Abstract:
OBJECTIVE:To compare the effectiveness of beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy in the treatment of patients with fever and neutropenia. DATA SOURCES:Medline, Embase, Lilacs, the Cochrane Library, and conference proceedings to 2002. References of included studies and contact with authors. No restrictions on language, year of publication, or publication status. STUDY SELECTION:All randomised trials of beta lactam monotherapy compared with beta lactam-minoglycoside combination therapy as empirical treatment for patients with fever and neutropenia. DATA SELECTION:Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. An intention to treat approach was used. Relative risks were pooled with the random effect model. MAIN OUTCOME MEASURE:All cause fatality. RESULTS:Forty seven trials with 7807 patients met inclusion criteria. Nine trials compared the same beta lactam. There was no significant difference in all cause fatality (relative risk 0.85, 95% confidence interval 0.72 to 1.02). For success of treatment there was a significant advantage with monotherapy (0.92, 0.85 to 0.99), though there was considerable heterogeneity among trials. There was no significant difference between monotherapy and combination treatment in trials that compared the same beta lactam, whereas there was major advantage with monotherapy in trials that compared different beta lactams (0.87, 0.80 to 0.93). Rates of superinfection were similar. Adverse events, including those associated with severe morbidity, were significantly more common in the combination treatment group. Detected flaws in methods did not affect results. CONCLUSIONS:For patients with fever and neutropenia there is no clinical advantage in treatment with beta lactam-aminoglycoside combination therapy. Broad spectrum beta lactams as monotherapy should be regarded as the standard of care for such patients.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Paul M,Soares-Weiser K,Leibovici Ldoi
10.1136/bmj.326.7399.1111keywords:
subject
Has Abstractpub_date
2003-05-24 00:00:00pages
1111issue
7399eissn
0959-8138issn
1756-1833pii
326/7399/1111journal_volume
326pub_type
杂志文章,meta分析,评审abstract:OBJECTIVE:To investigate the risks of adverse pregnancy and birth outcomes for treated and untreated bipolar disorder during pregnancy. DESIGN:Population based cohort study using data from national health registers. SETTING:Sweden. PARTICIPANTS:332,137 women with a last menstrual period anytime after 1 July 2005 and...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e7085
更新日期:2012-11-08 00:00:00
abstract:OBJECTIVE:Rapid diagnostic tests for malaria seem cost effective in standard analyses, but these do not take account of clinicians' response to test results. This study tested the impact of clinicians' response to rapid diagnostic test or microscopy results on the costs and benefits of testing at different levels of ma...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.39395.696065.47
更新日期:2008-01-26 00:00:00
abstract:OBJECTIVE:To determine the effect of home blood pressure monitoring on blood pressure levels and proportion of people with essential hypertension achieving targets. DESIGN:Meta-analysis of 18 randomised controlled trials. PARTICIPANTS:1359 people with essential hypertension allocated to home blood pressure monitoring...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.38121.684410.AE
更新日期:2004-07-17 00:00:00
abstract:OBJECTIVE:To assess the efficacy of high serum cholesterol concentration, raised blood pressure, and smoking as predictors of coronary heart disease. DESIGN:Prospective cohort study of middle aged men conducted over 25 years. SETTING:Finish components of an ongoing international study (seven countries study). PARTIC...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6691.81
更新日期:1989-07-08 00:00:00
abstract:OBJECTIVE:To describe temporal trends in the time interval between first and second attempts at defibrillation and the association between this time interval and outcomes in patients with persistent ventricular tachycardia or ventricular fibrillation (VT/VF) arrest in hospital. DESIGN:Retrospective cohort study SETTI...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.i1653
更新日期:2016-04-06 00:00:00
abstract:OBJECTIVE:To evaluate dynamic contrast enhanced computed tomography for detecting and localising pancreatic necrosis in acute pancreatitis. DESIGN:Prospective evaluation with blind reporting of scans. SETTING:Single teaching hospital. PATIENTS:60 Consecutive patients with acute pancreatitis suspected to have pancrea...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6737.1425
更新日期:1990-06-02 00:00:00
