Summary of findings 4. Topical antimicrobial agent compared with systemic antimicrobial agent.
| Topical antimicrobial agent compared with systemic antimicrobial agent | ||||||
| Patient or population: Foot ulcers in people with diabetes Setting: Mixed Intervention: Topical antimicrobial agent Comparison: Systemic antibiotic | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with systemic antibiotic agent | Risk with topical antimicrobial agent | |||||
| Proportion of wounds healed | Not reported for this comparison | N/A | N/A | N/A | Outcome not reported for this comparison. | |
| Incidence of infection | Not reported for this comparison | N/A | N/A | N/A | Outcome not reported for this comparison. | |
| Resolution of infection | 333 per 1000 | 503 per 1000 (303 to 830) | RR 1.51 (0.91 to 2.49) | 102 participants (2 studies) | ⊕⊝⊝⊝ very low1 | It is uncertain whether the effects of topical antimicrobial treatment on resolution of infection differ from those of systemic antibiotics. |
| Risk difference: 170 more resolved infections per 1000 (30 fewer to 497 more) | ||||||
| Adverse events | 450 per 1000 | 409 per 1000 (351 to 477) | RR 0.91 (0.78 to 1.06) | 937 participants (4 studies) |
⊕⊕⊕⊝ moderate2 |
On average, there is probably little difference in the risk of adverse events between the systemic antibiotics and topical antimicrobial treatments compared here. |
| Risk difference: 40 fewer adverse events per 1000 (99 fewer to 27 more) | ||||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; N/A: not applicable; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
1Downgraded twice for imprecision: small sample size and small number of events. Downgraded once for risk of performance bias. 2Downgraded once for risk of performance bias.