Antibiotics combat bacterial infections, like strep throat. But its overuse has been tied to a rise in organisms that build a resistance to the drugs.

The systematic review of data from 66 studies appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Most of the studies were conducted at a single hospital -- one of the main factors that prevented the researchers from drawing meaningful conclusions about the benefits of individual interventions. Also, none of the studies compared one intervention to another, so it was impossible to identify a superior approach.

"What might work in one hospital, won't necessarily work in another," said Erwin Brown, M.D., a medical microbiologist on the review team. "The literature wasn't sufficiently robust for us to say: 'This works or this doesn't.'"

Ralph Gonzales, M.D., an associate professor of medicine at the University of California, San Francisco, said antibiotic resistance is an especially critical problem in hospitals.

Each antibiotic is effective only against certain bacteria -- the organisms that cause infection. Often it takes a physician's best guess, laboratory tests and time to pinpoint the bacteria responsible for an illness.

"The chances are extremely low that an ambulatory-care patient will die because they don't get the correct antibiotic. That chance is greater for a critical-care patient in a hospital," Gonzales said.

Gonzales, who was not involved in the Cochrane review, has worked in the United States to c
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Contact: Peter Davey
p.g.davey@chs.dundee.ac.uk
Center for the Advancement of Health
18-Oct-2005