Normal view MARC view ISBD view

Fluoroquinolone-based versus beta lactam-based regimens for complicated intra-abdominal infections: a meta-analysis of randomized controlled trials. [Review]

MedStar author(s):

Citation: International Journal of Antimicrobial Agents. 2019 Jan 10PMID: 30639629Institution: MedStar Washington Hospital CenterDepartment: Surgery/General Surgery | Surgery/Trauma SurgeryForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2019 ISSN:

0924-8579

Name of journal: International journal of antimicrobial agentsAbstract: Complicated intra-abdominal infections (cIAIs) are common and confer significant morbidity, mortality, and cost. In this era of evolving antimicrobial resistance, selection of appropriate empiric antimicrobials is paramount. This systematic review and meta-analysis of randomized controlled trials compares the effectiveness and safety of fluoroquinolone (FQ) versus beta-lactam (BL)-based regimens for the treatment of patients with cIAIs. The primary outcomes were treatment success in the clinically-evaluable (CE) and all-cause mortality in the intention-to-treat (ITT) population. Subgroup analyses were performed based on specific antimicrobials, source of infection, and isolated pathogens. Seven trials (4125 patients) were included. FQ-based regimens included moxifloxacin (4 studies) or ciprofloxacin/metronidazole (3 studies); BL-based regimens were ceftriaxone/metronidazole (3 studies), carbapenems (2 studies), or piperacillin/tazobactam (2 studies). There was no difference in effectiveness in the CE [2883 patients, pooled risk ratio (RR) 1.00, 95% CI 0.95 - 1.04] or ITT population (3055 patients, RR 0.97 [0.94 - 1.01]); mortality (3614 patients, RR 1.04 [0.75 - 1.43]), and related adverse events (2801 patients, RR 0.97 [0.70 - 1.33]) were also similar. On subset analysis, moxifloxacin was slightly less effective than beta lactams in the CE (1934 patients, RR 0.96 [0.93 - 0.99]) and ITT population (1743 patients, RR 0.94 [0.91 - 0.98]). Although, fluoroquinolone-based and beta lactam-based regimens appear equally effective and safe for the treatment of patients with cIAIs, limited data suggests slightly inferior results with moxifloxacin. Selection of empiric coverage should be based on local bacterial epidemiology and patterns of resistance, as well as stewardship protocols.Copyright (c) 2019. Published by Elsevier B.V.All authors: Economopoulos KP, Falagas ME, Kyriakidou M, Mavros MN, Sava JA, Theochari NAFiscal year: FY2019Digital Object Identifier:

https://dx.doi.org/10.1016/j.ijantimicag.2019.01.004

Date added to catalog: 2019-01-18

Holdings ( 1 )
Title notes ( 3 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	30639629	Available		30639629

Complicated intra-abdominal infections (cIAIs) are common and confer significant morbidity, mortality, and cost. In this era of evolving antimicrobial resistance, selection of appropriate empiric antimicrobials is paramount. This systematic review and meta-analysis of randomized controlled trials compares the effectiveness and safety of fluoroquinolone (FQ) versus beta-lactam (BL)-based regimens for the treatment of patients with cIAIs. The primary outcomes were treatment success in the clinically-evaluable (CE) and all-cause mortality in the intention-to-treat (ITT) population. Subgroup analyses were performed based on specific antimicrobials, source of infection, and isolated pathogens. Seven trials (4125 patients) were included. FQ-based regimens included moxifloxacin (4 studies) or ciprofloxacin/metronidazole (3 studies); BL-based regimens were ceftriaxone/metronidazole (3 studies), carbapenems (2 studies), or piperacillin/tazobactam (2 studies). There was no difference in effectiveness in the CE [2883 patients, pooled risk ratio (RR) 1.00, 95% CI 0.95 - 1.04] or ITT population (3055 patients, RR 0.97 [0.94 - 1.01]); mortality (3614 patients, RR 1.04 [0.75 - 1.43]), and related adverse events (2801 patients, RR 0.97 [0.70 - 1.33]) were also similar. On subset analysis, moxifloxacin was slightly less effective than beta lactams in the CE (1934 patients, RR 0.96 [0.93 - 0.99]) and ITT population (1743 patients, RR 0.94 [0.91 - 0.98]). Although, fluoroquinolone-based and beta lactam-based regimens appear equally effective and safe for the treatment of patients with cIAIs, limited data suggests slightly inferior results with moxifloxacin. Selection of empiric coverage should be based on local bacterial epidemiology and patterns of resistance, as well as stewardship protocols.

English