20 Jan Preventive Antibiotics Did Not Improve Stroke Outcomes But Reduced Infections
MedicalResearch.com Interview with:
Prof. dr. Diederik van de Beek
Department of Neurology,
Academic Medical Center, University of Amsterdam
The Netherlands
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. van de Beek: In adults with acute stroke, infections occur commonly and are associated with an unfavourable functional outcome. In the Preventive Antibiotics in Stroke Study (PASS) we aimed to establish whether or not preventive antimicrobial therapy with a third-generation cephalosporin, ceftriaxone, improves functional outcome in patients with acute stroke. PASS is an investigator-initiated, randomised, open-label, masked-endpoint trial that was undertaken between 2010 and 2014 in 30 Dutch centres and enrolled 2550 patients with ischaemic or haemorrhagic stroke. Randomly assigned in a 1:1 ratio to either preventive antibiotic therapy or a control group, all patients received standard stroke unit care. Starting within 24 h after stroke onset, patients in the preventive antibiotic group were given additional treatment with ceftriaxone administered intravenously at a dose of 2 g every 24 h for 4 days. The main findings were that preventive ceftriaxone did not improve 3-month functional outcome on the modified Rankin Scale (adjusted common odds ratio 0·95 [95% CI 0·82–1·09]); however, clinically diagnosed post-stroke infections were significantly reduced (adjusted odds ratio 0·55 [0·44–0·70]). Preventive antibiotic therapy with ceftriaxone is a safe treatment.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. van de Beek: Preventive ceftriaxone does not improve functional outcome at 3 months in adults with acute stroke, but did reduce infection rates after stroke.
The results of our trial do not support the use of preventive antibiotics in adults with acute stroke.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. van de Beek: Further exploration showed that ceftriaxone decreased unfavourable out comes in the patients who received intravenous alteplase. Alteplase is an effective treatment for patients with acute ischaemic stroke within a timeframe of 4・5 h of stroke onset. The effect of ceftriaxone in this subgroup might imply that ceftriaxone is beneficial if administered early. This finding warrants further trials.
Citation:
The Lancet Available online 20 January 2015
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Last Updated on January 20, 2015 by Marie Benz MD FAAD