Meta-analysis: randomized controlled trials of clindamycin/aminoglycoside vs. β-lactam monotherapy for the treatment of intra-abdominal infections

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Abstract

Aim

To compare the effectiveness and safety of clindamycin/aminoglycoside with broad-spectrum β-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

β-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 β-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 β-lactam (3050 ITT patients, OR = 0.68, 95% CI: 0.46–1.00).

Conclusion

The results of our meta-analysis suggest that β-lactams are more effective in the treatment of intra-abdominal infections compared with clindamycin/aminoglycoside.

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