Utility of broad-spectrum antibiotics for diagnosing pulmonary tuberculosis in adults: a systematic review and meta-analysis
Review of 8 studies found current policy/practice on trial of antibiotics appear inappropriate, given weak evidence base, poor diagnostic performance, potential contribution to global antimicrobial resistance, and adverse health consequences from misclassification of TB status.
Source:
The Lancet Infectious Diseases
SPS commentary:
According to a commentary, the methods and results of these eight studies varied so greatly that the combined statistics and pooled meta-analyses have questionable precision. However it believes that these issues are still unlikely to challenge the review’s conclusion that a trial of antibiotics is unreliable for informing tuberculosis diagnosis. It adds that broad-spectrum antibiotics might still be necessary, not to inform tuberculosis diagnosis, but rather because the patient's illness requires antibiotic treatment, ideally guided by laboratory testing, but it also points out that there is compelling evidence broad-spectrum antibiotic therapy for patients with a suspected respiratory tract infection might often be safely withheld initially, potentially reducing the risk of side-effects and antibiotic resistance.