]STUDY ELIGIBILITY CRITERIA:[/h] Randomised-controlled trials (RCTs) and observational studies published January 1998 to March 2018.
[h=4]PARTICIPANTS:[/h] Any population.
[h=4]INTERVENTIONS:[/h] Vaccines versus placebo, no vaccine or another vaccine.
[h=4]METHODS:[/h] Titles, abstracts, and full-texts were screened independently by two reviewers. Certainty of RCT evidence was assessed using GRADE.
[h=4]RESULTS:[/h] 4980 records identified; 895 full-text reports assessed; 96 studies included (24 RCTs, 72 observational). There was high certainty evidence that influenza vaccine reduces days of antibiotic use among healthy adults (1 RCT; n = 4253; rate reduction 28?1% [95% CI 16?0, 38?4]); moderate certainty evidence that influenza vaccines probably reduce antibiotic use in children aged 6 months to 14 years (3 RCTs; n = 610; ratio of means 0?62 [95% CI 0?54, 0?70) and probably reduces community antibiotic use in children aged 3-15 years (1 RCT; n = 10,985 person-seasons; risk ratio 0?69 [95% CI 0?58, 0?83]); moderate certainty evidence that pneumococcal vaccination probably reduces antibiotic use in children aged 6 weeks to 6 years (2 RCTs; n = 47,945; rate ratio 0?93 [95% CI 0?87, 0?99]) and reduces illness episodes requiring antibiotics in children aged 12-35 months (1 RCT; n = 264; rate ratio 0?85 [95% CI 0?75, 0?97]). Other RCT evidence was of low or very low certainty, and observational evidence was affected by confounding.
[h=4]CONCLUSIONS:[/h] The evidence base is poor. Although some vaccines may reduce antibiotic use, collection of high-quality data in future vaccine trials is needed to improve the evidence base.
[h=4]PROSPERO REGISTRATION:[/h] CRD42018103881.
Copyright ? 2019. Published by Elsevier Ltd.
[h=4]KEYWORDS:[/h] antibiotic; global health; meta analysis; systematic review; vaccine
PMID: 31284031 DOI: 10.1016/j.cmi.2019.06.030
[h=1]Impact of vaccination on antibiotic usage: a systematic review and meta-analysis.[/h] Buckley BS[SUP]1[/SUP], Henschke N[SUP]2[/SUP], Bergman H[SUP]3[/SUP], Skidmore B[SUP]4[/SUP], Klemm EJ[SUP]5[/SUP], Villanueva G[SUP]3[/SUP], Garritty C[SUP]6[/SUP], Paul M[SUP]7[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Vaccines may reduce antibiotic use and the development of resistance.
[h=4]OBJECTIVES:[/h] To provide a comprehensive, up-to-date assessment of the evidence base relating to the effect of vaccines on antibiotic use.
[h=4]DATA SOURCES:[/h] Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and WHO Trials Registry.
[h=4]STUDY ELIGIBILITY CRITERIA:[/h] Randomised-controlled trials (RCTs) and observational studies published January 1998 to March 2018.
[h=4]PARTICIPANTS:[/h] Any population.
[h=4]INTERVENTIONS:[/h] Vaccines versus placebo, no vaccine or another vaccine.
[h=4]METHODS:[/h] Titles, abstracts, and full-texts were screened independently by two reviewers. Certainty of RCT evidence was assessed using GRADE.
[h=4]RESULTS:[/h] 4980 records identified; 895 full-text reports assessed; 96 studies included (24 RCTs, 72 observational). There was high certainty evidence that influenza vaccine reduces days of antibiotic use among healthy adults (1 RCT; n = 4253; rate reduction 28?1% [95% CI 16?0, 38?4]); moderate certainty evidence that influenza vaccines probably reduce antibiotic use in children aged 6 months to 14 years (3 RCTs; n = 610; ratio of means 0?62 [95% CI 0?54, 0?70) and probably reduces community antibiotic use in children aged 3-15 years (1 RCT; n = 10,985 person-seasons; risk ratio 0?69 [95% CI 0?58, 0?83]); moderate certainty evidence that pneumococcal vaccination probably reduces antibiotic use in children aged 6 weeks to 6 years (2 RCTs; n = 47,945; rate ratio 0?93 [95% CI 0?87, 0?99]) and reduces illness episodes requiring antibiotics in children aged 12-35 months (1 RCT; n = 264; rate ratio 0?85 [95% CI 0?75, 0?97]). Other RCT evidence was of low or very low certainty, and observational evidence was affected by confounding.
[h=4]CONCLUSIONS:[/h] The evidence base is poor. Although some vaccines may reduce antibiotic use, collection of high-quality data in future vaccine trials is needed to improve the evidence base.
[h=4]PROSPERO REGISTRATION:[/h] CRD42018103881.
Copyright ? 2019. Published by Elsevier Ltd.
[h=4]KEYWORDS:[/h] antibiotic; global health; meta analysis; systematic review; vaccine
PMID: 31284031 DOI: 10.1016/j.cmi.2019.06.030