title: Addressing resistance to antibiotics in systematic reviews of antibiotic interventions.
abstract: Antibiotics are among the most important interventions in healthcare. Resistance of bacteria to antibiotics threatens the effectiveness of treatment. Systematic reviews of antibiotic treatments often do not address resistance to antibiotics even when data are available in the original studies. This omission creates a skewed view, which emphasizes short-term efficacy and ignores the long-term consequences to the patient and other people. We offer a framework for addressing antibiotic resistance in systematic reviews. We suggest that the data on background resistance in the original trials should be reported and taken into account when interpreting results. Data on emergence of resistance (whether in the body reservoirs or in the bacteria causing infection) are important outcomes. Emergence of resistance should be taken into account when interpreting the evidence on antibiotic treatment in randomized controlled trials or systematic reviews.
authors.affiliation: Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva; and Sackler Faculty of Medicine, Tel-Aviv University, Israel leibovic@post.tau.ac.il.
authors.forename: Leonard
authors.initials: L
authors.lastname: Leibovici
authors.affiliation: Division of Infectious Diseases, Rambam Health Care Campus, Haifa; and Technion-Israel Institute of Technology and the Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel.
authors.forename: Mical
authors.initials: M
authors.lastname: Paul
authors.affiliation: Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Garner
authors.affiliation: Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Sinclair
authors.affiliation: Rigshospitalet, Department of Anaesthesiology, Mother and Children's Section, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Arash
authors.initials: A
authors.lastname: Afshari
authors.affiliation: Cochrane Anaesthesia, Critical and Emergency Care Group, Copenhagen, Denmark; and Department of Anesthesiology, University of Utah, Salt Lake City, UT 84132-2304, USA.
authors.forename: Nathan Leon
authors.initials: NL
authors.lastname: Pace
authors.affiliation: Cochrane Wounds Group; and School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
authors.forename: Nicky
authors.initials: N
authors.lastname: Cullum
authors.affiliation: Centre of Evidence Based Dermatology, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: Hywel C
authors.initials: HC
authors.lastname: Williams
authors.affiliation: Cochrane Cystic Fibrosis and Genetic Disorders Group; and Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Smyth
authors.affiliation: Cochrane Haematological Malignancies Group; and Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Skoetz
authors.affiliation: Cochrane Acute Respiratory Infections Group; and Centre for Research in Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Del Mar
authors.affiliation: Cochrane ENT Group; and Ear Institute, University College London, London, UK.
authors.forename: Anne G M
authors.initials: AG
authors.lastname: Schilder
authors.affiliation: Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva; and Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Dafna
authors.initials: D
authors.lastname: Yahav
authors.affiliation: Cochrane Editorial Unit, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Tovey
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D024881:Drug Resistance, Bacterial; D006801:Humans; D009154:Mutation; D015995:Prevalence; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents