Impact of vaccination on antibiotic usage: a systematic review and meta-analysis. (October 2019)

• Record Type: Journal Article
• Authors: Buckley, B.S.; Henschke, N.; Bergman, H.; Skidmore, B.; Klemm, E.J.; Villanueva, G.; Garritty, C.; Paul, M.
• Is Part Of: Clinical microbiology and infection. Volume 25:Number 10(2019)
• Page Start: 1213
• Page End: 1225
• Publication Date: 2019-10
• Subjects: Antibiotic -- Global health -- Meta analysis -- Systematic review -- Vaccine; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2019.06.030
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Background: Vaccines may reduce antibiotic use and the development of resistance. Objectives: To provide a comprehensive, up-to-date assessment of the evidence base relating to the effect of vaccines on antibiotic use. Data sources: Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and WHO Trials Registry. Study eligibility criteria: Randomized controlled trials (RCTs) and observational studies published from January 1998 to March 2018. Participants: Any population. Interventions: Vaccines versus placebo, no vaccine or another vaccine. Methods: Titles, abstracts and full-texts were screened independently by two reviewers. Certainty of RCT evidence was assessed using GRADE. Results: In all, 4980 records identified; 895 full-text reports assessed; 96 studies included (24 RCTs, 72 observational). There was high-certainty evidence that influenza vaccine reduces days of antibiotic use among healthy adults (one RCT; n = 4253; rate reduction 28·1%; 95% CI 16·0–38·4); moderate-certainty evidence that influenza vaccines probably reduce antibiotic use in children aged 6 months to 14 years (three RCTs; n = 610; ratio of means 0·62; 95% CI 0·54–0·70) and probably reduce community antibiotic use in children aged 3–15 years (one RCT; n = 10 985 person-seasons; risk ratio 0·69, 95% CI 0·58–0·83); and moderate-certainty evidence that pneumococcal vaccination probably reduces antibiotic use in children aged 6 weeks to 6 years (two RCTs; n = 47 945; rate ratio 0·93, 95% CI 0·87–0·99) and reduces illness episodes requiring antibiotics in children aged 12–35 months (one RCT; n = 264; rate ratio 0·85, 95% CI 0·75–0·97). Other RCT evidence was of low or very low certainty, and observational evidence was affected by confounding. Conclusions: The evidence base is poor. Although some vaccines may reduce antibiotic use, collection of high-quality data in future vaccine trials is needed to improve the evidence base. PROSPERO registration: CRD42018103881.