Efficacy and safety of tigecycline monotherapy versus combination therapy for the treatment of hospital-acquired pneumonia (HAP): a meta-analysis of cohort studies

Abstract

The broad spectrum antibiotic tigecycline shows promising efficacy against many multiple drug resistant (MDR) pathogens. However, its clinical efficacy in the treatment of hospital-acquired pneumonia (HAP) is unclear. Several studies have reported on the treatment failures of tigecycline monotherapy, suggesting that it may not be sufficient to control severe infections. Combination therapy has become an option to treat MDR bacterial infections. We conducted a literature search using PubMed, Cochrane Library, Embase, Elsevier and the Web of Knowledge databases up to 29 February 2017 to identify relevant published studies. Studies were considered eligible if they were a cohort study that assessed mortality and the safety of tigecycline monotherapy versus combination therapy with other antimicrobial agents for HAP. The primary outcome was treatment mortality rate, while the secondary outcomes were adverse events. Meta-analysis was done using fixed-effects models. Five trials were included. The monotherapy tigecycline had a higher mortality compared to the combination therapy group. There was a significant difference for the treatment of HAP. However, two prospective cohort studies showed that there was no significant difference in mortality rate between the tigecycline monotherapy and the tigecycline combination therapy. Three retrospective cohort studies showed that tigecycline monotherapy had a high mortality rate. Tigecycline combination therapy efficiently treats HAP. There is a great need for well-designed studies to evaluate the effectiveness and safety of combination therapies as they compare to tigecycline monotherapy.

The Clinical Outcomes and Safety of Tigecycline in Monotherapy or Combination with Cefoperazone/sulbactam for Carbapenem-Resistant Acinetobacter baumannii-Associated Pneumonia: A Multicenter Retrospective Study

“…Although we noticed that Food and Drugs Administration (FDA)-approved indications were only for cIAI, cSSSI, and CAP, not including HAP, due to ascended multidrug-resistant infections, TGC had been widely used for non-approved indications, among whom used in research related to CRAB HAP accounted for 1/3 [8]. A previous meta-analysis of 5 trials [19] analyzed the prognosis of patients with CRAB HAP receiving TGC monotherapy compared to those with TGC combination, no signi cant difference was from two prospective cohort studies (OR = 2.22, 95% CI 0.79-6.20, P = 0.13). Except for in-hospital mortality, Li Y et al [20] found that regimens containing TGC-CPS combination therapy patients with CRAB HAP were not superior to those with TGC monotherapy in clinical and microbiological e cacies.…”

<p>High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant <em>Acinetobacter baumannii</em> in Intensive Care Unit</p>

“…32 Our previous meta-analysis results indicated that there was no significant association between high dose of TGC and mortality. 33 A review study showed that mortality with highdose tigecycline in the cohort studies ranged from 8.3% to 26%, while mortality in the low-dose groups (50 mg q12 h) ranged from 8% to 61% and depended on the underlying infection severity. Available data are limited regarding the effectiveness and safety of high-dose tigecycline.…”

Protection of dopamine neurons by CDNF and neurturin variant N4 against MPP+ in dissociated cultures from rat mesencephalon

“…The need for the use of multiple agents to effectively treat a disease would not be unique. Indeed, it has proved essential for the treatment of many forms of cancer [77,78], HIV/AIDS [79], and pneumonia [80].…”