abstract::Aside from email and the world wide web, there are several other systems for distributing information on the Internet. Telnet is a system that allows you to log on to a remote computer from anywhere on the Internet and affords access to many useful biomedical sites on the Internet. File transfer protocol (FTP) is a me...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7020.1626
更新日期:1995-12-16 00:00:00
abstract:OBJECTIVE:To examine doctors' perspectives about their experiences with handheld computers in clinical practice. DESIGN:Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. SETTING:Six practice settings across the United States and two additional focus group sessi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.328.7449.1162
更新日期:2004-05-15 00:00:00
abstract:OBJECTIVE:To determine, using research on duloxetine for major depressive disorder as an example, if there are inconsistencies between protocols, clinical study reports, and main publicly available sources (journal articles and trial registries), and within clinical study reports themselves, with respect to benefits an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.g3510
更新日期:2014-06-04 00:00:00
abstract:OBJECTIVE:To map and assess prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease (COPD). DESIGN:Systematic review. DATA SOURCES:PubMed until November 2018 and hand searched references from eligible articles. ELIGIBILITY CRITERIA FOR STUDY SELECTION:Studies developing, valid...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.l5358
更新日期:2019-10-04 00:00:00
abstract:OBJECTIVE:To examine the distribution of patterns of macronutrient density in relation to obesity. DESIGN:Cross sectional. SETTING:Denmark. SUBJECTS:323 men and women aged 35-65 years, selected randomly from a larger population sample of Danish adults. MAIN OUTCOME MEASURE:Bias in dietary reporting of energy and pr...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7011.986
更新日期:1995-10-14 00:00:00
abstract:OBJECTIVE:To examine the impact of antenatal supplementation with multiple micronutrients or iron and folic acid compared with folic acid alone on birth weight, duration of gestation, and maternal haemoglobin concentration in the third trimester. DESIGN:Cluster randomised double blind controlled trial. SETTING:Two ru...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.a2001
更新日期:2008-11-07 00:00:00
abstract:OBJECTIVES:To determine the association between ambulance response time and survival from out of hospital cardiopulmonary arrest and to estimate the effect of reducing response times. DESIGN:Cohort study. SETTING:Scottish Ambulance Service. SUBJECTS:All out of hospital cardiopulmonary arrests due to cardiac disease ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.322.7299.1385
更新日期:2001-06-09 00:00:00
abstract:OBJECTIVES:To examine whether British South Asian children differ in insulin resistance, adiposity, and cardiovascular risk profile from white children. DESIGN:Cross sectional study. SETTING:Primary schools in 10 British towns. PARTICIPANTS:British children aged 8 to 11 years (227 South Asian and 3415 white); 73 Sou...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.324.7338.635
更新日期:2002-03-16 00:00:00
abstract:OBJECTIVE:To find out whether enalapril or ramipril causes the sensitivity of the cough reflex to change or symptomatic cough to develop in patients with hypertension. DESIGN:Prospective, placebo controlled, double blind, randomised crossover study. SETTING:Academic units of clinical pharmacology and medicine. PATIE...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.299.6690.13
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVE:To describe and quantify the patients and clinical activities of independent short stay hospitals. DESIGN:Retrospective survey of hospital records for sampled periods of one financial year and comparison with data from 1981 to 1986. SETTING:217 independent hospitals in England and Wales, 1992-3. MAIN OUTCO...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.308.6945.1699
更新日期:1994-06-25 00:00:00
abstract:OBJECTIVE:To determine whether inhaled salmeterol, a new long acting inhaled beta adrenergic agonist, reduces nocturnal bronchoconstriction and improves sleep quality in patients with nocturnal asthma. DESIGN:Randomised, double blind, placebo controlled crossover study. SETTING:Hospital outpatient clinics in Edinburg...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.301.6765.1365
更新日期:1990-12-15 00:00:00
abstract::Telephone helplines are an effective way of dealing with health related incidents in which large numbers of people need personal counselling or information for reassurance or case finding. Helplines often have to be set up at short notice, which is labour intensive and makes recruitment of appropriate staff difficult....
