Antibiotics for preventing leptospirosis.
BACKGROUND
Leptospirosis is an infectious disease transmitted by animals. Death occurs in about five per cent of the patients. In clinical practice, doxycycline is widely used for prevention.


OBJECTIVE
To evaluate the effectiveness and safety of any antibiotic regimen versus placebo or other antibiotic regimens in the prophylaxis of leptospirosis.


METHODS
The sources used were: EMBASE, LILACS, MEDLINE, SCISEARCH, The Cochrane Controlled Trials Register, The Cochrane Hepato-Biliary Group Controlled Trials Register, bibliographies of published papers, and personal communication with authors. There were no language or date restrictions in any of the searches.


METHODS



METHODS
All randomised clinical trials in which antibiotics were used as prophylactic regimen for leptospirosis.


METHODS
People potentially exposed to leptospirosis, such as people in endemic areas during the rainy season, health professionals and other professionals with high risk of infection.


METHODS
Any antibiotic regimen compared with a control group (placebo or another antibiotic regimen).


RESULTS
Infection (primary outcome) and adverse events (secondary outcome).


METHODS
Data were independently extracted and methodological quality of each trial was assessed by two reviewers as well as cross-checked. Details of the randomisation (generation and concealment), blinding, and the number of patients lost to follow-up were recorded. The results of each trial were summarised on an intention-to-treat basis in 2 x 2 tables for each outcome.


RESULTS
Two trials comparing doxycycline with placebo met the inclusion criteria. We did not find trials comparing doxycycline versus other antibiotics, or other antibiotics versus placebo. One of the trials had excellent methodological quality. In the other trial, the allocation concealment process, generation of allocation sequence, and blinding methods were not described. Of the 1022 participants enrolled, 509 were treated with doxycycline and 513 with placebo. Of these, 940 participants were soldiers included in one trial. The patients assigned to the antibiotics group compared with the ones assigned to the placebo group showed: Symptomatic, verified leptospirosis: 0.6% (3/509) versus 4.9% (25/ 513); risk difference (random effects model) -4.1%, 95% confidence interval -5.9% to -2.3%. Number needed-to-treat 24 (95% confidence interval 17 to 43). Adverse effects: 3% (13/469 participants) versus 0.2% (1/471 participants); random effects model 2.6%, 95% confidence interval 1.0% to 4.1%. Number needed-to-harm 39 (95% confidence interval 25 to 100).


CONCLUSIONS
Prophylaxis of leptospirosis may be achieved by administrating doxycycline to soldiers training in endemic areas with a high risk of exposure to leptospirosis. Whether these findings apply to other scenarios or not remains to be proven.
Guidugli
F
F
Internal Medicine, Federal University of Sao Paulo, Rua Humberto I, 962 apt. 16, Sao Paulo, Sao Paulo, Brazil, 04018-033. cochrane.dmed@epm.br
Castro
A A
AA
Atallah
A N
AN
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D004318:Doxycycline / Q000627:therapeutic use; D006801:Humans; D007922:Leptospirosis / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents; D004318:Doxycycline