Poststroke pneumonia is usually hospital-acquired, poses an economic burden and is associated with significant mortality and morbidity. In a recent meta-analysis published in the Journal of Stroke & Cerebrovascular Diseases, preventive antibiotics use was associated with reduced risk for pneumonia, urinary tract infection and other infections after stroke. However, the authors state the available evidence as insufficient to currently recommend the routine use of preventive antibiotics after acute stroke.
Researchers searched Medline, EMBASE and Cochrane databases to identify 6 randomised controlled trials (4111 patients aged ≥18 years) that compared preventive antibiotics to placebo or no antibiotics after acute stroke. Poststroke pneumonia was the primary outcome.
The proportion of dysphagia ranged from 26% to 100%. Preventive antibiotics reduced risk for poststroke pneumonia (risk ratio [RR], 0.75; 95% CI, 0.57-0.99), all infections (RR, 0.58; 95% CI, 0.48-0.69) and urinary tract infections (RR, 0.49; 95% CI, 0.26-0.85). No significant difference was observed between preventive antibiotic use and control for dependency (RR, 1.00; 95% CI, 0.93-1.08) and 90-day mortality (RR, 0.96; 95% CI, 0.78-1.19). Preventive antibiotics did not increase the risk for elevated liver enzymes (RR, 1.20; 95% CI, 0.97-1.49) or drug resistant infections (RR, 1.37; 95% CI, 0.45-4.16). Effects on other adverse events were uncertain.
Authors call for more adequately powered double-blinded randomised trials involving patients with dysphagia after acute stroke for determining if preventive antibiotics after acute stroke onset could prevent pneumonia and improve outcomes with good safety and cost-effectiveness.
