Antibiotics for the treatment of leptospirosis: systematic review and meta-analysis of controlled trials

Abstract

Leptospirosis is a zoonotic disease prevalent mainly in developing countries and is associated with high case fatality. Antibiotics especially penicillin are the mainstay of treatment for a suspected or confirm case of leptospirosis but role of Penicillin has not been evaluated systematically in the light of current evidence. The present systematic review and meta-analysis is done to evaluate the role of antibiotics in the treatment of leptospirosis. Parallel group clinical trials involving use of penicillin in treatment of leptospirosis were searched from all available sources. Ten clinical trials were found suitable as per laid inclusion criteria eligible for present systematic review and five clinical trials were included in meta-analysis. Clinical trials included for meta-analysis were compared on the basis of mortality, fever days, numbers of patients presenting with oliguria, and number of patients undergoing need-based dialysis. Analysis was done by comprehensive meta-analysis software 2. Qualitative outcomes are summarized as odds ratio and quantitative outcomes are summarized as standard mean difference with 95% confidence interval. Random and fixed models are used for analysis. There was no significant difference between penicillin group and controlled group for mortality (Odds ratio 1.59 (95% CI 0.59-4.29), P = 0.35), fever days (std difference in mean = -0.223 (95% CI 0.394-0.995), P = 0.358), number of patients presenting with oliguria (Odds ratio 1.795 (95% CI 0.325-9.929), P = 0.502), and number of patients who underwent need based dialysis (Odds ratio 1.587 (95% CI 0.919-2.731), P = 0.098). Role of various antibiotics in treatment of leptospirosis is uncertain, and can be attributed to nonavailability of adequate clinical trials. Role of penicillin in the treatment of leptospirosis can be debated.

Keywords: Antibiotics; doxycycline; leptospirosis; penicillin; weils disease.

Figure 1

Effect of penicillin therapy on mortality in the patients of leptospirosis [Random model = Odds ratio 1.59 (95% CI 0.59-4.29) Z = 0.93, P = 0.35]. Fixed model [odds ratio 1.70 (95% CI 0.75-3.82) Z = 1.29, P = 0.19]

Figure 2

Effect of penicillin therapy on fever days in the patients of leptospirosis. [Random model-std difference in mean = −0.223 (95% CI 0.394-0.995), Z = −0.918, P = 0.358]. Fixed model [std difference in mean = −0.150 (95% CI 0.469-0.170), Z = −0.918, P = 0.358]

Figure 3

Effect of penicillin therapy on number of patient becoming oliguric. Random model (Odds ratio 1.795 (95% CI 0.325-9.929), Z = 0.675, P = 0.502), Fixed model (Odds ratio 1.795 (95% CI 0.325-9.929), Z = 0.675, P = 0.502)

Figure 4

Effect of penicillin therapy on number of patient needed dialysis. Random model (Odds ratio 1.587 (95% CI 0.919-2.731), Z = 1.657, P = 0.098) and fixed model (Odds ratio 1.587 (95% CI 0.919–2.731), Z = 1.657, P = 0.098)

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