Antibiotic prophylaxis for infections in patients with acute stroke: a systematic review and meta-analysis of randomized controlled trials

Objective

Infections are frequent after stroke and lead to increased mortality and neurological disability. Antibiotic prophylaxis has potential of decreasing the risk of infections and mortality and improving poor functional outcome. Several studies evaluated antibiotic prophylaxis for infections in acute stroke patients have generated conflicting results. The systematic review of randomized clinical trials (RCTs) aimed at comprehensively assessing the evidence of antibiotic prophylaxis for the treatment of acute stroke patients.

Materials and Methods

PubMed, EMBASE, the Cochrane library and the reference lists of eligible articles were searched to identify all potential studies. We included the studies that investigated the efficacy and safety of antibiotic prophylaxis for the treatment of acute stroke patients. The primary outcome included mortality and infection rate. The secondary outcomes included poor functional outcome and adverse events.

Results

Seven trials randomizing 4,261 patients were included. Pooled analyses showed that antibiotic prophylaxis did not improve the mortality (risk ratio (RR) = 1.03, 95% confidence interval (CI) 0.84 to 1.26, p = 0.78, I² = 25%) and poor functional outcome (RR = 0.93, 95% CI 0.80 to 1.08, p = 0.32, I² = 80%), but reduced the incidence of infection (RR = 0.67, 95% CI 0.53 to 0.84, p = 0.0007, I² = 49%). No major side effects were reported. Sensitivity analyses confirmed the results of infection rate and poor functional outcome.

Conclusions

Antibiotic prophylaxis can be used to treat the infectious events of acute stroke patients although it has no potential of decreased mortality and improved functional outcome.

[Study on the enzyme dependant colon targeting prodrug--dexamethasone succinate dextran and its tablets]

AIM

To develop an orally administered colon targeting drug delivery system dexamethasone succinate dextran (DSD) tablets.

METHODS

Dexamethasone succinate dextran was synthesized in an anhydrous environment. Using 4-dimethyl aminopyridine and 1,1'-carbonyldiimidazole as the catalyzer. The chemical structure was identified by UV, IR, NMR and MS. The contents of dexamethasone in various samples were determined by HPLC.

RESULTS

Dexamethasone was distributed mainly in plasma and gastric contents after the oral administration of common tablets. In contrast, after oral administration of DSD tablets, the recovery of dexamethasone in plasma and gastric contents decreased significantly, while the percentage of dexamethasone in cecum and colon increased obviously.

CONCLUSION

The experimental results showed the good colon targeting property of DSD prodrug compared with free dexamethasone.

[Preparation of hepatic targeting antivirus agent NGA-ACV and its targeting property]

Neoglycoalbumin (NGA), a special ligend of asialoglycoprotein receptor on the hepatocyte, was linked via a butanediacyl bridge to acyclovir to form a conjugate NGA-ACV. By using DTA (Differential thermoanalysis) and HPLC analysis, ACV was shown to be connected with NGA by covalent bonds and stable in blood. The radio-biodistribution of 131I-NGA-ACV with high drug density in vivo was carried out in mice. The maximum absorption of 131I-NGA-ACV in liver was 81.7 +/- 10.4% at 5 min. The radioimage of 131I-NGA-ACV with high or low drug density in rabbit showed no significant difference in liver targeting property. The competitive connection tests indicated that 131I-NGA-ACV was concentrated in liver through receptor mediated mechanism. A tentative test of antihepatitis B of NGA-ACV and ACV in vitro showed that the effective dose of the former was significantly lower than that of the latter.

Experimental studies on peripheral nerve regeneration enhanced by nerve growth factor

The effect of exogenous nerve growth factor (NGF) examined on the neural repair of adult rabbit sciatic nerve was evaluated in the present study. A nerve regeneration chamber was created by suturing the proximal and distal ends of a transected sciatic nerve into a silicone chamber. A gap of 6 mm in chamber was left after removal of a 3 mm piece of nerve in the distal ends and insertion of the proximal and distal stumps into the chamber. Animals were operated on bilaterally, one side of the chamber was filled with a 1 mg/ml NGF/normal saline (NS) (experimental) and the contralateral side with NS (control). The regenerated nerves from within the silicone chamber were dissected and fixed 1 to 5 weeks following surgery for histological studies at both the light microscopic and ultrastructural levels. The NGF chamber showed a more mature regenerated nerve based on a larger diameter of the regenerated nerve trunk, a great number of axons, and thicker myelin sheaths.