Reappraisal of Acetazolamide for the Prevention of Acute Mountain Sickness: A Systematic Review and Meta-Analysis

Abstract Kayser, Bengt, Lionel Dumont, Christopher Lysakowski, Christophe Combescure, Guy Haller, Martin R. Tramer. Reappraisal of acetazolamide for the prevention of acute mountain sickness: A systematic review and meta-analysis. High Alt. Med. Biol. 13:82–92.—Acetazolamide is used to prevent acute mountain sickness (AMS). We assessed efficacy and harm of acetazolamide for the prevention of AMS, and tested for dose-responsiveness. We systematically searched electronic databases (until April 2011) for randomized trials comparing acetazolamide with placebo for the prevention of AMS. For each dose, risk ratios were aggregated using a Mantel-Haenszel fixed effect model. Numbers needed to treat (NNT) to benefit one subject with each dose were calculated for different baseline risks. Modes of ascent were taken as proxies of baseline risks. Twenty-four trials were included; 1011 subjects received acetazolamide 250, 500, or 750 mg day−1; 854 received placebo. When climbing, median speed of ascent was 14 m/h, ave...