Macrolides vs. quinolones for community-acquired pneumonia: meta-analysis of randomized controlled trials.

The relative efficacy, safety and ecological implications of macrolides vs. quinolones in the treatment of community-acquired pneumonia (CAP) are debatable. We performed a systematic review and meta-analysis of randomized controlled trials comparing any macrolide vs.

Iron supplementation for the treatment of chronic heart failure and iron deficiency: systematic review and meta-analysis.

Aims: Over half of chronic heart failure (CHF) patients are anaemic, and iron deficiency is common. Iron replacement therapy (oral or i.v.

Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy.

Background: Bacterial infections are a major cause of morbidity and mortality in patients who are neutropenic following chemotherapy for malignancy. Trials have shown the efficacy of antibiotic prophylaxis in reducing the incidence of bacterial infections but not in reducing mortality rates. Our systematic review from 2006 also showed a reduction in mortality.

Colistin: new lessons on an old antibiotic.

Colistin has been re-introduced into clinical practice for the treatment of carbapenem-resistant Gram-negative bacteria. Studies in the last decade attempted to reconstruct the path that present-day medications undergo prior to clinical use. In this review, we summarize the results of recent clinical studies.

Antibiotic prophylaxis in cardiac surgery: systematic review and meta-analysis.

Background: Antibiotic prophylaxis is recommended in cardiac surgery. Current debate concerns the type of antibiotic(s), dosing and the duration of prophylaxis.

Methods: Systematic review of randomized controlled trials comparing one antibiotic regimen versus another in cardiac surgery.

Ethical dilemmas in antibiotic treatment.

Patients with moderate to severe infections are given less than maximum empirical antibiotic treatment in order to reduce the rise in resistance. This practice involves two ethical dilemmas: whether the danger to a present patient should be increased (even if by a small degree) to benefit future, unidentified patients; and whether this should be done without the consent of the patient, disregarding the patient's autonomy. We argue that future patients have a right to come to no harm.

Antibiotics for preventing meningococcal infections.

Background: Meningococcal disease is a contagious bacterial infection caused by Neisseria meningitidis (N. meningitidis). Household contacts have the highest risk of contracting the disease during the first week of a case being detected.

Efficacy and safety of tigecycline: a systematic review and meta-analysis.

Background: Tigecycline is a novel glycylcycline that exhibits broad-spectrum antibacterial activity. Recently, the US FDA issued a warning concerning increased mortality with tigecycline in randomized controlled trials (RCTs).

Methods: We conducted a systematic review and meta-analysis of RCTs that compared tigecycline with any other antibiotic regimen for the treatment of any infection.

[The clinician-scientist: proposal for a new paradigm].

The decline in the attraction and prestige of the clinician-scientist paradigm is due to the dissonance between clinical work and conducting research in basic science. Medicine entails alleviating distress and prolonging life. Thus, medical research deals directly with the questions: what ails our patients and what shortens their lives? How can it be prevented? How can we alleviate suffering and prolong life? Research designs that fit these questions are: researcher (or patient) initiated randomized controlled trials; systematic reviews and meta-analysis; high-quality observational studies that address risk factors, natural history of disease, side-effects, and efficiency of treatment; research in ethics; and qualitative research.

Thrombocytopenia in Staphylococcus aureus bacteremia: risk factors and prognostic importance.

Objective: To identify risk factors and outcomes associated with thrombocytopenia at sepsis onset in Staphylococcus aureus bacteremia.

Patients And Methods: This single-center, retrospective, cohort study consists of all adult patients with a first episode of clinical S aureus bacteremia between April 1, 1988, and September 30, 1994, and between January 1, 1999, and December 31, 2007. Thrombocytopenia was defined as a platelet count less than 150 × 10(9)/L.

Benefit of early treatment with oseltamivir in hospitalized patients with documented 2009 influenza A (H1N1): retrospective cohort study.

Background: We assessed the association between early oseltamivir treatment and influenza complications in hospitalized patients.

Methods: A retrospective cohort study, including adults with laboratory-confirmed 2009 influenza A (H1N1) in three hospitals in Israel, was performed between July 2009 and January 2010, when admission was limited to high-risk patients. We compared patients treated with oseltamivir early versus late (>48 h after symptom onset).

Clinical implications of β-lactam-aminoglycoside synergism: systematic review of randomised trials.

