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Therapeutics
Review: sedative hypnotic agents reduce mortality and duration of delirium in the alcohol withdrawal syndrome

https://doi.org/10.1136/ebm.10.1.17

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    Mayo-Smith MF, Beecher LH, Fischer TL, et al. Management of alcohol withdrawal delirium: an evidence-based practice guideline. Arch Intern Med 2004;164:1405–12.
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 Q What is the optimal drug treatment for alcohol withdrawal delirium?

    Clinical impact ratings GP/FP/Primary Care ★★★★★☆☆ IM/Ambulatory care ★★★★★☆☆ Internal medicine ★★★★★☆☆

    METHODS

    Embedded ImageData sources:

    Medline (1966 to September 2001) and bibliographies of relevant studies, reviews, and textbooks.

    Embedded ImageStudy selection and assessment:

    prospective controlled trials on the management of patients meeting the DMS-IV criteria for alcohol withdrawal delirium.

    Embedded ImageOutcomes:

    mortality, duration of delirium, time required for control of agitation, proportion with adequate control of delirium, and treatment complications.

    MAIN RESULTS

    9 controlled trials were included. Publication dates ranged from 1959–78. 5 trials (n = 386) compared sedative hypnotic agents with neuroleptic drugs and evaluated mortality. The sedative hypnotic drugs were paraldehyde, diazepam, chlordiazepoxide, and pentobarbital (1 trial combined chloral hydrate with paraldehyde). The neuroleptic drugs were chlorpromazine, promazine, and perphenazine (1 trial combined chloral hydrate with promazine). Of the 2 …

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    Footnotes

    • For correspondence: Dr M F Mayo-Smith, Veterans Administration Medical Center, Manchester, NH, USA. Michael.Mayo-Smith{at}med.va.gov

    • Sources of funding: American Society of Addiction Medicine and Stepping Stones Foundation.