Fluoroquinolone-based versus beta lactam-based regimens for complicated intra-abdominal infections: a meta-analysis of randomized controlled trials. [Review]
- 2019
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.