Meta-analysis: ertapenem for complicated intra-abdominal infections.
BACKGROUND
Ertapenem is a new member of the carbapenem class of antibiotics, with a favourable pharmacokinetic profile, but a narrower spectrum of antimicrobial activity, compared with older representatives of this class.


OBJECTIVE
To evaluate the effectiveness and safety of ertapenem for treatment of complicated intra-abdominal infections.


METHODS
We performed a meta-analysis of randomized-controlled trials identified in PubMed, Cochrane and Scopus that compared ertapenem with other antimicrobial regimens, in patients of all ages, with complicated intra-abdominal infections. The primary outcomes evaluated were clinical success (cure or improvement) in the modified intention-to-treat population and clinical adverse events.


RESULTS
Six randomized-controlled trials involving patients with complicated intra-abdominal infections, mainly of mild-to-moderate severity (three with a double-blind design; one performed in children) that compared ertapenem treatment (once daily) against piperacillin/tazobactam, ceftriaxone plus metronidazole and ticarcillin/clavulanic acid (in three, two and one randomized-controlled trials respectively) were included. No difference was found between adult patients with complicated intra-abdominal infections treated with ertapenem vs. comparators, regarding clinical success (five randomized-controlled trials, 2002 patients, fixed-effect model, odds ratio: 1.11, 95% confidence interval (CI): 0.89-1.39); clinical adverse events (four randomized-controlled trials, 1530 patients, fixed-effect model, OR: 0.86, 95% CI: 0.61-1.20); microbiological success; mortality and withdrawals because of adverse events. Ertapenem was associated with more laboratory adverse events (four randomized-controlled trials, 1530 patients, fixed-effect model, OR: 1.73, 95% CI: 1.14-2.61), but none was reported as serious.


CONCLUSIONS
This meta-analysis provides additional evidence that ertapenem can be used as effectively and safely, as other recommended antimicrobial regimens, for the treatment of complicated intra-abdominal infections, particularly of mild-to-moderate severity.
Falagas
M E
ME
Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece. m.falagas@aibs.gr
Peppas
G
G
Makris
G C
GC
Karageorgopoulos
D E
DE
Matthaiou
D K
DK
D000005:Abdomen; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D000077727:Ertapenem; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D047090:beta-Lactams / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000077727:Ertapenem