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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng240er19-lrg.png" alt="Cover of Evidence review for antibiotics for bacterial meningitis caused by Listeria monocytogenes" /></a><div class="icnblk_cntnt"><h1 id="_NBK604082_"><span itemprop="name">Evidence review for antibiotics for bacterial meningitis caused by Listeria monocytogenes</span></h1><div class="subtitle">Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management</div><p><b>Evidence review E5</b></p><p><i>NICE Guideline, No. 240</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2024 Mar</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-5769-9</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="niceng240er19.s1"><h2 id="_niceng240er19_s1_">Antibiotics for bacterial meningitis caused by Listeria monocytogenes</h2><div id="niceng240er19.s1.1"><h3>Review question</h3><p>What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</p><div id="niceng240er19.s1.1.1"><h4>Introduction</h4><p>Bacterial meningitis is a rare but serious infection. The causative organism is usually confirmed by tests performed on cerebrospinal fluid or blood samples. Listeria monocytogenes is a rare cause of bacterial meningitis, usually seen in people at the extremes of age or with significant underlying immunosuppression.</p><p>The aim of this review is to determine what antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes.</p></div><div id="niceng240er19.s1.1.2"><h4>Summary of the protocol</h4><p>See <a href="/books/NBK604082/table/niceng240er19.tab1/?report=objectonly" target="object" rid-ob="figobniceng240er19tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.</p><p>For further details see the review protocol in <a href="#niceng240er19.appa">appendix A</a>.</p></div><div id="niceng240er19.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng240er19.appa">appendix A</a> and the <a href="/books/NBK604082/bin/NG240-Methods-pdf.pdf">methods</a> document (supplementary document 1).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng240er19.s1.1.4"><h4>Effectiveness evidence</h4><div id="niceng240er19.s1.1.4.1"><h5>Included studies</h5><p>A systematic review of the literature was conducted but no studies were identified which were applicable to this review question.</p><p>See the literature search strategy in <a href="#niceng240er19.appb">appendix B</a> and study selection flow chart in <a href="#niceng240er19.appc">appendix C</a>.</p></div><div id="niceng240er19.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng240er19.appj">appendix J</a>.</p></div></div><div id="niceng240er19.s1.1.5"><h4>Summary of included studies</h4><p>No studies were identified which were applicable to this review question (and so there are no evidence tables in <a href="#niceng240er19.appd">Appendix D</a>). No meta-analysis was conducted for this review (and so there are no forest plots in <a href="#niceng240er19.appe">Appendix E</a>).</p></div><div id="niceng240er19.s1.1.6"><h4>Summary of the evidence</h4><p>No studies were identified which were applicable to this review question (and so there are no GRADE tables in <a href="#niceng240er19.appf">Appendix F</a>).</p></div><div id="niceng240er19.s1.1.7"><h4>Economic evidence</h4><div id="niceng240er19.s1.1.7.1"><h5>Included studies</h5><p>A single economic search was undertaken for all topics included in the scope of this guideline, but no economic studies were identified which were applicable to this review question.</p></div></div><div id="niceng240er19.s1.1.8"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.</p></div><div id="niceng240er19.s1.1.9"><h4>The committee’s discussion and interpretation of the evidence</h4><div id="niceng240er19.s1.1.9.1"><h5>The outcomes that matter most</h5><p>Bacterial meningitis is associated with high rates of mortality and morbidity, and antibiotics are the mainstay of treatment for bacterial meningitis. Therefore, all-cause mortality and long-term neurological impairment were prioritised as critical outcomes due to the severity of these outcomes. Severe developmental delay was prioritised over functional impairment in children and babies, as it is a more relevant and important outcome for this population. Functional impairment was prioritised as a critical outcome in adults due to the concern about the potential long-term limitations of bacterial meningitis on the ability to carry out certain activities of daily life.</p><p>In addition to functional impairment (in children and babies), hearing impairment, serious intervention-related adverse effects, and cerebrospinal fluid (CSF) sterilisation were selected as important outcomes in all age groups as these are relatively common after bacterial meningitis and may be related to antibiotic therapy. Intracranial collections as a complication was also included as an important outcome for adults as this is a rare but severe and life threatening complication of bacterial meningitis that may require prolonged antibiotic treatment.