Antibiotics for treating osteomyelitis in people with sickle cell disease

Review question

We reviewed the evidence to determine whether antibiotics (alone or in combination) given to people with sickle cell disease who have osteomyelitis (a bone infection) before the specific bacterium causing an infection is known is effective and safe as compared to bacterium-directed antibiotic treatment and whether this effectiveness and safety is dependent on different treatment regimens, age or setting. This is an update of a previously published Cochrane Review.

Background

Sickle cell disease affects millions of people throughout the world. Osteomyelitis is one of the major complications. Antibiotics are given to treat it, but there is no worldwide standard treatment.

Search date

The evidence is current to: 18 August 2016.

Study characteristics

There are no trials included in this review.

Key results

We conclude that a randomised controlled trial should attempt to answer these questions.

Authors' conclusions: 

We were unable to identify any relevant trials on the efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from osteomyelitis. Randomised controlled trials are needed to establish the optimum antibiotic treatment for this condition.

Read the full abstract...
Background: 

Osteomyelitis (both acute and chronic) is one of the most common infectious complications in people with sickle cell disease. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from osteomyelitis. This is an update of a previously published Cochrane Review.

Objectives: 

To determine whether an empirical antibiotic treatment approach (monotherapy or combination therapy) is effective and safe as compared to pathogen-directed antibiotic treatment and whether this effectiveness and safety is dependent on different treatment regimens, age or setting.

Search strategy: 

We searched The Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 20 October 2016), African Index Medicus (20 October 2016), ISI Web of Knowledge (20 October 2016) and World Health Organization International Clinical Trials Registry Platform (20 October 2016).

Date of most recent search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 18 August 2016.

Selection criteria: 

We searched for published or unpublished randomised and quasi-randomised controlled trials.

Data collection and analysis: 

Each author intended to independently extract data and assess trial quality by standard Cochrane methodologies, but no eligible randomised controlled trials were identified.

Main results: 

This update was unable to find any randomised or quasi-randomised controlled trials on antibiotic treatment approaches for osteomyelitis in people with sickle cell disease.

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