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Meta‐analysis: randomized controlled trials of clindamycin/aminoglycoside vs. β‐lactam monotherapy for the treatment of intra‐abdominal infections

2007; Wiley; Volume: 25; Issue: 5 Linguagem: Inglês

10.1111/j.1365-2036.2006.03240.x

1365-2036

Matthew E. Falagas, Dimitrios K. Matthaiou, E. A. Karveli, George Peppas,

Antibiotic Resistance in Bacteria

Summary Aim To compare the effectiveness and safety of clindamycin/aminoglycoside with broad‐spectrum β‐lactam monotherapy in patients with intra‐abdominal infections by performing a meta‐analysis of randomized controlled trials (RCTs). Methods The relevant 28 RCTS were retrieved from PubMed searches and reviewed by two reviewers independently. Results β‐lactam monotherapy was more effective regarding cure of the infection than clindamycin/aminoglycoside (3177 clinically evaluable patients, fixed effects model, OR = 0.67, 95% CI: 0.55–0.81). The same result was found in several subset analyses. There was no difference in all‐cause mortality and attributable‐to‐infection mortality [2382 intention‐to‐treat (ITT) patients, fixed effects model, OR = 1.25, 95% CI: 0.74–2.11 and 1976 ITT patients, OR = 1.19, 95% CI: 0.59–2.41, respectively]. There was no difference regarding overall adverse events and ototoxicity (1460 ITT patients, OR = 1.05, 95% CI: 0.80–1.37, and 1404 ITT patients, OR = 3.22, 95% CI: 0.72–14.45, respectively). However, treatment with clindamycin/aminoglycoside was more likely to be associated with nephrotoxicity compared to β‐lactam (3065 ITT patients, OR = 3.7, 95% CI: 2.09–6.57). Clindamycin/aminoglycoside was less likely to be associated with antibiotic‐associated diarrhoea compared to β‐lactam (3050 ITT patients, OR = 0.68, 95% CI: 0.46–1.00). Conclusion The results of our meta‐analysis suggest that β‐lactams are more effective in the treatment of intra‐abdominal infections compared with clindamycin/aminoglycoside.