The efficacy and safety of prophylactic antibiotics for
post-acute stroke infection: a systematic review and meta-analysis
Qing Wang 1,2,
Zi-Yang Wu 1,3,
Hui-Lin Tang 4, Zhan-Miao Yi1,3,*and Suo-Di Zhai 1,3,*
1 Department of Pharmacy, Peking University Third
Hospital, Beijing, China; 2 Department of Pharmacy,
The First People’s Hospital of Yinchuan, Yinchuan, China;3 Institute for Drug Evaluation, Peking University
Health Science Center, Beijing, China; 4 Department of
Pharmaceutical Outcomes and Policy, University of Florida College of
Pharmacy, Gainesville, FL, America;
* Correspondence author. zhaisuodi@163.com (Z.S.D);
yzm@bjmu.edu.cn (Y.Z.M);
Tel.: +86-(010)-82266686 (Z.S.D.); +86-(010)-82265740 (Y.Z.M.)
Competing interests: All authors report no conflict of interest.
Funding: The study was funded by the China National Natural
Science Foundation (72104003).
Background: Infections are common complications after stroke
and associated with unfavorable outcomes. We evaluated the efficacy and
safety of prophylactic antibiotics for post-acute stroke infection.
Methods: We searched PubMed, Embase, the Cochrane Library,
SinoMed, China National Knowledge Infrastructure, and WanFangData from
inception to February 15th, 2022. We calculated the pooled risk ratio
(RR) and mean differences (MDs) with 95% confidence interval (CI),
evaluated the risk of bias and conducted sensitivity analysis with
RevMan version 5.4.1 and Stata version 14.0 software. The overall
quality of evidence was evaluated using the Grading of Recommendations,
Assessment, Development and Evaluations (GRADE) approach.
Results: Twelve studies (4809 participants) were included in
this meta-analysis. There was no significant difference in the mortality
rate [RR 1.03 (95% Cl: 0.91-1.16)],
pneumonia [RR 0.94 (95% CI:
0.79-1.11)], and the incidence of adverse events between the
prophylactic antibiotics and control groups. Prophylactic antibiotics
significantly reduced the incidence of infections [RR 0.72 (95% Cl:
0.58-0.89)], and urinary tract infections [RR 0.39 (95% Cl:
0.3-0.49)] in patients with acute stroke. We performed a subgroup
analysis and found a decreasing trend in pneumonia in patients with
early prophylactic use of antibiotics within 24 hours after admission
[RR 0.81 (95%CI: 0.62-1.07)] as compared with those using
prophylactic use of antibiotics within 48 hours after admission [RR
0.94 (95%CI: 0.79-1.11)].
Conclusions: Prophylactic antibiotics did not significantly
reduce the mortality rate and pneumonia in patients with acute stroke
but reduced the incidence of infections and urinary tract infections.
Keywords: acute stroke,
prophylactic antibiotics, infection, efficacy, safety