SynthesiseLife2024
The effect of combining antibiotics on resistance: A systematic review and meta-analysis.
Synthesis in eLife, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The effect of combining antibiotics on resistance: A systematic review and meta-analysis.eLife · 2024Pooled it
- Targeting WHO-Priority MDR and XDR Gram-Negative Ocular Isolates by Combining Conventional Antimicrobials with Membrane-Active Peptides.Antibiotics (Basel, Switzerland) · 2026Article
- Peptoid-based antimicrobial strategies against polymyxin-resistant Gram-negative bacteria.Journal of applied microbiology · 2026Article
- Antimicrobial Resistance: A Bibliometric Review of Patient Health, Mechanisms, and Therapeutic Strategies.Pathogens (Basel, Switzerland) · 2026Review
- Antibiotic hybrids: A promising strategy to replenish the pipeline and combat antimicrobial resistance.Journal of microbiology (Seoul, Korea) · 2026Review
- Risk Factors, Pathogen Distribution, and Treatment Strategies for Mortality in Elderly Patients with Pulmonary Bacterial Infections.Clinical interventions in aging · 2026Article
- Comparative Efficacy of Triple Versus Quadruple Therapy for the Eradication ofJGH open : an open access journal of gastroenterology and hepatology · 2025Review
- The Actual Clinical Situation Ruthlessly Exposes the Challenge of Rational Care for Nosocomial and Community-Acquired Infections and Requires Even More Efforts for Satisfactory Antibiotic Stewardship.Antibiotics (Basel, Switzerland) · 2025Article
- The impact of treatment strategies on the epidemiological dynamics of plasmid-conferred antibiotic resistance.Proceedings of the National Academy of Sciences of the United States of America · 2024Article
- Article
- The antimicrobial and antibiofilm effects of gentamicin, imipenem, and fucoidan combinations against dual-species biofilms of Staphylococcus aureus and Acinetobacter baumannii isolated from diabetic foot ulcers.Annals of clinical microbiology and antimicrobials · 2024Article
- The many dimensions of combination therapy: How to combine antibiotics to limit resistance evolution.Evolutionary applications · 2024Article
Corrections and comments
- Update of
Authors and funding
6 authors.
Funding
Abstract
Background: Under which conditions antibiotic combination therapy decelerates rather than accelerates resistance evolution is not well understood. We examined the effect of combining antibiotics on within-patient resistance development across various bacterial pathogens and antibiotics. Methods: We searched CENTRAL, EMBASE, and PubMed for (quasi)-randomised controlled trials (RCTs) published from database inception to 24 November 2022. Trials comparing antibiotic treatments with different numbers of antibiotics were included. Patients were considered to have acquired resistance if, at the follow-up culture, a resistant bacterium (as defined by the study authors) was detected that had not been present in the baseline culture. We combined results using a random effects model and performed meta-regression and stratified analyses. The trials' risk of bias was assessed with the Cochrane tool. Results: 42 trials were eligible and 29, including 5054 patients, qualified for statistical analysis. In most trials, resistance development was not the primary outcome and studies lacked power. The combined odds ratio for the acquisition of resistance comparing the group with the higher number of antibiotics with the comparison group was 1.23 (95% CI 0.68-2.25), with substantial between-study heterogeneity ( Conclusions: The evidence for combining a higher number of antibiotics compared to fewer from RCTs is scarce and overall compatible with both benefit or harm. Trials powered to detect differences in resistance development or well-designed observational studies are required to clarify the impact of combination therapy on resistance. Funding: Support from the Swiss National Science Foundation (grant 310030B_176401 (SB, BS, CW), grant 32FP30-174281 (ME), grant 324730_207957 (RDK)) and from the National Institute of Allergy and Infectious Diseases (NIAID, cooperative agreement AI069924 (ME)) is gratefully acknowledged.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.