Evaluation of phenobarbital based approach in treating patient with alcohol withdrawal syndrome: A systematic review and meta-analysis
Abstract
Background Alcohol Withdrawal Syndrome (AWS) among patients with chronic and heavy alcohol consumption can range from mild to severe and is associated with high morbidity and mortality. Currently, treating AWS with benzodiazepines is the standard of care, but phenobarbital has also been hypothesized to be an effective first-line treatment due to its pharmacological properties and mechanism of action. We conducted a meta-analysis to review relevant literature and compare the clinical outcomes for patients diagnosed with AWS in ED and ICU settings.Methods We performed a literature search in in the PubMed, Scopus, and Web of Science databases from inception to June 30, 2022. Randomized trials and observational (prospective or retrospective) studies were eligible if they included adult patients who presented in the ED and were treated in the ED and/or the intensive care unit (ICU) with a diagnosis of AWS. The primary outcome was the rate of intubation among patients who received phenobarbital, compared with benzodiazepines. Secondary outcomes such as rates of seizures, hospital, and ICU length of stay (LOS), also were included. The PROSPERO registration is CRD42022318862.Results We included twelve studies (1934 patients) in our analysis. Of the 1934 patients in these studies, 765 (41.7%) were treated with phenobarbital and 1169 (58.3%) were treated with other modalities for alcohol withdrawal. Treating AWS patients with phenobarbital did not affect their risk for intubation, as the risk for intubation was similar between the phenobarbital and the control group (RR 0.70, 95% CI 0.36-1.38, P = 0.31). In addition, patients who were treated with phenobarbital were found to have similar rates of seizures (RR 0.73, 95% CI 0.29-1.89) and length of stay in the hospital (Standardized Mean Difference -0.02, 95% CI -0.26, 0.21) or the ICU (SMD -0.02, 95% CI -0.21, 0.25) when compared with patients receiving benzodiazepines.Conclusions Management of patients with AWS with phenobarbital is associated with similar rates of intubation, length of stay in the ICU, or length of stay in the hospital as treatment with benzodiazepines. However, due to the inclusion of mostly observational studies and a significant level of heterogeneity among the studies assessed in this review, additional trials with strong methodology are needed.
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In a meta-analysis of twelve studies and 1934 patients, rates of intubation, seizures, hospital and ICU length of stay did not differ between benzodiazepine and phenobarbital groups.
“The results did not differ between the benzodiazepine and phenobarbital groups [21].”
From A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder (2024) · cites this paper as [21]
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A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder
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- Authors
- Pourmand, A., AlRemeithi, R., Kartiko, S., Bronstein, D., & Tran, Q. K.
- Affiliations
- George Washington University (US)
- University of Maryland, Baltimore (US)
- Corresponding author
- Pourmand, Ali
- Venue
- The American Journal of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2023-07
- Volume
- 69
- Pages
- 65-75
- ISSN
- 0735-6757 (ISSN-L)
- OpenAlex
- W4362604180
- Cited by
- 13
- References
- 28
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 4 · 2023: 1
- FWCI
- 0.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The American Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- alcohol withdrawal, phenobarbital, benzodiazepines, intubation, seizures, length of hospital stay, intensive care unit, emergency department, alcoholism treatment, benzodiazepine withdrawal, barbiturates
- MeSH terms
- Adult, Alcoholism, Benzodiazepines, Humans, Phenobarbital, Prospective Studies, Retrospective Studies, Seizures, Substance Withdrawal Syndrome
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