The following is a summary of “Evaluation of phenobarbital based approach in treating patient with alcohol withdrawal syndrome: A systematic review and meta-analysis,” published in the July 2023 issue of Emergency Medicine by Pourmand et al.

Alcohol Withdrawal Syndrome (AWS) is associated with high morbidity and mortality and can range from mild to severe in patients with chronic and excessive alcohol consumption. Due to its pharmacological properties and mechanism of action, phenobarbital has been hypothesized to be an effective first-line treatment for AWS. Currently, benzodiazepines are the treatment of choice for AWS. Researchers conducted a meta-analysis to review pertinent literature and compare the clinical outcomes of patients diagnosed with AWS in the emergency department (ED) and intensive care unit (ICU) settings. 

Randomized trials and observational (prospective or retrospective) studies were eligible if they included adult patients who presented to the ED and intensive care unit (ICU) with a diagnosis of AWS and were treated in the ED and ICU. The primary outcome was the rate of intubation among phenobarbital-treated patients compared to benzodiazepine-treated patients. Also included were secondary effects such as seizure rates, hospital and ICU length of stay (LOS). The registration number for PROSPERO is CRD42022318862. Their analysis included 12 investigations (1,934 patients). In these studies, 765 (41.7%) of the 1,934 patients were treated with phenobarbital for alcohol withdrawal, while 1169 (58.3%) were treated with other modalities. 

Intubation risk was comparable between the phenobarbital and control groups (RR 0.70, 95% CI: 0.36–1.38, P = 0.31). In addition, phenobarbital-treated patients were found to have comparable 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) compared to benzodiazepine-treated patients. The administration of phenobarbital to patients with AWS is associated with comparable rates of intubation, ICU length of stay, and hospital length of stay compared to the administration of benzodiazepines. Due to the inclusion of predominantly observational studies and high heterogeneity among the studies evaluated in this review, however, additional well-designed trials are required.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001869