Does antibiotic treatment benefit patients with low back pain and Modic changes?

  • Bråten LCH & al.
  • BMJ
  • 16 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with chronic low back pain and Modic changes at the level of a previous disc herniation, 3 months amoxicillin treatment did not provide a clinically important benefit compared with placebo.

Why this matters

  • Findings do not support the use of antibiotics treatment for chronic low back pain and Modic changes.

Study design

  • 180 patients with chronic low back pain, previous disc herniation and type 1 or 2 Modic changes were randomly assigned to receive 3 months of oral amoxicillin 750 mg (n=89) or placebo (n=91) 3 times daily.
  • Primary outcome: Roland-Morris Disability Questionnaire (RMDQ) score (range, 0-24) at 1-year follow-up.
  • Funding: Governmental organisations Helse Sør-Øst and Helse Vest.

Key results

  • In the primary analysis, the adjusted mean difference (MD) in the RMDQ score between the amoxicillin and the placebo group was −1.6 (95% CI, −3.1 to 0.0) points; P=.04.
  • In the secondary analysis, the adjusted MD in the RMDQ score between the groups was −2.3 (95% CI, −4.2 to −0.4) points (P=.02) for patients with type 1 Modic changes and −0.1 (95% CI, −2.7 to 2.6) points (P=.95) for patients with type 2 Modic changes.
  • Overall, 50 (56%) patients in the amoxicillin group experienced ≥1 drug-related adverse event compared with 31 (34%) in the placebo group.

Limitations

  • Initiation of antibiotic treatment without first documenting infection in tissue samples taken from individual patients.
  • Heterogeneity of the treated sample.