Meta-analysis: randomized controlled trials of clindamycin/aminoglycoside vs. beta-lactam monotherapy for the treatment of intra-abdominal infections.
OBJECTIVE
To compare the effectiveness and safety of clindamycin/aminoglycoside with broad-spectrum beta-lactam monotherapy in patients with intra-abdominal infections by performing a meta-analysis of randomized controlled trials (RCTs).


METHODS
The relevant 28 RCTS were retrieved from PubMed searches and reviewed by two reviewers independently.


RESULTS
beta-lactam monotherapy was more effective regarding cure of the infection than clindamycin/aminoglycoside (3177 clinically evaluable patients, fixed effects model, OR = 0.67, 95% CI: 0.55-0.81). The same result was found in several subset analyses. There was no difference in all-cause mortality and attributable-to-infection mortality [2382 intention-to-treat (ITT) patients, fixed effects model, OR = 1.25, 95% CI: 0.74-2.11 and 1976 ITT patients, OR = 1.19, 95% CI: 0.59-2.41, respectively]. There was no difference regarding overall adverse events and ototoxicity (1460 ITT patients, OR = 1.05, 95% CI: 0.80-1.37, and 1404 ITT patients, OR = 3.22, 95% CI: 0.72-14.45, respectively). However, treatment with clindamycin/aminoglycoside was more likely to be associated with nephrotoxicity compared to beta-lactam (3065 ITT patients, OR = 3.7, 95% CI: 2.09-6.57). Clindamycin/aminoglycoside was less likely to be associated with antibiotic-associated diarrhoea compared to beta-lactam (3050 ITT patients, OR = 0.68, 95% CI: 0.46-1.00).


CONCLUSIONS
The results of our meta-analysis suggest that beta-lactams are more effective in the treatment of intra-abdominal infections compared with clindamycin/aminoglycoside.
Falagas
M E
ME
Alfa Institute of Biomedical Sciences, Athens, Greece. m.falagas@aibs.gr
Matthaiou
D K
DK
Karveli
E A
EA
Peppas
G
G
D000617:Aminoglycosides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D004066:Digestive System Diseases / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D047090:beta-Lactams / Q000627:therapeutic use*
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D047090:beta-Lactams