title: Management of alcohol withdrawal delirium. An evidence-based practice guideline.
abstract: BACKGROUND
  Alcohol withdrawal delirium is the most serious manifestation of alcohol withdrawal. Evidence suggests that appropriate care improves mortality, but systematic reviews are unavailable.
  
  
  METHODS
  Articles with original data on management of alcohol withdrawal delirium underwent structured review and meta-analysis.
  
  
  RESULTS
  Meta-analysis of 9 prospective controlled trials demonstrated that sedative-hypnotic agents are more effective than neuroleptic agents in reducing duration of delirium and mortality, with a relative risk of death when using neuroleptic agents of 6.6. Statistically significant differences among various benzodiazepines and barbiturates were not found. No deaths were reported in 217 patients from trials using benzodiazepines or barbiturates.
  
  
  CONCLUSIONS
  Control of agitation should be achieved using parenteral rapid-acting sedative-hypnotic agents that are cross-tolerant with alcohol. Adequate doses should be used to maintain light somnolence for the duration of delirium. Coupled with comprehensive supportive medical care, this approach is highly effective in preventing morbidity and mortality.
authors.affiliation: Primary Care Service, Veterans Administration Medical Center, Manchester, NH 03104, USA. Michael.Mayo-Smith@med.va.gov
authors.forename: Michael F
authors.initials: MF
authors.lastname: Mayo-Smith
authors.forename: Lee H
authors.initials: LH
authors.lastname: Beecher
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Fischer
authors.forename: David A
authors.initials: DA
authors.lastname: Gorelick
authors.forename: Jeanette L
authors.initials: JL
authors.lastname: Guillaume
authors.forename: Arnold
authors.initials: A
authors.lastname: Hill
authors.forename: Gail
authors.initials: G
authors.lastname: Jara
authors.forename: Chris
authors.initials: C
authors.lastname: Kasser
authors.forename: John
authors.initials: J
authors.lastname: Melbourne
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy* / Q000191:economics; D014150:Antipsychotic Agents / Q000191:economics / Q000592:standards / Q000627:therapeutic use; D001569:Benzodiazepines / Q000191:economics / Q000592:standards / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D003365:Costs and Cost Analysis; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D015201:Meta-Analysis as Topic; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000191:economics
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines