Ciprofloxacin/metronidazole versus β-lactam-based treatment of intra-abdominal infections: a meta-analysis of comparative trials

Matthaiou, Dimitrios K.; Peppas, George; Bliziotis, Ioannis A.; Falagas, Matthew E.

doi:10.1016/j.ijantimicag.2006.04.005

Cited by 16 publications

(15 citation statements)

References 28 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: 89%

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: 89%

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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“…The five meta-analyses studying different antibiotic regimens for the treatment of intra-abdominal infections compared ertapenem with other antibiotic regimens, 50 clindamycin/aminoglycoside with b-lactam monotherapy, 55 ciprofloxacin/metronidazole with b-lactam based regimens, 65 aminoglycosides with other antibiotic regimens, 73 and meropenem with other antimicrobials. 79 Ertapenem was found to be as effective as other antimicrobials for the treatment of complicated intra-abdominal infections.…”

Section: Meta-analyses Focusing On Topics Other Than Antibiotic Prophmentioning

confidence: 99%

Meta-analysis on Surgical Infections

Matthaiou¹,

Peppas²,

Falagas³

2009

Infectious Disease Clinics of North America

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“…The small number of available trials and the variability in the specific fluoroquinolones and the comparator regimens used in these studies does not allow for a formal meta‐analysis regarding the overall clinical efficacy of fluoroquinolones when used in intra‐abdominal infections. However, as mentioned above, in a previous meta‐analysis of data from five comparative trials 35, 42, 43, 46, 47 we found that there was a statistically significant difference regarding cure of patients with intra‐abdominal infections in favour of the ciprofloxacin/metronidazole combination when compared with β ‐lactam‐based therapeutic regimens (OR = 1.69, 95% CI: 1.20–2.39) 1 . Nevertheless, in that study no statistically significant difference was found between the compared arms regarding all‐cause mortality or mortality attributable to infection.…”

Section: Evaluation Of the Available Datamentioning

confidence: 75%

“…Their pharmacokinetic and pharmacodynamic characteristics as well as their broad antimicrobial spectrum have been suggested to be good reasons to support their use for patients with intra‐abdominal infections either alone or in combination with other antimicrobial agents. In a recent meta‐analysis of comparative trials performed by our research group the combination of ciprofloxacin with metronidazole was compared with β ‐lactam‐based treatment for intra‐abdominal infections 1 . The pooling of the data suggested that ciprofloxacin/metronidazole combination may be superior to β ‐lactam‐based therapeutic regimens in the treatment of intra‐abdominal infections regarding cure of the infections, although no difference in mortality was found.…”

Section: Introductionmentioning

confidence: 99%

Systematic review: fluoroquinolones for the treatment of intra‐abdominal surgical infections

Falagas

Matthaiou

Bliziotis

2007

Aliment Pharmacol Ther

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Ciprofloxacin/metronidazole versus β-lactam-based treatment of intra-abdominal infections: a meta-analysis of comparative trials

Cited by 16 publications

References 28 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 on Surgical Infections

Systematic review: fluoroquinolones for the treatment of intra‐abdominal surgical infections

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