Anti-inflammatories as adjunct treatment for cellulitis: a systematic review and meta-analysis

IF 2 4区 医学 Q2 EMERGENCY MEDICINE
Laura Hamill, Gerben Keijzers, Scott Robertson, Chiara Ventre, Nuri Song, Paul Glasziou, Anna Mae Scott, Justin Clark, Krishan Yadav
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引用次数: 0

Abstract

Objectives

Existing guideline recommendations suggest considering corticosteroids for adjunct treatment of cellulitis, but this is based on a single trial with low certainty of evidence. The objective was to determine if anti-inflammatory medication (non-steroidal anti-inflammatory drugs [NSAIDs], corticosteroids) as adjunct cellulitis treatment improves clinical response and cure.

Methods

Systematic review and meta-analysis including randomized controlled trials of patients with cellulitis treated with antibiotics irrespective of age, gender, severity and setting, and an intervention of anti-inflammatories (NSAIDs or corticosteroids) vs. placebo or no intervention. Medline (PubMed), Embase (via Elsevier), and Cochrane CENTRAL were searched from inception to August 1, 2023. Data extraction was conducted independently in pairs. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2. Data were pooled using a random effects model. Primary outcomes are time to clinical response and cure.

Results

Five studies (n = 331) were included, all were adults. Three trials reported time to clinical response. There was a benefit with use of an oral NSAID as adjunct therapy at day 3 (risk ratio 1.81, 95%CI 1.42–2.31, I2 = 0%). There was no difference between groups at day 5 (risk ratio 1.19, 95%CI 0.62–2.26), although heterogeneity was high (I2 = 96%). Clinical cure was reported by three trials, and there was no difference between groups at all timepoints up to 22 days. Statistical heterogeneity was moderate to low. Adverse events (N = 3 trials) were infrequent.

Conclusions

For patients with cellulitis, the best available data suggest that oral nonsteroidal anti-inflammatory drugs (NSAIDs) as adjunct therapy to antibiotics may lead to improved early clinical response, although this is not sustained beyond 4 days. There is insufficient data to comment on the role of corticosteroids for clinical response. These results must be interpreted with caution due to the small number of included studies.

Registration

Open Science Framework: https://osf.io/vkxae?view_only=fb4f8ca438a048cb9ca83c5f47fd4d81.

Abstract Image

作为蜂窝组织炎辅助治疗的消炎药:系统综述与荟萃分析
目的现有指南建议考虑将皮质类固醇用于蜂窝组织炎的辅助治疗,但这只是基于一项证据确定性较低的试验。方法系统综述和荟萃分析,包括对接受抗生素治疗的蜂窝组织炎患者进行的随机对照试验,不考虑年龄、性别、严重程度和环境,以及抗炎药物(非甾体抗炎药或皮质类固醇)干预与安慰剂或无干预的对比。对 Medline (PubMed)、Embase (通过 Elsevier) 和 Cochrane CENTRAL 进行了检索,检索时间从开始到 2023 年 8 月 1 日。数据提取由两人独立完成。使用 Cochrane 偏倚风险工具 2 评估偏倚风险。采用随机效应模型对数据进行汇总。主要结果为临床反应时间和治愈时间。结果纳入了五项研究(n = 331),均为成人研究。三项试验报告了临床反应时间。在第 3 天使用口服非甾体抗炎药作为辅助治疗有一定的获益(风险比 1.81,95%CI 1.42-2.31,I2 = 0%)。第 5 天时,各组间无差异(风险比 1.19,95%CI 0.62-2.26),但异质性很高(I2 = 96%)。有三项试验报告了临床治愈情况,在 22 天内的所有时间点,各组间均无差异。统计异质性为中低。结论对于蜂窝组织炎患者,现有的最佳数据表明,口服非甾体抗炎药(NSAIDs)作为抗生素的辅助疗法可能会改善早期临床反应,尽管这种反应不会持续到4天以后。关于皮质类固醇对临床反应的作用,目前还没有足够的数据可供评论。由于纳入的研究较少,因此必须谨慎解释这些结果。注册开放科学框架:https://osf.io/vkxae?view_only=fb4f8ca438a048cb9ca83c5f47fd4d81。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Canadian Journal of Emergency Medicine
Canadian Journal of Emergency Medicine Medicine-Emergency Medicine
CiteScore
2.90
自引率
12.50%
发文量
171
审稿时长
>12 weeks
期刊介绍: CJEM is a peer-reviewed journal owned by CAEP. CJEM is published every 2 months (January, March, May, July, September and November). CJEM presents articles of interest to emergency care providers in rural, urban or academic settings. Publishing services are provided by the Canadian Medical Association.
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