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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Preventive antibacterial therapy in acute ischemic stroke: a randomized controlled trial

Hendrik Harms1, Konstantin Prass, Christian Meisel

  • 1Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany.

Plos One
|May 15, 2008
PubMed
Abstract

Insights

Preventive moxifloxacin therapy reduced post-stroke infections in patients with severe ischemic stroke. This study highlights the role of immunodepression in infection development after stroke.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Clinical Trials

Background:

  • Pneumonia is a significant cause of mortality following acute stroke.
  • Mouse models show moxifloxacin reduces post-stroke infections, mortality, and improves neurological outcomes.
  • This study evaluates moxifloxacin's efficacy in human stroke patients.

Purpose of the Study:

  • To investigate the effectiveness of preventive antibacterial therapy with moxifloxacin in patients with acute ischemic stroke.
  • To assess the impact of moxifloxacin on infection rates, neurological outcomes, and survival.
  • To explore the role of stroke-induced immunodepression and bacterial resistance.

Main Methods:

  • The Preventive ANtibacterial THERapy in acute Ischemic Stroke (PANTHERIS) trial was a randomized, double-blind, placebo-controlled study.
  • 80 patients with severe, non-lacunar, ischemic stroke (NIHSS>11) in the MCA territory were enrolled.
  • Patients received intravenous moxifloxacin (400 mg daily) or placebo for 5 days, starting within 36 hours of stroke onset.

Main Results:

  • Intention-to-treat analysis showed a trend towards reduced infection rates with moxifloxacin (15.4% vs. 32.5%, p=0.114).
  • Per-protocol analysis revealed a significant reduction in infection rates (17.1% vs. 41.9%, p=0.032) with moxifloxacin.
  • Moxifloxacin did not significantly influence neurological outcome or survival; fluoroquinolone resistance rates were similar between groups.
  • Treatment arm and monocytic HLA-DR expression predicted post-stroke infections.

Conclusions:

  • Preventive moxifloxacin administration appears superior to placebo in reducing infections after severe non-lacunar ischemic stroke.
  • The study underscores the critical role of immunodepression in the development of post-stroke infections.
  • Further research may be warranted to optimize preventive strategies for post-stroke infections.

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