Role of glycopeptides as part of initial empirical treatment of febrile neutropenic patients: a meta-analysis of randomised controlled trials.
We did a meta-analysis of randomised controlled trials studying glycopeptides as part of the initial empirical treatment of febrile neutropenic patients with a beta-lactam and with or without an aminoglycoside. 14 randomised controlled trials that studied 2413 patients were included in the analysis. A better outcome regarding treatment success, without modification of the initial regimen, was accomplished with the inclusion of a glycopeptide in the empirical therapy; this better outcome applied to the full set of studied patients (OR=1.63, 95% CI 1.17-2.28), as well as in three important subsets of patients--those with microbiologically documented infections (2.03, 1.39-2.97), patients with bacteraemia (1.80, 1.23-2.63), and patients with severe neutropenia, defined as a white blood cell count below 100 cells/microL (2.24, 1.15-4.39). However, mortality was not different in the compared groups (0.67, 0.42-1.05). Overall treatment success was not different if a glycopeptide was added to the antimicrobial regimen in the case of continuation of fever 72 hours or more after the start of treatment (1.02, 0.68-1.52). Also, the inclusion of a glycopeptide in the empirical regimen did not lead to a difference regarding time to defervesence. Adverse effects (4.98, 2.91-8.55), including nephrotoxicity (2.10, 1.12-3.95), were more common in the group receiving a glycopeptide as part of the empirical treatment. In conclusion, our meta-analysis suggests that there are good reasons why glycopeptides should not be routinely used as part of the initial empirical treatment of febrile neutropenic patients.
Vardakas
Konstantinos Z
KZ
Alfa Institute of Biomedical Sciences, Athens, Greece.
Samonis
George
G
Chrysanthopoulou
Stavroula A
SA
Bliziotis
Ioannis A
IA
Falagas
Matthew E
ME
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006020:Glycopeptides / Q000627:therapeutic use*; D006801:Humans; D009503:Neutropenia / Q000150:complications; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents; D006020:Glycopeptides