JAC Advance Access published online on September 1, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg409
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Medicine
E, Beilinson Campus, Rabin Medical Center, Petah-Tiqva 49100; Sackler Faculty of Medicine, Tel-Aviv
University, Ramat-Aviv, Tel-Aviv, Israel
Received 4 May 2003
; revised 7 July 2003
; accepted 9 July 2003
Context: Microorganisms resistant
to antibiotic drugs are a threat to the health and chances of survival
of patients. Systematic reviews on antibiotic drugs that ignore
the topic of resistance present readers with a skewed view, emphasizing
short-term efficacy or effectiveness while ignoring long-term consequences. Objectives: To examine whether systematic reviews
of antibiotic treatment consider resistance; if not, to find out
whether data on resistance were reported in the original trials;
and based on that, to offer a framework for taking resistance into
account in systematic reviews. Data sources: The Cochrane Database of Systematic
Reviews (the Cochrane Library, 2001, issue 2); and MEDLINE, 1996-2000. Study selection: (i) Systematic reviews or meta-analyses
of antimicrobial therapy, published during 1996-2000.
(ii) Randomized, controlled trials abstracted in systematic reviews
that addressed a topic highly relevant to antibiotic resistance. Data extraction: We examined each systematic
review, and each article, to see whether the implications of resistance
were discussed; and whether data on resistance were collected. Results: Out of 111 systematic reviews, only
44 (40%) discussed resistance. Ten reviews (9%)
planned or performed collection of data on the response of patients
with susceptible or resistant isolates. In 22 systematic reviews
(20%), collection of data on induction of resistance was
planned or performed. The topic of 41 reviews was judged highly
relevant to resistance, and these reviews extracted data from 337
articles, out of which we retrieved 279 articles (83%).
In 201 (72%) articles, resistance was discussed or data
pertaining to it were collected. Ninety-seven articles (35%)
gave actual data on resistance of pathogens to the study drugs, 71
articles (25%) data on efficacy of antibiotic drugs in
patients with susceptible and resistant pathogens, and 55 articles
(20%) provided data on infection or colonization with resistant
strains during treatment. Conclusions: Most systematic reviews on antibiotic
treatment ignored the issue of resistance, although many of the
original articles referred to it and some reported relevant data.
Reviewers should collect data on resistance and discuss the implications
in their discussion and sections concerned with policy implications.
Keywords: meta-analysis, antimicrobial drugs, susceptibility
to antibiotic drugs
Considering resistance in systematic reviews of
antibiotic treatment
2 Department of Medicine
E, Beilinson Campus, Rabin Medical Center, Petah-Tiqva 49100
3 UK Cochrane Centre, Oxford
4 International Health Division, Liverpool School
of Tropical Medicine, Liverpool, UK
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