NEUROLOGIE SELECTION CRITERIA: Randomised controlled trials (RCTs) of preventive antibiotic therapy versus control (placebo or open control) in patients with acute ischaemic or haemorrhagic stroke. DATA COLLECTION AND ANALYSIS: Two authors independently selected articles and performed data extraction; we discussed and resolved discrepancies in a consensus meeting with a third observer. We contacted the study authors to obtain missing data when required. An independent observer assessed methodological quality. We calculated relative risks (RRs) for dichotomous outcomes, assessed heterogeneity amongst included studies and performed subgroup analyses on study quality. MAIN RESULTS: We included five studies involving 506 patients. Study population, study design, type of antibiotic and definition of infection differed considerably. The number of patients who died in the preventive antibiotic group was non-significantly reduced (33/248 (13%) versus 38/258 (15%), RR 0.85, 95% confidence interval (CI) 0.47 to 1.51); the number of dependent patients in the preventive antibiotic therapy group was also nonsignificantly reduced (97/208 (47%) versus 127/208 (61%), RR 0.67, 95% CI 0.32 to 1.43). Preventive antibiotic therapy did reduce the incidence of infections in patients with acute stroke from 36% to 22% (36/166 (22%) versus 61/169 (36%), RR 0.58, 95% CI 0.43 to 0.79). No major side-effects of preventive antibiotic therapy were reported. AUTHORS’ CONCLUSIONS: In this meta-analysis, preventive antibiotic therapy seemed to reduce the risk of infection, but did not reduce the number of dependent or deceased patients. However, the included studies were small and heterogeneous. Large randomised trials are urgently needed. Overige artikelen Structural and diffusion MRI measures of the hippocampus and memory performance. den Heijer T, van der Lijn F, Vernooij MW, de Groot M, Koudstaal PJ, van der Lugt A, Krestin GP, Hofman A, Niessen WJ, Breteler MMB. NeuroImage 2012;63:1782-1789. Preventive antibiotics in acute stroke: summary of a cochrane systematic review and meta-analysis. Westendorp WF, Vermeij JD, Vermeij FH, Hertog HM den, Dippel DWJ, Van de Beek D, Nederkoorn PJ. Stroke; a journal of cerebral circulation. 11/2012; 43(11):e113-4. Voordrachten Praktische Neurologie voor de huisarts: “(sub)acute hoofdpijnen”, “bewegingsstoornissen in de neurologie” en “zwakte en/of pijn aan de extremiteiten”. Bakker SLM. Paramaribo: Nascholing huisartsen Suriname, 10-18 november 2012. 71 WETENSCHAPPELIJK jaarverslag 2012 Pagina 70
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