Wong Arnold Y L, Mallow G Michael, Pinto Sabina M, Hornung Alexander L, Rudisill Samuel S, Aboushaala Khaled, Udby Peter M, An Howard S, Samartzis Dino
Department of Rehabilitation Sciences The Hong Kong Polytechnic University Hung Hom, Hong Kong SAR China.
Department of Orthopedic Surgery Rush University Medical Center Chicago Illinois USA.
JOR Spine. 2023 Sep 19;7(1):e1281. doi: 10.1002/jsp2.1281. eCollection 2024 Mar.
This systematic review and meta-analysis aimed to summarize evidence regarding the effectiveness and safety of oral antibiotic intervention for chronic low back pain (CLBP) patients with/without type-1 Modic changes (MC1).
AMED, CINAHL, Cochrane Library, Embase, and Medline were searched from inception to March 3, 2023. Randomized controlled trials (RCTs) or non-RCTs that investigated the effectiveness or safety of oral antibiotics in treating CLBP patients were eligible for inclusion. Two independent reviewers screened abstracts, full-text articles, and extracted data. The methodological quality of each included article were evaluated by RoB2 and NIH quality assessment tools. The quality of evidence was appraised by GRADE. Meta-analyses were performed, where applicable. A subgroup analysis was conducted to evaluate the RCTs and case series separately, and to evaluate the effect of removing a low-quality RCT.
Three RCTs and four case series were included. All Amoxicillin-clavulanate/Amoxicillin treatments lasted for approximately 3 months. Moderate- and low-quality evidence suggested that antibiotic was significantly better than placebo in improving disability and quality of life in CLBP patients with MC1 at 12-month follow-up, respectively. Low-quality evidence from meta-analyses of RCTs showed that oral antibiotic was significantly better than placebo in improving pain and disability in CLBP patients with MC1 immediately post-treatment. Very low-quality evidence from the case series suggested that oral Amoxicillin-clavulanate significantly improved LBP/leg pain, and LBP-related disability. Conversely, low-quality evidence found that oral Amoxicillin alone was not significantly better than placebo in improving global perceived health in patients with CLBP at the 12-month follow-up. Additionally, oral antibiotic users had significantly more adverse effects than placebo users.
Although oral antibiotics were statistically superior to placebo in reducing LBP-related disability in patients with CLBP and concomitant MC1, its clinical significance remains uncertain. Future large-scale high-quality RCTs are warranted to validate the effectiveness of antibiotics in individuals with CLBP.
本系统评价和荟萃分析旨在总结有关口服抗生素干预对伴有或不伴有1型Modic改变（MC1）的慢性腰痛（CLBP）患者有效性和安全性的证据。
检索了从数据库建立至2023年3月3日的AMED、CINAHL、Cochrane图书馆、Embase和Medline。纳入研究口服抗生素治疗CLBP患者有效性或安全性的随机对照试验（RCT）或非RCT。两名独立评审员筛选摘要、全文文章并提取数据。采用RoB2和美国国立卫生研究院质量评估工具评估每篇纳入文章的方法学质量。采用GRADE评估证据质量。在适用的情况下进行荟萃分析。进行亚组分析以分别评估RCT和病例系列，并评估剔除一项低质量RCT的影响。
纳入3项RCT和4个病例系列。所有阿莫西林克拉维酸/阿莫西林治疗持续约3个月。中等质量和低质量证据表明，在12个月随访时，抗生素在改善伴有MC1的CLBP患者的残疾和生活质量方面分别显著优于安慰剂。RCT荟萃分析的低质量证据表明，口服抗生素在治疗后即刻改善伴有MC1的CLBP患者的疼痛和残疾方面显著优于安慰剂。病例系列的极低质量证据表明，口服阿莫西林克拉维酸可显著改善腰痛/腿痛以及与腰痛相关的残疾。相反，低质量证据发现，在12个月随访时，单纯口服阿莫西林在改善CLBP患者的整体健康感知方面并不显著优于安慰剂。此外，口服抗生素使用者的不良反应明显多于安慰剂使用者。
虽然口服抗生素在降低伴有MC1的CLBP患者与腰痛相关的残疾方面在统计学上优于安慰剂，但其临床意义仍不确定。未来有必要进行大规模高质量RCT以验证抗生素对CLBP患者的有效性。
