Aminoglycosides for intra-abdominal infection: equal to the challenge?
BACKGROUND
Aminoglycosides, combined with antianaerobic agents, have been used widely for the treatment of intra-abdominal infection. However, some prospective randomized controlled trials and other data suggested that aminoglycosides were less efficacious than newer comparators for the treatment of these infections. We therefore performed a meta-analysis of all prospective randomized controlled trials utilizing aminoglycosides to reevaluate the efficacy of these agents for the treatment of intra-abdominal infection.


METHODS
Published English-language prospective randomized controlled trials comparing aminoglycosides with other agents for treatment of intra-abdominal infection were identified by MEDLINE search. For each study, data were collected regarding the number of patients enrolled and evaluated, their basic demographic characteristics, the sources of the intra-abdominal infections, the number of failures as determined by the study investigators, quality score, and the use of serum drug concentrations to monitor aminoglycoside therapy. These data were combined to calculate odds ratios for risk of therapeutic failure, which were assessed for significance using Chi-square analysis.


RESULTS
Forty-seven prospective randomized controlled trials comparing aminoglycosides to other agents were identified. These were published between 1981 and 2000, and included a total of 5,182 evaluable patients. Analysis of all studies combined revealed an odds ratio that slightly, but significantly, favored the comparators. After excluding six trials using comparators that lacked accepted antianaerobic efficacy, the odds ratio more strongly favored comparators. Trials published since 1990 also notably favored comparators. Analyzing results by quality score or the use of aminoglycoside monitoring did not alter these findings.


CONCLUSIONS
In this meta-analysis, aminoglycosides were less efficacious than newer comparators for the treatment of intra-abdominal infection. Given the well-known toxicities of these agents, we conclude that they should not be used as first-line therapy for these infections.
Bailey
Jeffrey A
JA
Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri 63110, USA. baileyja@slu.edu
Virgo
Katherine S
KS
DiPiro
Joseph T
JT
Nathens
Avery B
AB
Sawyer
Robert G
RG
Mazuski
John E
JE
D000005:Abdomen; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004066:Digestive System Diseases / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents