Reviews of antibiotic treatment for pain conditions
| Study and year | Study type | Patient population and disorder | Results | Comments |
| Ford et al, 2018195 | Meta-analysis of randomized placebo controlled trials | Nine studies of 2845 patients with irritable bowel syndrome | All studies favored antibiotics compared with placebo, with three study falling just below the threshold for statistical significance | Seven studies evaluated the minimally absorbed antibiotic rifaximin, with two others evaluating ciprofloxacin and neomycin, both of which were positive. When four rifaximin studies with low risk of bias were evaluated separately, results favored antibiotics (Risk Ratio 0.87; 95% confidence interval 0.82 to 0.93). |
| Anothaisintawee et al, 2011196 | Systematic review and network meta-analysis of randomized placebocontrolled trials | Three studies of 215 patients with chronic prostatitis or pelvic pain syndrome | In the network meta-analysis that included 14 studies, reduction in pain compared with placebo: Pooled risk ratio −4.4 (95% confidence interval −7.0 to −1.9) for antibiotics, −5.7 (−7.8 to −3.6) for α blockers plus antibiotics | Antibiotics plus α blockers more effective than other treatments evaluated but direct comparison based on only one study197; duration of treatment 6-12 weeks; antibiotics studied included ciprofloxacin, levofloxacin, and tetracycline |
| Wanis et al, 2017198 | Meta- analysis of randomized controlled trials | Five studies of 337 patients with acute postsurgical pain after hemorrhoidectomy | Patients who received metronidazole had lower reported pain scores on postoperative days 1 (Standardized mean difference –0.87 (Standard error0.44); 95% confidence interval –1.73 to –0.015; P=0.046; n=4) and 4 (–1.43 (0.71); –2.83 to –0.037; P=0.044; n=3). | Two studies compared metronidazole with usual care (not blinded or placebo controlled); no significant difference was seen when the largest study with high risk of bias was excluded; longest follow-up was 14 days |
| Andraws et al, 2005199 | Meta-analysis of randomized placebo controlled trials evaluating antichlamydial antibiotics | 11 studies of 19 217 patients with coronary artery disease | Pooled rate of unstable angina 9.2% in antibiotic group v 9.6% in placebo group (odds ratio 0.91; 95% confidence interval 0.76 to 1.07; P=0.25); no significant differences in myocardial infarction or mortality rates | All studies except one (fluoroquinolone) evaluated macrolide antibiotics. Follow-up ranged from six months to four years. Subgroup analysis of patients with antichlamydial titers (three trials, n=4548 patients) also found no significant differences |
| Gilligan et al, 2021142 | Narrative review | Eight studies, of which three were placebo controlled (413 patients in controlled trials had chronic low back pain and vertebral endplate signal changes) | Two of four observational studies and two of three controlled trials were positive; herniated and degenerated discs contain a low bacterial burden that could be below detection threshold and samples are prone to contamination; almost 50% of degenerated discs were infected, mostly with Cutibacterium Acnes | Two positive controlled studies enrolled patients with only Modic type 1 endplate signal changes and treated patients with amoxicillin-clavulanic acid, while the negative controlled study enrolled patients with Modic type 1 and 2 changes and treated patients with amoxicillin; all studies treated patients for between 90 and 100 days; both positive controlled studies showed a significant reduction in disability and pain; a subset of patients could benefit from oral antibiotic treatment but this hypothesis requires further investigation |
| Norton et al, 2017200 | Systematic review | 15 studies, including only one randomized study comparing effectiveness of two antibiotics (n=29), in patients with inflammatory bowel disease201 | In the one randomized study,201 metronidazole and ciprofloxacin both reduced abdominal symptoms (84% response rate for bloating, 47% for abdominal pain) with no difference between either antibiotic | Small bowel bacterial overgrowth present in 29 of 145 patients with Crohn’s disease, with baseline abdominal pain present in 48%; no difference in response rates between metronidazole and ciprofloxacin given for 10 days; glucose breath tests returned to normal in 27 of 29 patients after treatment |
| Swedish Council on Health Technology Assessment, 2007202 | Systematic review based primarily on randomized controlled trials and systematic literature reviews published between 1999 and 2005 | Functional dyspepsia | Antibiotic treatment that eradicates Helicobacter pylori offers mild relief of functional dyspepsia symptoms (evidence grade 3), but most patients with functional dyspepsia are not infected with H pylori and do not benefit (evidence grade 2). | Highlights that functional dyspepsia is a disorder (not disease) with an unknown cause; results consistent with the study group's previous report in 2000 concluding that drug treatment yields very limited benefits |