</p></div><div id="niceng240er19.s1.1.9.2"><h5>The quality of the evidence</h5><p>No studies were identified which were applicable to this review question.</p></div><div id="niceng240er19.s1.1.9.3"><h5>Benefits and harms</h5><p>No evidence was identified on the effectiveness of antibiotics for the treatment of meningitis caused by Listeria monocytogenes, and the committee agreed that given the absence of evidence the first line treatment recommended by the previous NICE guideline on meningitis (<a class="bk_pop" href="#niceng240er19.ref1">NICE 2010</a>) should be retained. The committee recommended intravenous amoxicillin or ampicillin for 21 days for people with meningitis caused by Listeria monocytogenes. They also recommended that advice from an infection specialist should be sought if people have not recovered after 21 days. The previous guideline recommendation only applied to children younger than 3 months, however the committee agreed that the recommendation could be extended to cover all ages as Listeria monocytogenes is also a common infective organism in older adults and there are additional risk factors for Listeria monocytogenes which are not restricted to extremes of age (pregnancy, malignancy, kidney disease, liver disease, diabetes, alcoholism, and immunocompromising treatment). The committee agreed that there is no evidence that the effectiveness of antibiotics in sterilising the cerebrospinal fluid (CSF) would be different in adults and children. The committee acknowledged that there is some evidence that antibiotics penetrate the CSF of very young children better than in older children and adults because their blood-brain barriers are less intact, but, in the committee’s experience, this difference disappears when the meninges are inflamed; therefore, the committee would expect the antibiotics to penetrate into the CSF equally well regardless of age in people with bacterial meningitis.</p><p>The committee also recommended seeking the advice of an infection specialist on the addition of intravenous co-trimoxazole for the first 7 days. The committee agreed that this should not happen routinely as co-trimoxazole can be toxic and has additional monitoring requirements associated with it. However, they agreed that combination therapy can be beneficial, especially where there is a bacteraemic or septic component to the illness, but that it should only be done in consultation with an infection specialist (a microbiologist or infectious diseases specialist) because of the associated risks and monitoring requirements. The committee agreed that although gentamicin is more often used as an addition to amoxicillin in current practice, co-trimoxazole would be more appropriate for older adults due to a significant risk of nephrotoxicity with gentamicin. Where co-trimoxazole is used, the committee agreed that it should only be used during the first stage of treatment such as the first 7 days, as this is when it would be most beneficial, and it would avoid using it longer than necessary due to risks associated with it. The committee noted that this was an off-label use of co-trimoxazole (in January 2024) and doses, frequency, and duration in the BNF (British National Formulary 2023) and BNFC (British National Formulary for Children 2023) for severe infections should be followed.</p><p>There was no evidence found on antibiotic use for meningitis caused by Listeria monocytogenes in people with an antibiotic allergy, but the committee agreed it was important to make a recommendation for this population. The committee agreed that clinicians should seek information about the nature of the allergy and advice from an infection specialist before making a treatment decision, particularly for people who are pregnant. The committee acknowledged that it is important that treatment is not delayed; however, they agreed that information about the nature of allergy is often readily available from the patient’s family. Given that amoxicillin and ampicillin are penicillin antibiotics an alternative first line treatment was required. Based on their clinical knowledge and experience, the committee agreed that cephalosporin-induced anaphylaxis is rare. The committee recommended that ceftriaxone or cefotaxime should be considered if the nature of the allergic reaction they get is not severe. They also recommended the addition of cotrimoxazole (for 21 days). This is in line with <a href="https://bnf.nice.org.uk/treatment-summaries/central-nervous-system-infections-antibacterial-therapy/#:%7E:text=Meningitis%20caused%20by%20Listeria%20Amoxicillin%20%28or%20ampicillin%29%20%2B,history%20of%20immediate%20hypersensitivity%20reaction%20to%20penicillin%2C%20co-trimoxazole" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">BNF advice</a> in the case of history of hypersensitivity to penicillin for people with meningitis caused by Listeria monocytogenes. If the allergic reaction is severe, alternatives to ceftriaxone or cefotaxime will be needed. The committee discussed that chloramphenicol is commonly used in the case of severe beta-lactam (penicillin, amoxicillin, or cephalosporin) allergy. Based on clinical knowledge and experience, the committee recommended chloramphenicol (in addition to co-trimoxazole) for people with meningitis caused by Listeria monocytogenes and severe antibiotic allergy.