The efficacy and safety of oral antibiotic treatment in patients with chronic low back pain and Modic changes: A systematic review and meta-analysis.
The efficacy and safety of oral antibiotic treatment in patients with chronic low back pain and Modic changes: A systematic review and meta-analysis.
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DOI：
10.1002/jsp2.1281
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发表时间：
2024-03
期刊：
影响因子：
3.7
通讯作者：
Samartzis, Dino
中科院分区：
文献类型：
--
作者：
Wong, Arnold Y. L.;Mallow, G. Michael;Pinto, Sabina M.;Hornung, Alexander L.;Rudisill, Samuel S.;Aboushaala, Khaled;Udby, Peter M.;An, Howard S.;Samartzis, Dino
本系统评价和荟萃分析旨在总结有关口服抗生素干预对伴有/不伴有 1 型 Modic 改变 (MC1) 的慢性腰痛 (CLBP) 患者的有效性和安全性的证据。 AMED、CINAHL、Cochrane Library、Embase 和 Medline 的检索时间从开始到 2023 年 3 月 3 日。调查口服抗生素治疗 CLBP 患者有效性或安全性的随机对照试验 (RCT) 或非 RCT 符合纳入条件。两名独立审稿人筛选摘要、全文文章并提取数据。通过 RoB2 和 NIH 质量评估工具评估每篇纳入文章的方法学质量。证据质量由 GRADE 评估。在适用的情况下进行了荟萃分析。进行亚组分析，分别评估随机对照试验和病例系列，并评估去除低质量随机对照试验的效果。其中包括三项随机对照试验和四个病例系列。所有阿莫西林克拉维酸/阿莫西林治疗持续约 3 个月。中等和低质量的证据表明，在 12 个月的随访中，抗生素在改善 MC1 CLBP 患者的残疾和生活质量方面分别显着优于安慰剂。随机对照试验荟萃分析的低质量证据表明，口服抗生素在改善 MC1 CLBP 患者治疗后立即疼痛和残疾方面明显优于安慰剂。病例系列中的极低质量证据表明，口服阿莫西林克拉维酸盐可显着改善腰痛/腿部疼痛以及腰痛相关的残疾。相反，低质量证据发现，在 12 个月的随访中，单独口服阿莫西林在改善 CLBP 患者整体健康认知方面并不明显优于安慰剂。此外，口服抗生素使用者比安慰剂使用者有更多的不良反应。尽管口服抗生素在减少 CLBP 和伴随 MC1 患者的 LBP 相关残疾方面在统计学上优于安慰剂，但其临床意义仍不确定。未来有必要进行大规模高质量随机对照试验来验证抗生素对 CLBP 患者的有效性。本系统评价和荟萃分析旨在总结有关口服抗生素干预对伴有/不伴有 1 型 Modic 改变 (MC1) 的慢性腰痛 (CLBP) 患者的有效性和安全性的证据。尽管口服抗生素在减少 CLBP 和伴随 MC1 患者的 LBP 相关残疾方面在统计学上优于安慰剂，但其临床意义仍不确定。未来有必要进行大规模高质量随机对照试验来验证抗生素对 CLBP 患者的有效性。
This systematic review and meta‐analysis aimed to summarize evidence regarding the effectiveness and safety of oral antibiotic intervention for chronic low back pain (CLBP) patients with/without type‐1 Modic changes (MC1). AMED, CINAHL, Cochrane Library, Embase, and Medline were searched from inception to March 3, 2023. Randomized controlled trials (RCTs) or non‐RCTs that investigated the effectiveness or safety of oral antibiotics in treating CLBP patients were eligible for inclusion. Two independent reviewers screened abstracts, full‐text articles, and extracted data. The methodological quality of each included article were evaluated by RoB2 and NIH quality assessment tools. The quality of evidence was appraised by GRADE. Meta‐analyses were performed, where applicable. A subgroup analysis was conducted to evaluate the RCTs and case series separately, and to evaluate the effect of removing a low‐quality RCT. Three RCTs and four case series were included. All Amoxicillin‐clavulanate/Amoxicillin treatments lasted for approximately 3 months. Moderate‐ and low‐quality evidence suggested that antibiotic was significantly better than placebo in improving disability and quality of life in CLBP patients with MC1 at 12‐month follow‐up, respectively. Low‐quality evidence from meta‐analyses of RCTs showed that oral antibiotic was significantly better than placebo in improving pain and disability in CLBP patients with MC1 immediately post‐treatment. Very low‐quality evidence from the case series suggested that oral Amoxicillin‐clavulanate significantly improved LBP/leg pain, and LBP‐related disability. Conversely, low‐quality evidence found that oral Amoxicillin alone was not significantly better than placebo in improving global perceived health in patients with CLBP at the 12‐month follow‐up. Additionally, oral antibiotic users had significantly more adverse effects than placebo users. Although oral antibiotics were statistically superior to placebo in reducing LBP‐related disability in patients with CLBP and concomitant MC1, its clinical significance remains uncertain. Future large‐scale high‐quality RCTs are warranted to validate the effectiveness of antibiotics in individuals with CLBP. This systematic review and meta‐analysis aimed to summarize evidence regarding the effectiveness and safety of oral antibiotic intervention for chronic low back pain (CLBP) patients with/without type‐1 Modic changes (MC1). Although oral antibiotics were statistically superior to placebo in reducing LBP‐related disability in patients with CLBP and concomitant MC1, its clinical significance remains uncertain. Future large‐scale high‐quality RCTs are warranted to validate the effectiveness of antibiotics in individuals with CLBP.
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影响因子：
3.7
作者：
Herlin C;Kjaer P;Espeland A;Skouen JS;Leboeuf-Yde C;Karppinen J;Niinimäki J;Sørensen JS;Storheim K;Jensen TS
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