Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care

Roberto D'Amico; Silvia Pifferi; Valter Torri; Luca Brazzi; Elena Parmelli; Alessandro Liberati<sup>a</sup>

doi:10.1002/14651858.CD000022.pub3

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Figure 1

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Analysis 1.1

Comparison 1 Topical plus systemic versus no prophylaxis, Outcome 1 Overall mortality.

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Analysis 1.2

Comparison 1 Topical plus systemic versus no prophylaxis, Outcome 2 Mortality according to quality of allocation concealment.

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Analysis 1.3

Comparison 1 Topical plus systemic versus no prophylaxis, Outcome 3 Mortality according to blinding of the studies.

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Analysis 1.4

Comparison 1 Topical plus systemic versus no prophylaxis, Outcome 4 RTIs.

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Analysis 1.5

Comparison 1 Topical plus systemic versus no prophylaxis, Outcome 5 RTIs according to quality of allocation concealment.

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Analysis 1.6

Comparison 1 Topical plus systemic versus no prophylaxis, Outcome 6 RTIs according to blinding of the studies.

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Analysis 2.1

Comparison 2 Topical versus control, Outcome 1 Overall mortality.

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Analysis 2.2

Comparison 2 Topical versus control, Outcome 2 Mortality according to quality of allocation concealment.

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Analysis 2.3

Comparison 2 Topical versus control, Outcome 3 Mortality according to blinding of the studies.

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Analysis 2.4

Comparison 2 Topical versus control, Outcome 4 RTIs.

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Analysis 2.5

Comparison 2 Topical versus control, Outcome 5 RTIs according to quality of allocation concealment.

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Analysis 2.6

Comparison 2 Topical versus control, Outcome 6 RTIs according to blinding of the studies.

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Comparison 1. Topical plus systemic versus no prophylaxis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Overall mortality Show forest plot	17	4075	Odds Ratio (M‐H, Fixed, 95% CI)	0.75 [0.65, 0.87]

2 Mortality according to quality of allocation concealment Show forest plot	17	4075	Odds Ratio (M‐H, Fixed, 95% CI)	0.75 [0.65, 0.87]

2.1 Adequate	10	3336	Odds Ratio (M‐H, Fixed, 95% CI)	0.77 [0.66, 0.90]
2.2 Not adequate	7	739	Odds Ratio (M‐H, Fixed, 95% CI)	0.67 [0.48, 0.93]
3 Mortality according to blinding of the studies Show forest plot	17	4075	Odds Ratio (M‐H, Fixed, 95% CI)	0.75 [0.65, 0.87]

3.1 Double‐blind	4	1013	Odds Ratio (M‐H, Fixed, 95% CI)	0.63 [0.48, 0.83]
3.2 Open	13	3062	Odds Ratio (M‐H, Fixed, 95% CI)	0.80 [0.68, 0.95]
4 RTIs Show forest plot	16	3024	Odds Ratio (M‐H, Random, 95% CI)	0.28 [0.20, 0.38]

5 RTIs according to quality of allocation concealment Show forest plot	16	3024	Odds Ratio (M‐H, Random, 95% CI)	0.28 [0.20, 0.38]

5.1 Adequate	9	2335	Odds Ratio (M‐H, Random, 95% CI)	0.36 [0.27, 0.47]
5.2 Not adequate	7	689	Odds Ratio (M‐H, Random, 95% CI)	0.19 [0.10, 0.37]
6 RTIs according to blinding of the studies Show forest plot	16	3024	Odds Ratio (M‐H, Random, 95% CI)	0.28 [0.20, 0.38]

6.1 Double‐blind	4	963	Odds Ratio (M‐H, Random, 95% CI)	0.40 [0.30, 0.53]
6.2 Open	12	2061	Odds Ratio (M‐H, Random, 95% CI)	0.22 [0.14, 0.34]

Comparison 1. Topical plus systemic versus no prophylaxis

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Comparison 2. Topical versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Overall mortality Show forest plot	20	3016	Odds Ratio (M‐H, Fixed, 95% CI)	0.97 [0.82, 1.16]

1.1 Topical plus systemic versus systemic	7	1233	Odds Ratio (M‐H, Fixed, 95% CI)	0.98 [0.73, 1.32]
1.2 Topical versus no prophylaxis	13	1783	Odds Ratio (M‐H, Fixed, 95% CI)	0.97 [0.79, 1.20]
2 Mortality according to quality of allocation concealment Show forest plot	20	3016	Odds Ratio (M‐H, Fixed, 95% CI)	0.97 [0.82, 1.16]

2.1 Adequate	2	139	Odds Ratio (M‐H, Fixed, 95% CI)	0.64 [0.27, 1.52]
2.2 Not adequate	18	2877	Odds Ratio (M‐H, Fixed, 95% CI)	0.99 [0.83, 1.18]
3 Mortality according to blinding of the studies Show forest plot	20	3016	Odds Ratio (M‐H, Fixed, 95% CI)	0.98 [0.82, 1.16]

3.1 Double‐blind	15	2601	Odds Ratio (M‐H, Fixed, 95% CI)	0.99 [0.83, 1.20]
3.2 Open	5	415	Odds Ratio (M‐H, Fixed, 95% CI)	0.88 [0.56, 1.37]
4 RTIs Show forest plot	18	2850	Odds Ratio (M‐H, Random, 95% CI)	0.44 [0.31, 0.63]

4.1 Topical plus systemic versus systemic	6	1115	Odds Ratio (M‐H, Random, 95% CI)	0.79 [0.56, 1.13]
4.2 Topical versus no prophylaxis	12	1735	Odds Ratio (M‐H, Random, 95% CI)	0.34 [0.21, 0.55]
5 RTIs according to quality of allocation concealment Show forest plot	18	2850	Odds Ratio (M‐H, Random, 95% CI)	0.44 [0.31, 0.63]

5.1 Adequate	1	91	Odds Ratio (M‐H, Random, 95% CI)	0.18 [0.04, 0.91]
5.2 Not adequate	17	2759	Odds Ratio (M‐H, Random, 95% CI)	0.46 [0.32, 0.66]
6 RTIs according to blinding of the studies Show forest plot	18	2850	Odds Ratio (M‐H, Random, 95% CI)	0.44 [0.31, 0.63]

6.1 Double‐blind	14	2553	Odds Ratio (M‐H, Random, 95% CI)	0.52 [0.36, 0.75]
6.2 Open	4	297	Odds Ratio (M‐H, Random, 95% CI)	0.20 [0.10, 0.41]

Comparison 2. Topical versus control

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