</p><p>Given that no evidence was identified for this review the committee discussed including a research recommendation on the effectiveness of antibiotics for the treatment of meningitis caused by Listeria monocytogenes. However, the committee agreed that given this condition is very rare it would be unlikely that a clinical trial would be feasible.</p></div><div id="niceng240er19.s1.1.9.4"><h5>Cost effectiveness and resource use</h5><p>This review question was not prioritised for economic analysis and therefore the committee made a qualitative assessment of the likely cost-effectiveness of their recommendations. Given the absence of any evidence the committee retained the recommendations made by the previous NICE guideline (<a class="bk_pop" href="#niceng240er19.ref1">NICE 2010</a>) and therefore no significant resource impact is anticipated.</p></div></div><div id="niceng240er19.s1.1.10"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.6.14 and 1.6.16. Other evidence supporting recommendation 1.6.16 can be found in evidence reviews on antibiotic regimens for bacterial meningitis before or in the absence of identifying causative infecting organism (see evidence reviews D1 to D3) and for specific causative organisms (see evidence reviews E1 to E4, and E6).</p></div></div><div id="niceng240er19.rl.r1"><h3>References – included studies</h3><ul class="simple-list"><div id="niceng240er19.rl.r1.1"><h4>Effectiveness</h4><ul class="simple-list"><p>No studies were identified which were applicable to this review question.</p></ul></div><div id="niceng240er19.rl.r1.2"><h4>Economic</h4><ul class="simple-list"><p>No studies were identified which were applicable to this review question.</p></ul></div><div id="niceng240er19.rl.r1.3"><h4>Other</h4><ul class="simple-list"><li class="half_rhythm"><div class="bk_ref" id="niceng240er19.ref1"><p id="p-67">
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<strong>NICE 2010</strong>
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</p>National Institute for Health and Care Excellence (2010). Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management [NICE Clinical guideline No. CG102]. Available at: <a href="https://www.nice.org.uk/guidance/cg102" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>.nice.org.uk/guidance/cg102</a> [Accessed on 2022 Apr 19] [<a href="https://pubmed.ncbi.nlm.nih.gov/31846263" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31846263</span></a>]</div></li></ul></div></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng240er19.appa"><h3>Appendix A. Review protocols</h3><p id="niceng240er19.appa.et1"><a href="/books/NBK604082/bin/niceng240er19-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</a><span class="small"> (PDF, 259K)</span></p></div><div id="niceng240er19.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng240er19.appb.et1"><a href="/books/NBK604082/bin/niceng240er19-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused Listeria monocytogenes?</a><span class="small"> (PDF, 209K)</span></p></div><div id="niceng240er19.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng240er19.appc.et1"><a href="/books/NBK604082/bin/niceng240er19-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</a><span class="small"> (PDF, 186K)</span></p></div><div id="niceng240er19.appd"><h3>Appendix D. Evidence tables</h3><div id="niceng240er19.appd.s1"><h4>Evidence tables for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng240er19.appe"><h3>Appendix E. Forest plots</h3><div id="niceng240er19.appe.s1"><h4>Forest plots for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</h4><p>No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng240er19.appf"><h3>Appendix F. GRADE tables</h3><div id="niceng240er19.appf.s1"><h4>GRADE tables for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng240er19.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng240er19.appg.et1"><a href="/books/NBK604082/bin/niceng240er19-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</a><span class="small"> (PDF, 98K)</span></p></div><div id="niceng240er19.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng240er19.apph.s1"><h4>Economic evidence tables for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</h4><p>No evidence was identified which was applicable to this review question.</p></div></div><div id="niceng240er19.appi"><h3>Appendix I. Economic model</h3><div id="niceng240er19.appi.s1"><h4>Economic model for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng240er19.