Table 1

Clinical studies of antibiotic treatment in patients with stroke

StudyDesignStroke typeSample sizeAntibiotics regimenPrimary outcomesConclusion on patients' outcomeConclusion on infection
Halms et al61Phase 2, randomised, double-blind, placebo controlledIschaemic79Moxifloxacin, 400 mg daily for 5 days starting within 36 hoursInfection within 11 daysImproved neurological outcome and survival.Reduced infection.
Chamorro et al62Phase 2, randomised, double-blind, placebo-controlledIschaemic/haemorrhagic (110/26)136Levofloxacin, 500 mg daily for 3 days, starting within 24 hoursIncidence of infection 7 days after strokeLevofloxacin could lessen the chances of functional recovery.Did not prevent infection.
Schwarz et al63Phase 2, randomised, controlledIschaemic60Mezlocillin plus sulbactam, 2 g/1 g every 8 hours for 4 days, starting within 24 hoursIncidence and height of feverMay be associated with a better clinical outcome.Decreased infection.
Amiri-Nikpour et al11Phase 2, open-label, evaluator-blindedIschaemic53Minocycline 200 mg daily for 5 days, starting from 6 hours to 24 hoursNIHSS score at 90 daysBetter outcomes at 90 days in the minocycline group.NA
Kohler et al13Phase 2, randomised open-label, blinded end point evaluationIschaemic/haemorrhagic (77/11)95Minocycline 100 mg every 12 hours, five doses in total, within 24 hoursmRS at 90 daysSafe but not efficacious.NA
Lampl et al12Phase 2, open-label, evaluator-blindedIschaemic152Minocycline 200 mg daily for 5 days, starting within 6–24 hoursNIHSS change from baseline to 90 daysImproved patients’ outcome at 90 days.NA
Ulm et al15Phase 2, randomised, controlledIschaemic197PCTus-guided antibiotic, starting within 40 hours for 7 daysmRS at 3 monthsDid not improve functional outcome at 3 months.Did not reduce pneumonia.
Westendorp et al8Phase 3, randomised, open-label, maskedIschaemic/haemorrhagic (2125/269)2538ceftriaxone 2 g, intravenously once daily for 4 days starting within 24 hours after onsetmRS at 3 monthsDid not improve functional outcome at 3 monthsReduced all infection rates and urinary tract infection rates, but not pneumonia.
Kalra et al7Phase 3, cluster-randomised, open-label, maskedIschaemic/haemorrhagic (1091/125)1217Antibiotic conformed to local policy, starting within 48 hours, for 7 daysPneumonia in the first 14 daysDid not improve neurological function and outcome.Did not reduce pneumonia.
  • mRS, modified Rankin Scale; NA, not available; NIHSS, National Institute of Health Stroke Scale; PCTus, procalcitonin ultrasensitive.