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Systematic Reviews
Published in: Systematic Reviews 1/2019

Open Access 01-12-2019 | Antibiotic | Protocol

Influence of adjuvant antibiotics on fistula formation following incision and drainage of anorectal abscesses: a systematic review protocol

Authors: Laura Baker, Lara Williams, Remington Winter, Caitlin Cahill, Alexandra Davis, Dean Fergusson

Published in: Systematic Reviews | Issue 1/2019

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Abstract

Background

Development of fistula-in-ano following incision and drainage (I&D) of anorectal abscesses occurs in over 30% of patients. It is associated with significant patient morbidity and societal cost. The use of antibiotics following drainage is controversial, with randomized controlled trials reporting opposing conclusions regarding their influence on the rate of fistula formation. Given the significant burden associated with their development, it is imperative to determine strategies to minimize their occurrence. The objective of this review is to summarize the available evidence on the role of antibiotics following I&D of anorectal abscesses on fistula formation. Secondary objectives include determining if antibiotics are associated with morbidity, repeat presentation to the emergency department, and requirement for reoperation.

Methods/design

MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials, http://​apps.​who.​int/​trialsearch, and clinicaltrials.​gov will be searched to identify published and ongoing unpublished interventional and observational studies evaluating the role of antibiotics post I&D on the incidence of fistula formation. There will be no restriction on language, date, or journal. Title and abstracts as well as full texts will be screened in duplicate based on inclusion and exclusion criteria. The Cochrane Risk of Bias tool and ROBINS-I will be used to assess risk of bias in randomized and non-randomized studies, respectively. Our primary outcome is the incidence of fistula formation; secondary outcomes include morbidity, representation to ED, and reoperation. Study heterogeneity will be calculated with Cochran’s Q test, P value, and I2 index. SASS (version 9.4) will be used for meta-analysis.

Discussion

This is the first study to review the available evidence on adjuvant antibiotics and incidence of fistula formation following I&D of anorectal abscesses.

Systematic review registration

Appendix
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Metadata
Title
Influence of adjuvant antibiotics on fistula formation following incision and drainage of anorectal abscesses: a systematic review protocol
Authors
Laura Baker
Lara Williams
Remington Winter
Caitlin Cahill
Alexandra Davis
Dean Fergusson
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2019
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-019-1002-z

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