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng240er19.appj.s1"><h4>Excluded studies for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</h4><div id="niceng240er19.appj.s1.1"><h5>Excluded effectiveness studies</h5><p>The excluded studies table only lists the studies that were considered and then excluded at the full-text stage for this review (N=5) and not studies (N=187) that were considered and then excluded from the search at the full-text stage as per the PRISMA diagram in <a href="#niceng240er19.appc">Appendix C</a> for the other review questions in the same search.</p><div id="niceng240er19.appj.tab1" class="table"><h3><span class="label">Table 3</span><span class="title">Excluded studies and reasons for their exclusion</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604082/table/niceng240er19.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er19.appj.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng240er19.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng240er19.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Code [Reason]</th></tr></thead><tbody><tr><td headers="hd_h_niceng240er19.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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de Louvois, J.; Mulhall, A.; Hurley, R. (1982) Cefuroxime in the treatment of neonates. Archives of disease in childhood
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57(1): 59–62
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[<a href="/pmc/articles/PMC2863279/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2863279</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/7065695" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7065695</span></a>]
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</td><td headers="hd_h_niceng240er19.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design does not meet inclusion criteria</td></tr><tr><td headers="hd_h_niceng240er19.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Dzupova, O., Rozsypal, H., Smiskova, D.
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et al. (2013) Listeria monocytogenes meningitis in adults: The Czech Republic experience. BioMed Research International
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||
2013: 846186 [<a href="/pmc/articles/PMC3784069/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3784069</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24106719" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24106719</span></a>]
|
||
</td><td headers="hd_h_niceng240er19.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design does not meet inclusion criteria</td></tr><tr><td headers="hd_h_niceng240er19.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Roine, I., Ledermann, W., Foncea, L. M.
|
||
et al. (2000) Randomized trial of four vs. seven days of ceftriaxone treatment for bacterial meningitis in children with rapid initial recovery. Pediatric infectious disease journal
|
||
19(3): 219–222
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/10749463" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10749463</span></a>]
|
||
</td><td headers="hd_h_niceng240er19.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population does not meet inclusion criteria</td></tr><tr><td headers="hd_h_niceng240er19.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Romain, O. (2017) Antibiotherapy for early-onset neonatal bacterial infections in newborn borns > 34 week’s gestation. Archives de Pediatrie
|
||
24(supplement3): S24–S28
|
||
|
||
</td><td headers="hd_h_niceng240er19.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-English language article</td></tr><tr><td headers="hd_h_niceng240er19.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Thonnings, S., Knudsen, J. D., Schonheyder, H. C.
|
||
et al. (2016) Antibiotic treatment and mortality in patients with Listeria monocytogenes meningitis or bacteraemia. Clinical Microbiology and Infection
|
||
22(8): 725–730
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/27345176" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27345176</span></a>]
|
||
</td><td headers="hd_h_niceng240er19.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design does not meet inclusion criteria</td></tr></tbody></table></div></div></div><div id="niceng240er19.appj.s1.2"><h5>Excluded economic studies</h5><p>No studies were identified which were applicable to this review question.</p></div></div></div><div id="niceng240er19.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="niceng240er19.appk.s1"><h4>Research recommendations for review question: What antibiotic treatment regimens are effective in treating bacterial meningitis caused by Listeria monocytogenes?</h4><p>No research recommendation was made for this review.</p></div></div></div><div class="bk_prnt_sctn"><h2>Tables</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="niceng240er19.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK604082/table/niceng240er19.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng240er19.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_niceng240er19.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng240er19.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All adults, young people, children and babies (excluding neonates defined as aged 28 days old and younger) with confirmed bacterial meningitis caused by Listeria monocytogenes</td></tr><tr><th id="hd_b_niceng240er19.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng240er19.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Antibiotic agent of interest:
