Examining the Efficacy of Antimicrobial Therapy in Preventing the Development of Postinfectious Glomerulonephritis: A Systematic Review and Meta-Analysis

Abstract

Postinfectious glomerulonephritis (PIGN) is an immune-mediated acute glomerulonephritis classically seen weeks after infection with Streptococcus pyogenes, although other infectious etiologies have emerged. While it has become increasingly rare in industrialized regions, it continues to affect children in developing countries. There has been debate as to why incidence rates are declining, including the possibility of improved initial treatment of bacterial infections. The ability of antimicrobial therapy in preventing PIGN as infectious sequelae, however, has not been comprehensively assessed. As varying evidence from published studies exists, the objective of this meta-analysis is to determine if antimicrobial therapy utilized to treat an initial infection has an effect in reducing the development of PIGN in humans. EMBASE, MEDLINE, and CENTRAL were searched using a comprehensive terminology strategy. From an initial search that returned 337 publications, 9 articles were included for analysis. Eight studies showed an incidence of PIGN after antimicrobial use ranging from 0.05% to 10% with a mean standardized difference (MSD) of 0.03 (0.01-0.06). Three studies showed an occurrence of PIGN without antibiotic use ranging from 1% to 13% with an MSD of 0.06 (-0.09-0.21). Our findings suggest that antimicrobial treatment for the initial infection may help diminish the development of PIGN. Although Streptococcus pyogenes infections are generally treated aggressively to prevent rheumatic fever, these findings may help further support the early treatment of bacterial infections to prevent postinfectious sequelae, especially as we consider other infectious etiologies of PIGN antimicrobial resistance.

Keywords: Streptococcus pyogenes; antibiotic; antimicrobial; postinfectious glomerulonephritis.

Figure 1

Using PRISMA guidelines for meta-analysis, a flowchart was created to illustrate the sources, inclusion, and exclusion of identified studies from databases and citation searching.

Figure 2

Lists the author and study year, effect size (ES), standard error (SE), standardized mean difference (SMD), and 95% confidence interval (CI) for each study. The forest plot reveals SMD for each study plotted against a random effects model.

Figure 3

Lists the author and study year, effect size (ES), standard error (SE), standardized mean difference (SMD), and 95% confidence interval (CI) for each study. The forest plot reveals SMD for each study plotted against a random effects model.