β-Lactam-aminoglycoside combinations are commonly used despite lack of evidence of a clinical benefit. In this study, all randomised controlled trials (RCTs) assessing directly the clinical implications of synergism by comparing a β-lactam with the same β-lactam in combination with an aminoglycoside as empirical or definitive therapy for any type of infection and clinical scenario were compiled. A systematic search was undertaken to identify all trials regardless of language, date or publication status.

The effect of empiric antibiotic therapy on mortality in debilitated patients with dementia.

The purpose of this investigation was to assess the effect of empirical antibiotic treatment on 30-day mortality among debilitated inpatients with dementia and Gram-negative bacteremia. A retrospective cohort study in the years 2005-2007 was undertaken. Data were collected through patient chart review.

Aminoglycoside-containing antibiotic combinations for the treatment of bacterial endocarditis: an evidence-based approach.

This review deals with the question of whether the addition of an aminoglycoside to an antibiotic with activity against Gram-positive bacteria is safe and effective for the treatment of endocarditis. Aminoglycosides are more toxic than other drugs used in combination therapy for endocarditis, e.g.

PCR diagnosis of invasive candidiasis: systematic review and meta-analysis.

Invasive candidiasis (IC) is a significant cause of morbidity and mortality. Diagnosis relies on culture-based methods, which lack sensitivity and delay diagnosis. We conducted a systematic review assessing the diagnostic accuracy of PCR-based methods to detect Candida spp.

Dose-dense chemotherapy in nonmetastatic breast cancer: a systematic review and meta-analysis of randomized controlled trials.

Background: Dose-dense chemotherapy has become a mainstay regimen in the adjuvant setting for women with high-risk breast cancer. We performed a systematic review and meta-analysis of the existing data from randomized controlled trials regarding the efficacy and toxicity of the dose-dense chemotherapy approach in nonmetastatic breast cancer.

Methods: Randomized controlled trials that compared a dose-dense chemotherapy protocol with a standard chemotherapy schedule in the neoadjuvant or adjuvant setting in adult women older than 18 years with breast cancer were identified by searching The Cochrane Cancer Network register of trials, The Cochrane Library, and LILACS and MEDLINE databases (from January 1966 to January 2010).

Are all beta-lactams similarly effective in the treatment of methicillin-sensitive Staphylococcus aureus bacteraemia?

Methicillin-sensitive Staphylococcus aureus (MSSA) is susceptible to many beta-lactams. We compared cloxacillin and cefazolin, the first-line recommended antibiotics, and other beta-lactams in the treatment of MSSA bacteraemia. This was a retrospective cohort study.

Anti-pseudomonal beta-lactams for the initial, empirical, treatment of febrile neutropenia: comparison of beta-lactams.

Background: Several beta-lactams are recommended as single agents for the treatment of febrile neutropenia.

Objectives: To compare the effectiveness of different anti-pseudomonal beta-lactams as single agents in the treatment of febrile neutropenia. To compare the development of bacterial resistance, bacterial and fungal superinfections during or following treatment with the different beta-lactams.

Importance of appropriate empirical antibiotic therapy for methicillin-resistant Staphylococcus aureus bacteraemia.

Objectives: To document the effects of appropriate and inappropriate empirical antibiotic therapy on mortality in a cohort of patients with bacteraemia due to methicillin-resistant Staphylococcus aureus (MRSA) and to summarize effects with previous studies.

Methods: In the retrospective cohort study, episodes of clinically significant MRSA bacteraemia during a 15 year period were included. Polymicrobial episodes were excluded unless MRSA was isolated in more than one bottle and co-pathogens were given appropriate empirical antibiotic treatment.

Antimicrobial agents for treating uncomplicated urinary tract infection in women.

Background: Acute uncomplicated lower urinary tract infection (UTI) is one of the most common problems for which young women seek medical attention.

Objectives: To compare the efficacy, resistance development and safety of different antimicrobial treatments for acute uncomplicated lower UTI.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Renal Group's Specialised Register, MEDLINE, EMBASE and bibliographies of included studies.

Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis.

Quantifying the benefit of early antibiotic treatment is crucial for decision making and can be assessed only in observational studies. We performed a systematic review of prospective studies reporting the effect of appropriate empirical antibiotic treatment on all-cause mortality among adult inpatients with sepsis. Two reviewers independently extracted data.

A model for diagnosis of pulmonary infections in solid-organ transplant recipients.

Background: Opportunistic pulmonary infections are a major cause of morbidity and mortality among solid organ transplant recipients. The diagnosis of these infections is challenging because of the broad spectrum of bacteria, fungi and viruses affecting these patients and the lack of specific signs and symptoms. Treatment directed at the offending organism started as soon as possible improves survival.