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.309.6946.44
更新日期:1994-07-02 00:00:00
abstract::The identification of the gene for cystic fibrosis has led to the possibility of population based screening for carriers of cystic fibrosis to identify couples at risk of having an affected child. Pilot studies have shown that screening is feasible and does not cause untoward anxiety, though the uptake of testing vari...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6908.849
更新日期:1993-10-02 00:00:00
abstract:OBJECTIVES:To assess heat related mortalities in relation to climate within Europe. DESIGN:Observational population study. SETTING:North Finland, south Finland, Baden-Württemberg, Netherlands, London, north Italy, and Athens. SUBJECTS:People aged 65-74. MAIN OUTCOME MEASURES:Mortalities at temperatures above, below...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.321.7262.670
更新日期:2000-09-16 00:00:00
abstract:OBJECTIVE:To investigate the clinical effects of regulating umbilical cord clamping in preterm infants. DESIGN:A prospective randomised study. SETTING:The Queen Mother's Hospital, Glasgow. SUBJECTS:36 vaginally delivered infants over 27 and under 33 weeks' gestation. INTERVENTION:Holding the infant 20 cm below the ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.306.6871.172
更新日期:1993-01-16 00:00:00
abstract:OBJECTIVE:To assess the association between genotype at the insertion or deletion polymorphism of the angiotensin converting enzyme gene and risk of coronary restenosis after percutaneous coronary intervention. DESIGN:Meta-analysis of studies before July 2001 that reported on these genotypes and risk of coronary reste...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.325.7363.517
更新日期:2002-09-07 00:00:00
abstract:OBJECTIVE:To assess the effect of size at birth, maternal nutrition, and body mass index on blood pressure in late adolescence. DESIGN:Population based analysis of birth weight corrected for gestational age, mother's weight before pregnancy and weight gain in pregnancy, obtained from the Jerusalem perinatal study, and...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.315.7106.449
更新日期:1997-08-23 00:00:00
abstract:OBJECTIVES:To observe one general practice's attempt to reduce prescribing costs on becoming third wave fundholders through the introduction of a generic formulary applied to all new and repeat prescribing. To assess the impact on patients and prescribing patterns. DESIGN:An observational study using interviews with p...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6978.505
更新日期:1995-02-25 00:00:00
abstract:AIM:To compare perinatal morbidity and mortality for babies delivered in water with rates for babies delivered conventionally (not in water). DESIGN:Surveillance study (of all consultant paediatricians) and postal survey (of all NHS maternity units). SETTING:British Isles (surveillance study); England and Wales (post...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.319.7208.483
更新日期:1999-08-21 00:00:00
abstract::IgG4 related disease was recognized as a unified disease entity only 15 years ago. Awareness of IgG4 related disease has increased worldwide since then, and specialists are now familiar with most of its clinical manifestations. Involvement of the pancreato-biliary tract, retroperitoneum/aorta, head and neck, and saliv...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.m1067
更新日期:2020-06-16 00:00:00
abstract:OBJECTIVES:To determine prospectively the rates of change in bone mineral density in elderly people and to examine the relation between lifestyle and demographic factors and these rates of change. DESIGN:Longitudinal population based study. SETTING:Dubbo, New South Wales, Australia. SUBJECTS:Representative sample (n...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:
更新日期:1994-09-17 00:00:00
abstract:OBJECTIVES:To identify the need for reproductive health care among a community affected by conflict, and to ascertain the priority given by the community to reproductive health issues. DESIGN:Rapid appraisal. This comprised interviews with key informants, in-depth interviews, and group discussions. Secondary data were...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.319.7212.743
更新日期:1999-09-18 00:00:00
abstract:OBJECTIVE:To investigate whether residence before and after birth near 50 Hz high voltage installations increases a child's risk of cancer and whether risk correlates with the strength of the magnetic field. DESIGN:A population based case-control study. SETTING:Denmark. SUBJECTS:1707 children under the age of 15 wit...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6909.891
更新日期:1993-10-09 00:00:00
abstract:OBJECTIVES:To investigate the effect of milk supplementation on total body bone mineral acquisition in adolescent girls. DESIGN:18 month, open randomised intervention trial. SUBJECTS:82 white girls aged 12.2 (SD 0.3) years, recruited from four secondary schools in Sheffield. INTERVENTION:568 ml (one pint) of whole o...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.315.7118.1255
更新日期:1997-11-15 00:00:00