Yang Z, Hu J, Qu Y, Sun F, Leng X, Li H, Zhan S, et al.
The Cochrane Database of Systematic Reviews. Date of publication 2015 Dec 3;volume (12):CD010577.
1. Cochrane Database Syst Rev. 2015 Dec 3;(12):CD010577. doi:
10.1002/14651858.CD010577.pub2.
Interventions for treating gas gangrene.
Yang Z(1), Hu J, Qu Y, Sun F, Leng X, Li H, Zhan S.
Author information:
(1)Centre for Evidence Based Medicine and Clinical Research, Department of
Epidemiology and Biostatistics, School of Public Health, Peking University, 38
Xueyuan Road, Haidian District, Beijing, China, 100191.
BACKGROUND: Gas gangrene is a rapidly progressive and severe disease that results
from bacterial infection, usually as the result of an injury; it has a high
incidence of amputation and a poor prognosis. It requires early diagnosis and
comprehensive treatments, which may involve immediate wound debridement,
antibiotic treatment, hyperbaric oxygen therapy, Chinese herbal medicine,
systemic support, and other interventions. The efficacy and safety of many of the
available therapies have not been confirmed.
OBJECTIVES: To evaluate the efficacy and safety of potential interventions in the
treatment of gas gangrene compared with alternative interventions or no
interventions.
SEARCH METHODS: In March 2015 we searched: The Cochrane Wounds Group Specialized
Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The
Cochrane Library), Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, Science Citation
Index, the China Biological Medicine Database (CBM-disc), the China National
Knowledge Infrastructure (CNKI), and the Chinese scientific periodical database
of VIP INFORMATION (VIP) for relevant trials. We also searched reference lists of
all identified trials and relevant reviews and four trials registries for
eligible research. There were no restrictions with respect to language, date of
publication or study setting.
SELECTION CRITERIA: We selected randomized controlled trials (RCTs) and
quasi-RCTs that compared one treatment for gas gangrene with another treatment,
or with no treatment.
DATA COLLECTION AND ANALYSIS: Independently, two review authors selected
potentially eligible studies by reviewing their titles, abstracts and full-texts.
The two review authors extracted data using a pre-designed extraction form and
assessed the risk of bias of each included study. Any disagreement in this
process was solved by the third reviewer via consensus. We could not perform a
meta-analysis due to the small number of studies included in the review and the
substantial clinical heterogeneity between them, so we produced a narrative
review instead.
MAIN RESULTS: We included two RCTs with a total of 90 participants. Both RCTs
assessed the effect of interventions on the 'cure rate' of gas gangrene; 'cure
rate' was defined differently in each study, and differently to the way we
defined it in this review.One trial compared the addition of Chinese herbs to
standard treatment (debridement and antibiotic treatment; 26 participants)
against standard treatment alone (20 participants). At the end of the trial the
estimated risk ratio (RR) of 3.08 (95% confidence intervals (CI) 1.00 to 9.46)
favoured Chinese herbs. The other trial compared standard treatment (debridement
and antibiotic treatment) plus topical hyperbaric oxygen therapy (HBOT; 21
participants) with standard treatment plus systemic HBOT (23 participants). There
was no evidence of difference between the two groups; RR of 1.10 (95% CI 0.25 to
4.84). For both comparisons the GRADE assessment was very low quality evidence
due to risk of bias and imprecision so further trials are needed to confirm these
results.Neither trial reported on this review's primary outcomes of quality of
life, and amputation and death due to gas gangrene, or on adverse events. Trials
that addressed other therapies such as immediate debridement, antibiotic
treatment, systemic support, and other possible treatments were not available.
AUTHORS' CONCLUSIONS: Re-analysis of the cure rate based on the definition used
in our review did not show beneficial effects of additional use of Chinese herbs
or topical HBOT on treating gas gangrene. The absence of robust evidence meant we
could not determine which interventions are safe and effective for treating gas
gangrene. Further rigorous RCTs with appropriate randomisation, allocation
concealment and blinding, which focus on cornerstone treatments and the most
important clinical outcomes, are required to provide useful evidence in this
area.
DOI: 10.1002/14651858.CD010577.pub2
PMID: 26631369 [Indexed for MEDLINE]
