International journal of antimicrobial agents
-
Int. J. Antimicrob. Agents · Dec 2013
Review Meta Analysis Comparative StudyCombination antibiotic therapy versus monotherapy for Pseudomonas aeruginosa bacteraemia: a meta-analysis of retrospective and prospective studies.
The choice of antibiotic monotherapy or combination therapy to treat Pseudomonas aeruginosa bacteraemia is controversial. The aim of this review was to compare both types of therapy to determine which delivers the best outcome for P. aeruginosa bacteraemia. We systematically searched electronic bibliographic databases, including PubMed, Ovid EMBASE and The Cochrane Library, for clinical studies that compared combination therapy with monotherapy in the treatment of P. aeruginosa bacteraemia. ⋯ We found no difference between combination therapy and monotherapy when the data were combined (odds ratio = 0.89, 95% confidence interval 0.57-1.40; P = 0.614) or when data were analysed in subgroups. Neither combination therapy nor monotherapy treatment appears to have a significant effect on mortality rates in patients with P. aeruginosa bacteraemia. Further studies evaluating the effects of combination therapy or monotherapy in more specialised cases, such as when encountering a multidrug-resistant organism, are necessary.
-
Int. J. Antimicrob. Agents · Apr 2013
Review Meta Analysisβ-Lactam plus aminoglycoside or fluoroquinolone combination versus β-lactam monotherapy for Pseudomonas aeruginosa infections: a meta-analysis.
The objective of this review was to compare the effectiveness and safety of β-lactam combined with aminoglycoside or fluoroquinolone with that of β-lactam monotherapy for the treatment of Pseudomonas aeruginosa infections. We searched Scopus and PubMed databases and synthesised the outcomes of the individual studies in a meta-analysis. Both non-randomised studies and randomised controlled trials (RCTs) that evaluated outcomes of patients with P. aeruginosa infections receiving treatment with β-lactams alone or in combination with an aminoglycoside or a fluoroquinolone were included. ⋯ There was no difference in clinical cure either for RCTs (1.29, 0.91-1.83) or for non-randomised studies (1.18, 0.97-1.45). In conclusion, no benefit in mortality was observed in patients receiving combination therapy for P. aeruginosa infections. A well-designed multicentre RCT is warranted to address this important issue.
-
Int. J. Antimicrob. Agents · Jul 2010
Randomized Controlled Trial Meta Analysis Comparative StudyMoxifloxacin monotherapy versus beta-lactam-based standard therapy for community-acquired pneumonia: a meta-analysis of randomised controlled trials.
The aim of this study was to compare more conclusively the efficacy and safety of moxifloxacin, a new respiratory fluoroquinolone antibiotic, with beta-lactam-based standard therapy, which has been reported to possess good efficacy for community-acquired pneumonia (CAP). A meta-analysis of randomised controlled trials (RCTs) identified in PubMed, the Cochrane Library and Embase was performed. Seven RCTs, involving 3903 patients, were included in the meta-analysis. ⋯ No difference was found regarding the incidence of adverse events and serious adverse events between moxifloxacin and beta-lactam-based standard therapy. This meta-analysis provides evidence that moxifloxacin not only can be used as effectively and safely as beta-lactam-based standard therapy for CAP but also possesses a favourable pathogen eradication rate. The once-daily dosing of moxifloxacin monotherapy may be a useful alternative for beta-lactam-based standard therapy.
-
Int. J. Antimicrob. Agents · Sep 2006
Review Meta Analysis Comparative StudyCiprofloxacin/metronidazole versus beta-lactam-based treatment of intra-abdominal infections: a meta-analysis of comparative trials.
Intra-abdominal infections are polymicrobial and result in substantial morbidity and mortality. The combination of ciprofloxacin/metronidazole as well as several beta-lactam-based regimens are among the commonly used regimens for the treatment of patients with such infections. Thus, we sought to review the evidence from available comparative clinical trials studying ciprofloxacin/metronidazole versus broad-spectrum beta-lactam-based regimens in the treatment of intra-abdominal infections. ⋯ There was a statistically significant difference between the compared arms with regard to cure in favour of the ciprofloxacin/metronidazole combination (odds ratio (OR)=1.69, 95% confidence interval (CI) 1.20-2.39). There was no statistically significant difference between the compared arms with regard to total mortality (OR=1.10, 95% CI 0.71-1.69), mortality attributable to infection (OR=1.42, 95% CI 0.66-3.06) and toxicity (OR=1.25, 95% CI 0.66-2.35). In conclusion, pooled data from the available comparative trials suggest that the ciprofloxacin/metronidazole combination may be superior to beta-lactam-based therapeutic regimens in the treatment of intra-abdominal infections with regard to cure of infections, although no difference in mortality was found.