Ertapenem versus piperacillin/tazobactam for the treatment of complicated infections: a meta-analysis of randomized controlled trials

Abstract

BackgroundErtapenem, a new carbapenem with a favorable pharmacokinetic profile, has been approved for the treatment of complicated intra-abdominal Infections (cIAIs), acute pelvic infections (APIs) and complicated skin and skin-structure infections (cSSSIs). The aim of this study is to compare the efficacy and safety of ertapenem with piperacillin/tazobactam, which has been reported to possess good efficacy for the treatment of these complicated infections.MethodsWe performed a meta-analysis of randomized controlled trials identified in PubMed, Cochrane library and Embase that compared the efficacy and safety of ertapenem with piperacillin/tazobactam for the treatment of complicated infections including cIAIs, APIs, cSSSIs. The primary efficacy outcome was clinical treatment success assessed at the test-of-cure visit. The primary safety outcome was drug related clinical and laboratory adverse events occurred during the treatment and the post-treatment period.ResultSix RCTs, involving 3161 patients, were included in our meta-analysis. Ertapenem was associated similar clinical treatment success with piperacillin/tazobactam for complicated infections treatment (clinically evaluable population, 1937 patients, odds ratios: 1.15, 95% confidence intervals: 0.89-1.49; modified intention to treat population, 2855 patients, odds ratios: 1.03, 95% confidence intervals: 0.87-1.22). All of secondary efficacy outcomes analysis obtained similar findings with clinical treatment success. No difference was found about the incidence of drug related adverse events between ertapenem and piperacillin/tazobactam groups.ConclusionThis meta-analysis provides evidence that ertapenem 1 g once a day can be used as effectively and safely as recommended dose of piperacillin/tazobactam, for the treatment of complicated infections, particularly of mild to moderate severity. It is an appealing option for the treatment of these complicated infections.

Piperacillin/tazobactam versus carbapenems in patients with severe bacterial infections: A systematic review with meta‐analysis

“…[8][9][10][11][12][13][14][15] However, only three reviews included RCTs, and none assessed the certainty of evidence. 14,15,20 Of these, only one had a patient-important primary outcome and assessed risk of bias, but only regarding random sequence generation, allocation concealment and blinding. 15 In contrary to our assessment, authors concluded that the results were not affected by risk of bias.…”

“…However, the mortality difference was less pronounced after excluding isolates non‐susceptible to piperacillin/tazobactam 7 . Previous systematic reviews comparing empirical or definitive treatment with β‐lactam/β‐lactamase inhibitors and carbapenems have demonstrated similar effects on mortality suggesting that piperacillin/tazobactam and other β‐lactam/β‐lactamase inhibitors may be safe alternatives to carbapenems 8–15 …”

“…7 Previous systematic reviews comparing empirical or definitive treatment with β-lactam/β-lactamase inhibitors and carbapenems have demonstrated similar effects on mortality suggesting that piperacillin/tazobactam and other β-lactam/β-lactamase inhibitors may be safe alternatives to carbapenems. [8][9][10][11][12][13][14][15] It is unclear if piperacillin/tazobactam is inferior to carbapenems for the empirical or definitive treatment of other severe bacterial infections. This systematic review compared the desirable and undesirable effects of empirical and/or definitive piperacillin/tazobactam versus carbapenems in patients with severe bacterial infections.…”

Descripción del uso de ertapenem en un hospital público de alta complejidad en Medellín, Colombia

“…Diversos ensayos clínicos han demostrado la no inferioridad de ertapenem en el resultado clínico y microbiológico en la terapia de las patologías en las que está indicado e incluso, han mostrado superioridad frente a los manejos tradicionales como ampicilina-sulbactam, ceftriazona y piperacilina-tazobactam en pacientes con infecciones intraabdominales y del tracto genitourinario [12][13][14][15][16][17][18]. Esta superioridad se ex-presa en términos del porcentaje de pacientes tratados exitosamente, respuesta microbiológica favorable, curación, el perfil de seguridad, la costoefectividad y la menor inducción de resistencia en los microorganismos susceptibles a desarrollarla y también de resistencia cruzada con otros betalactámicos y carbapenémicos [19].…”

Piperacillin/tazobactam vs carbapenems for patients with bacterial infection: Protocol for a systematic review

“…BLBLIs have previously been compared to carbapenems in systematic reviews with meta‐analyses in patients with bacteraemia with ESBL‐producing Enterobacteriaceae, severe infections, and complicated IAIs, APIs and SSIs . Most have suggested no difference in mortality between groups for both empirical and definitive treatments, proposing BLBLIs as a safe alternative to carbapenems for various severe infections . The effect of definitive treatment with piperacillin/tazobactam vs meropenem in patients with bacteraemia with ceftriaxone‐nonsusceptible Escherichia coli or Klebsiella species (spp.)…”