|
||
<ul><li class="half_rhythm"><div>Ampicillin</div></li><li class="half_rhythm"><div>Amoxicillin</div></li><li class="half_rhythm"><div>Benzylpenicillin sodium</div></li><li class="half_rhythm"><div>Gentamicin</div></li><li class="half_rhythm"><div>Amikacin</div></li><li class="half_rhythm"><div>Meropenem</div></li><li class="half_rhythm"><div>Linezolid</div></li><li class="half_rhythm"><div>Co-trimoxazole</div></li></ul>
|
||
</td></tr><tr><th id="hd_b_niceng240er19.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng240er19.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Stage 1 (all antibiotic agents of interest):</b>
|
||
<ul><li class="half_rhythm"><div>Antibiotic agent A (single or combination)* vs Antibiotic agent B (single or combination)*</div></li></ul></p>
|
||
<p>*Gentamycin and amikacin to be used in combination with other antibiotics.</p><p><b>Stage 2 (antibiotic agents identified during stage 1 as most effective/for use where there are contraindications)</b></p>
|
||
<p>Comparisons:
|
||
<ul><li class="half_rhythm"><div>Antibiotic agent A – Dose A vs Antibiotic agent A – Dose B</div></li><li class="half_rhythm"><div>Antibiotic agent A – Duration of administration A vs Antibiotic agent A – Duration of administration B</div></li><li class="half_rhythm"><div>Antibiotic agent A – Short infusion vs Antibiotic agent A – Extended infusion</div></li></ul></p>
|
||
</td></tr><tr><th id="hd_b_niceng240er19.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_niceng240er19.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Critical</b></p><p>Population: adults, children and infants
|
||
<ul><li class="half_rhythm"><div>All-cause mortality (measured up to 1 year after discharge)</div></li><li class="half_rhythm"><div>Any long-term neurological impairment (defined as any motor deficits, sensory deficits [excluding hearing impairment], cognitive deficits, or behavioural deficits; measured from discharge up to 1 year after discharge)</div></li></ul></p>
|
||
<p>Population: adults
|
||
<ul><li class="half_rhythm"><div>Functional impairment (measured by any validated scale at any time point)</div></li></ul></p>
|
||
<p>Population: children and infants
|
||
<ul><li class="half_rhythm"><div>Severe developmental delay (defined as score of >2 SD below normal on validated assessment scales, or MDI or PDI <70 on Bayleys assessment scale, or inability to assign a score due to cerebral palsy or severity of cognitive delay; measured at the oldest age reported unless there is substantially more data available at a younger age)</div></li></ul></p>
|
||
<p><b>Important</b></p>
|
||
<p>Population: adults, children and infants
|
||
<ul><li class="half_rhythm"><div>Hearing impairment (defined as any level of hearing impairment; measured from discharge up to 1 year after discharge)</div></li><li class="half_rhythm"><div>Serious intervention-related adverse effects leading to death, disability or prolonged hospitalisation or that are life threatening or otherwise considered medically significant</div></li><li class="half_rhythm"><div>CSF sterilisation (defined as treatment failure, time-to-sterilisation or delay)</div></li></ul></p>
|
||
<p>Population: adults
|
||
<ul><li class="half_rhythm"><div>Intracranial collections as a complication (defined as abscess or empyema)</div></li></ul></p>
|
||
<p>Population: children and infants
|
||
<ul><li class="half_rhythm"><div>Functional impairment (measured by any validated scale at any time point)</div></li></ul></p>
|
||
<p>*For infants and children below school-age, cognitive and behavioural deficits will be assessed at school-age.</p></td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">CSF: cerebrospinal fluid; MDI: mental development index; PDI: psychomotor development index; SD: standard deviation</p></div></dd></dl></div></div></div></div></div><div><p>FINAL</p></div><div><p>Evidence review underpinning recommendations 1.6.14 and 1.6.16 in the NICE guideline</p><p>This evidence review was developed by NICE</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div></div></div>
|
||
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div><div class="small"><span class="label">Bookshelf ID: NBK604082</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/38829977" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">38829977</a></span></div></div></div>
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