Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia

Siempos, II; Vardakas, KZ; Manta, KG; Falagas, M.E.

doi:10.1183/09031936.00080206

Cited by 31 publications

(27 citation statements)

References 58 publications

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“…However, previous meta-analyses have reported that fluoroquinolones were associated with either more adverse outcomes compared with other antibiotics or no difference in toxicity was reported. [39][40][41][42][43] The findings of our meta-analysis about overall treatment success were similar to the results of a meta-analysis published in 2002. 44 However, only 3 of the trials included in that meta-analysis studied the effectiveness of the fluoroquinolones proposed in the 2007 guidelines.…”

Section: Discussionsupporting

confidence: 78%

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Vardakas¹,

Siempos²,

Grammatikos³

et al. 2008

Canadian Medical Association Journal

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CMAJ ResearchBackground: We investigated whether the use of respiratory fluoroquinolones was associated with better clinical outcomes compared with the use of macrolides and β-lactams among adults with pneumonia. Methods:We searched PubMed, Current Contents, Scopus, EMBASE, ClinicalTrials.gov and Cochrane with no language restrictions. Two reviewers independently extracted data from published trials that compared fluoroquinolones (levofloxacin, moxifloxacin, gemifloxacin) with macrolides or β-lactams or both. A meta-analysis was performed with the clinical outcomes of mortality, treatment success and adverse outcomes. Results:We included 23 trials in our meta-analysis. There was no difference in mortality among patients who received fluoroquinolones or the comparator antibiotics (OR 0.85, 95% CI 0.65-1.12). Pneumonia resolved in more patients who received fluoroquinolones compared with the comparator antibiotics for the included outcomes in the intention-to-treat population (OR 1.17, 95% CI 1.00-1.36), clinically evaluable population (OR 1.26, 95% CI 1.06-1.50) and the microbiologically assessed population (OR 1.67, 95% CI 1.28-2.20). Fluoroquinolones were more effective than a combination of β-lactam and macrolide (OR 1.39, 95% CI 1.02-1.90). They were also more effective for patients with severe pneumonia (OR 1.84, 95% CI 1.02-3.29), those who required admission to hospital (OR = 1.30, 95% CI 1.04-1.61) and those who required intravenous therapy (OR = 1.44, 15% CI 1.13-1.85). Fluoroquinolones were more effective than β-lactam and macrolide in open-label trials (OR = 1.35, 95% CI 1.08-1.69) but not in blinded randomized controlled trials (OR = 1.13, 95% CI 0.85-1.50).Interpretation: Fluoroquinolones were associated with higher success of treatment for severe forms of pneumonia; however, a benefit in mortality was not evident. A randomized controlled trial that includes patients with severe pneumonia with or without bacteremia is needed.

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Section: Discussionsupporting

confidence: 78%

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Vardakas¹,

Siempos²,

Grammatikos³

et al. 2008

Canadian Medical Association Journal

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“…Furthermore, early determination in the assessment of treatment success may have contributed to misclassification of outcome. 79 Second, it is evident that the observed higher mortality rate should be attributed to an open-label trial that studied the comparative effectiveness of linezolid and vancomycin for the treatment of patients with presumed or definitive gram-positive SSTIs and catheter-related bacteremia. 25 The removal of this trial from the analysis led to a result with no difference in mortality between comparators and vancomycin.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of Randomized Controlled Trials of Vancomycin for the Treatment of Patients With Gram-Positive Infections: Focus on the Study Design

Vardakas

Mavros

Roussos

et al. 2012

Mayo Clinic Proceedings

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Objective: To study the effectiveness and safety of vancomycin compared with that of other antibiotics for the treatment of gram-positive infections. Methods: Major electronic databases were searched. Data from published randomized controlled trials (January 1, 1950, to September 15, 2011 were pooled using a meta-analytic method. Results: Fifty-three trials comparing vancomycin with linezolid, daptomycin, quinupristin-dalfopristin, tigecycline, ceftaroline, ceftobiprole, telavancin, teicoplanin, iclaprim, and dalbavancin were included in the meta-analysis. Individual antibiotics were as effective as vancomycin, except for linezolid, which was more effective than vancomycin for the treatment of skin and soft tissue infections (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.07-2.43). Comparators were as effective as vancomycin in the intent-to-treat population (OR, 1.08; 95% CI, 0.98-1.18) but were more effective in the clinically evaluable population (OR, 1.14; 95% CI, 1.02-1.27) when all infections were pooled. When available data from all trials were pooled, no differences were noted when patients with febrile neutropenia (OR, 1.07; 95% CI, 0.82-1.39), pneumonia (OR, 1.10; 95% CI, 0.87-1.37), bacteremia (OR, 1.05; 95% CI, 0.76-1.45), and skin and soft tissue infections (OR, 1.11; 95% CI, 0.89-1.39) were studied. Comparators were more effective in open-label (OR, 1.28; 95% CI, 1.08-1.50) but not in double-blind trials (OR, 1.04; 95% CI, 0.90-1.20). Total adverse events attributed to studied antibiotics (OR, 1.07; 95% CI, 0.90-1.28) and patients withdrawn from trials (OR, 0.86; 95% CI, 0.68-1.09) were similar in the compared groups. Mortality was not different between vancomycin and comparator antibiotics when all trials were included in the analysis (OR, 1.09; 95% CI, 0.96-1.23). Comparators were associated with higher mortality in open-label (OR, 1.27; 95% CI, 1.05-1.54) but not double-blind trials (OR, 0.96; 95% CI, 0.80-1.14). Conclusion: On the basis mainly of data from open-label trials, vancomycin is a treatment choice that is as effective as other available antibiotics for patients with gram-positive infections. Study design seems to make a major contribution to the outcome.

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“…Thus, meta-analyses are consistently used as the basis for a grade A recommendation in clinical practice guidelines, including those dealing with antimicrobial therapy [4]. Convinced by the principles of evidence-based medicine, we attempted to perform several meticulous meta-analyses in the field of antimicrobial treatment for acute bacterial exacerbations of chronic bronchitis (ABECB) [1,5], as well as for other lower respiratory tract infections [6,7].…”

Section: Statement Of Interestmentioning

confidence: 99%

Meta-analysis may not be practicable for guiding antibiotic therapy

Chang¹,

Leung²

2008

European Respiratory Journal

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Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia

Cited by 31 publications

References 58 publications

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Meta-analysis of Randomized Controlled Trials of Vancomycin for the Treatment of Patients With Gram-Positive Infections: Focus on the Study Design

Meta-analysis may not be practicable for guiding antibiotic therapy

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