Is de-escalation of antimicrobials effective? A systematic review and meta-analysis.
BACKGROUND
De-escalation therapy is a strategy used widely to treat infections while avoiding the use of broad-spectrum antimicrobials. However, there is a paucity of clinical evidence to demonstrate the effectiveness and safety of de-escalation therapy compared to conventional therapy.


METHODS
A systematic review and meta-analysis was conducted on de-escalation therapy for a variety of infections. A search of the MEDLINE (via PubMed), EMBASE, and Cochrane Library databases up to July 2015 for relevant studies was performed. The primary outcome was relevant mortality, such as 30-day mortality and in-hospital mortality. A meta-analysis was to be conducted for the pooled odds ratio using the random-effects model when possible. Both randomized controlled trials and observational studies were included in the analysis.


RESULTS
A total of 23 studies were included in the analysis. There was no difference in mortality for most infections, and some studies favored de-escalation over non-de-escalation for better survival. The quality of most studies included was not high.


CONCLUSIONS
This review and analysis suggests that de-escalation therapy is safe and effective for most infections, although higher quality studies are needed in the future.
Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo 650-0017, Japan.
Goh
G
Ohji
Division of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Japan.
Asako
A
Doi
Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo 650-0017, Japan.
Shungo
S
Yamamoto
Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo 650-0017, Japan. Electronic address: kentaroiwata1969@gmail.com.
Kentaro
K
Iwata
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D003428:Cross Infection / Q000188:drug therapy; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000188:drug therapy*; D007362:Intensive Care Units; D011014:Pneumonia / Q000188:drug therapy; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy; D018805:Sepsis / Q000188:drug therapy
D000890:Anti-Infective Agents
De-escalation therapy; Meta-analysis; Systematic review