Do antibiotics have a role in treating injured workers with chronic low back pain? Systematic review and meta-analysis.

Mylordi, C; Anderson, D; van Gelder, J

Do antibiotics have a role in treating injured workers with chronic low back pain? Systematic review and meta-analysis.

Mylordi, C Anderson, D

van Gelder, J

Permalink

Publisher:: Wiley
Publication Type:: Journal Article
Citation:: Internal Medicine Journal, 2020, 50, (S1), pp. 13-13
Issue Date:: 2020-05

Closed Access

	Filename	Description	Size
	imj.6_14848.pdf	Published version	277.63 kB	Adobe PDF	View/Open

Copyright Clearance Process

Recently Added
In Progress
Closed Access

This item is closed access and not available.

Full metadata record

Field	Value	Language
dc.contributor.author	Mylordi, C
dc.contributor.author	Anderson, D https://orcid.org/0000-0001-7104-122X
dc.contributor.author	van Gelder, J
dc.date.accessioned	2020-12-16T22:40:18Z
dc.date.available	2020-12-16T22:40:18Z
dc.date.issued	2020-05
dc.identifier.citation	Internal Medicine Journal, 2020, 50, (S1), pp. 13-13
dc.identifier.issn	1444-0903
dc.identifier.issn	1445-5994
dc.identifier.uri	http://hdl.handle.net/10453/144775
dc.description.abstract	Background: In patients with chronic low back pain (CLBP), Modic‐1 endplate signs on MRI have been linked to chronic infection with bacteria, particularly P. Acnes. In a recent literature review, for biopsied disc material, the pooled estimate for the proportion of positive samples for bacteria was 25%. Two recent trials of antibiotics for CLBP and Modic‐Type‐1‐changes in vertebral endplates adjacent to disc herniation, had controversial and divergent conclusions. Objectives: This is a systematic review and meta‐analysis of randomised placebo‐controlled trials (RCT) to investigate antibiotic treatment for workers with CLBP & Modic‐changes and to generate research hypotheses. Methodology: We performed a database search for RCT for antibiotics and CLBP and applied the Risk‐of‐Bias‐2 protocol. We extracted outcomes and adverse events then performed random effects meta‐analysis. A minimum important change on Roland Morris Disability Questionnaire (RMDQ) of 5 points was pre‐specified. Results: Three trials were included that investigated oral amoxicillin, or amoxicillin with clavulanate. Each trial reported a statistically significant benefit of antibiotics. Meta‐analysis resulted in an estimated distribution for means that had an overall mean of ‐4.2 (95% CI: ‐6.6 to‐1.6) points on the RMDQ scale. There was high risk of bias in two studies. There was heterogeneity in the proportion of patients with recent surgery, and baseline disability. Conclusion: The overall estimated benefit of antibiotics for CLBP and Modic‐1 changes was statistically significant but had borderline clinical effect. In the small proportion of patients expected to have chronic infection there is probably an important benefit. Further research should focus on clinical investigations for patient selection.
dc.language	en
dc.publisher	Wiley
dc.relation.ispartof	Internal Medicine Journal
dc.relation.isbasedon	10.1111/imj.6_14848
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1102 Cardiorespiratory Medicine and Haematology, 1103 Clinical Sciences, 1117 Public Health and Health Services
dc.subject.classification	General & Internal Medicine
dc.title	Do antibiotics have a role in treating injured workers with chronic low back pain? Systematic review and meta-analysis.
dc.type	Journal Article
utslib.citation.volume	50
utslib.for	1102 Cardiorespiratory Medicine and Haematology
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health/GSH.Physiotherapy
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2020-12-16T22:40:05Z
pubs.issue	S1
pubs.publication-status	Published
pubs.volume	50
utslib.citation.issue	S1

Abstract:

Background: In patients with chronic low back pain (CLBP), Modic‐1 endplate signs on MRI have been linked to chronic infection with bacteria, particularly P. Acnes. In a recent literature review, for biopsied disc material, the pooled estimate for the proportion of positive samples for bacteria was 25%. Two recent trials of antibiotics for CLBP and Modic‐Type‐1‐changes in vertebral endplates adjacent to disc herniation, had controversial and divergent conclusions. Objectives: This is a systematic review and meta‐analysis of randomised placebo‐controlled trials (RCT) to investigate antibiotic treatment for workers with CLBP & Modic‐changes and to generate research hypotheses. Methodology: We performed a database search for RCT for antibiotics and CLBP and applied the Risk‐of‐Bias‐2 protocol. We extracted outcomes and adverse events then performed random effects meta‐analysis. A minimum important change on Roland Morris Disability Questionnaire (RMDQ) of 5 points was pre‐specified. Results: Three trials were included that investigated oral amoxicillin, or amoxicillin with clavulanate. Each trial reported a statistically significant benefit of antibiotics. Meta‐analysis resulted in an estimated distribution for means that had an overall mean of ‐4.2 (95% CI: ‐6.6 to‐1.6) points on the RMDQ scale. There was high risk of bias in two studies. There was heterogeneity in the proportion of patients with recent surgery, and baseline disability. Conclusion: The overall estimated benefit of antibiotics for CLBP and Modic‐1 changes was statistically significant but had borderline clinical effect. In the small proportion of patients expected to have chronic infection there is probably an important benefit. Further research should focus on clinical investigations for patient selection.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/144775