Benefit of antibiotic therapy on pouchitis after ileal pouch anal anastomosis: a systematic review and meta-analysis of clinical trials Elahi B, Nikfar S, Derakhshani S, Vafaie M, Abdollahi M CRD summary The authors concluded that antibiotics improved pouchitis symptoms following ileal pouch anal anastomosis, but the results should be interpreted with caution given the small number of trials and patients. Potential for error and bias in the review, the unclear quality and small number of included studies and absence of data from most eligible studies made the authors' caution warranted. Authors' objectives To assess the efficacy of antibiotics in the management of pouchitis following ileal pouch anal anastomosis (IPAA). Searching PubMed, EMBASE, Web of Science, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) were searched between 1966 and July 2008 for articles in any language. Search terms were reported. References of retrieved articles were handsearched. Study selection Randomised controlled trials that compared antibiotic therapy to placebo or other active therapies in patients with pouchitis were eligible for inclusion if they assessed clinical improvement and/or remission of pouchitis. Uncontrolled studies of antibiotic therapy for pouchitis also appeared to be eligible for inclusion. Only published studies were eligible for inclusion. Included studies evaluated metronidazole, riflaxin or ciprofloxacin monotherapy or combination therapy of ciprofloxacin and tinidazole, ciprofloxacin and rifaximin, and ciprofloxacin and metronidazole in varying doses in patients with acute or chronic pouchitis. Duration of therapy ranged from seven days to three months. Concomitant mesalamine therapy was administered in one study. Outcomes reported were remission, stool frequency, pouchitis disease activity scores and quality of life scores. Two reviewers assessed the studies for review. Assessment of study quality The authors did not state that they assessed the methodological quality of the included studies Data extraction Data were extracted for three studies included in the meta-analysis. Data were not extracted for the other six studies that met inclusion criteria. Number of patients in each group with clinical improvement or remission was extracted and used to calculate odds ratios (OR) with 95% confidence intervals (CI). The outcome of clinical improvement was not defined. The authors did not state how many reviewers performed data extraction. Methods of synthesis A pooled odds ration with 95% CI was calculated using a fixed-effects model. Statistical heterogeneity was assessed using the Breslow-Day test and visual inspection of L'Abbe plot. Results of the review Nine studies met the inclusion criteria. Results were reported for three RCTs (n=69). No results were reported for the other six studies. Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2019 University of York Page: 1 / 3