Safety, Efficacy of PB for AWS Are Unclear

Background: Phenobarbital (PB) maintains a position on the treatment algorithm for alcohol withdrawal syndrome (AWS) despite mixed or unclear evidence supporting its role as an alternative therapy. Objective: To compare the safety and efficacy of PB to benzodiazepines (BZD) for the treatment of AWS in the emergency department (ED). Design: Systematic review and meta-analysis. Methods: A comprehensive search of medical databases from inception through May 2022 was conducted to evaluate the published literature. The authors searched specifically for randomized controlled trials (RCTs) and cohort studies comparing treatment with PB to BZD controls. Nonalcohol-related conditions were excluded. The review was conducted by 2 blinded investigators in addition to a third author. Presence or absence of treatment effects was evaluated through the identification of utilization, pharmacologic, and clinical outcomes. The primary outcome measures were the proportion of patients in withdrawal who w more...