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Eur Respir J 2007; 30:815-816
Copyright ©ERS Journals Ltd 2007

From the authors

I. I. Siempos1, G. Dimopoulos1,2 and M. E. Falagas1,3,4

1 Alfa Institute of Biomedical Sciences (AIBS), and 2 Intensive Care Unit, Attikon University Hospital, and 3 Dept of Medicine, Henry Dunant Hospital, Athens, Greece. 4 Dept of Medicine, Tufts University School of Medicine, Boston, MA, USA.

We would like to thank M. Miravitlles and co-workers for their interest in our meta-analysis 1. They commented on our choice not to include randomised controlled trials (RCTs) in the meta-analysis that were written in languages other than English, French, German or Italian. In addition, they criticised the fact that the references of the excluded RCTs were not available. We welcome the letter by our respectable colleagues and would like to respond to the points they raised.

We would like to emphasise that our research team's policy regarding the reporting of meta-analyses is to provide the references of all excluded trials to secure transparency and reproducibility of our work. For instance, in another meta-analysis performed by our team that has been recently published in the European Respiratory Journal (ERJ), we have done so 2. However, for the contribution under discussion, we would have to have provided 139 additional references (i.e. the number of the studies that were omitted for various reasons as explained in the relevant figure of our article); we considered that this number was probably excessive, given the space limitations of the ERJ.

We carefully reviewed the abstracts of the five RCTs that were excluded due to language restrictions 3–7. None of them provided data relevant to the subject of our meta-analysis (namely the comparison of macrolides, quinolones and amoxicillin/clavulanate for the treatment of patients with acute bacterial exacerbations of chronic bronchitis). Thus, the findings of our meta-analysis would not be different if we did not use language restrictions.

We would also like to point out that a considerable proportion of meta-analyses that are published in high-impact factor journals include only English language studies. In addition, in the Quality Of Reporting Of Meta-analyses (QUOROM) statement, language-inclusive meta-analyses are encouraged, but restriction in study selection based on the language of publication is not considered unacceptable. Besides, a recent comprehensive study on the topic revealed that "for conventional medicine interventions, language-restricted systematic reviews, compared with language-inclusive ones, did not introduce biased results, in terms of estimates of intervention effectiveness" and concluded that "language restrictions do not change the results of conventional medicine systematic reviews" 8. Apparently, the Editors of the ERJ have been aware of this evidence and, given the clinical importance of our meta-analysis, decided to publish it after the appropriate peer review.

Nevertheless, we certainly share the reasonable concerns of our colleagues regarding the penetration of the English language in modern research. In fact, we are very sensitive regarding this issue as well and, moreover, we have already commented on it 9. In addition, we have also compiled a list of a number of non-English language world databases of summaries of articles in the biomedical fields with the hope that such databases might contain data useful for researchers and clinicians 10.

REFERENCES

  1. Siempos II, Dimopoulos G, Korbila IP, Manta K, Falagas ME. Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis.. Eur Respir J 2007;29:1127–1137.[Abstract/Free Full Text]
  2. Siempos II, Vardakas KZ, Manta KG, Falagas ME. Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia.. Eur Respir J 2007;29:548–560.[Abstract/Free Full Text]
  3. Gómez J, Baños V, Simarro E, et al. [Prospective, comparative study (1994–1998) of the influence of short-term prophylactic treatment with azithromycin on patients with advanced COPD.]. Rev Esp Quimioter 2000;13:379–383.[Medline] [Order article via Infotrieve]
  4. Alvarez Gutiérrez FJ, Soto Campos G, del Castillo Otero D, et al. [A randomized comparative study of 3 days of azithromycin treatment and 10 days of cefuroxime treatment in exacerbations in patients with chronic obstructive pulmonary disease.]. Med Clin (Barc) 1999;113:124–128.[Medline] [Order article via Infotrieve]
  5. Sawae Y, Kashiwagi S, Kumagai Y, et al. [Clinical studies on the utility of ofloxacin for lower respiratory infections.]. Jpn J Antibiot 1991;44:48–57.[Medline] [Order article via Infotrieve]
  6. Faber M, Jahnz-Rózyk K, Targowski T, Mamelka B. [Comparative analysis of the effectiveness and costs of azithromycin and cefoperazone treatment of patients during COPD exacerbation.]. Pol Merkur Lekarski 2003;14:36–38.[Medline] [Order article via Infotrieve]
  7. Haanaes OC, Hansen G, Holten K, Vigander T. [Antibiotics in chronic bronchitis.]. Tidsskr Nor Laegeforen 1980;100:1902–1904.[Medline] [Order article via Infotrieve]
  8. Pham B, Klassen TP, Lawson ML, Moher D. Language of publication restrictions in systematic reviews gave different results depending on whether the intervention was conventional or complementary.. J Clin Epidemiol 2005;58:769–776.[Web of Science][Medline] [Order article via Infotrieve]
  9. Falagas ME, Fabritsi E, Chelvatzoglou FC, Rellos K. Penetration of the English language in science: the case of a German national interdisciplinary critical care conference.. Crit Care 2005;9:655–656.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  10. Falagas ME, Giannopoulou KP, Issaris EA, Spanos A. World databases of summaries of articles in the biomedical fields.. Arch Intern Med 2007;167:1204–1206.[Free Full Text]




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