beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for fever with neutropenia: systematic review and meta-analysis
- 22 May 2003
- Vol. 326 (7399), 1111
- https://doi.org/10.1136/bmj.326.7399.1111
Abstract
Objective To compare the effectiveness of β lactam monotherapy versus β lactam-aminoglycoside combination therapy in the treatment of patients with fever and neutropenia. Data sources Medline, Embase, Lilacs, the Cochrane Library, and conference proceedings to 2002. References of included studies and contact with authors. No restrictions on language, year of publication, or publication status. Study selection All randomised trials of β lactam monotherapy compared with β lactam-minoglycoside combination therapy as empirical treatment for patients with fever and neutropenia. Data selection Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. An intention to treat approach was used. Relative risks were pooled with the random effect model. Main outcome measure All cause fatality. Results Forty seven trials with 7807 patients met inclusion criteria. Nine trials compared the same β lactam. There was no significant difference in all cause fatality (relative risk 0.85, 95% confidence interval 0.72 to 1.02). For success of treatment there was a significant advantage with monotherapy (0.92, 0.85 to 0.99), though there was considerable heterogeneity among trials. There was no significant difference between monotherapy and combination treatment in trials that compared the same β lactam, whereas there was major advantage with monotherapy in trials that compared different β lactams (0.87, 0.80 to 0.93). Rates of superinfection were similar. Adverse events, including those associated with severe morbidity, were significantly more common in the combination treatment group. Detected flaws in methods did not affect results. Conclusions For patients with fever and neutropenia there is no clinical advantage in treatment with β lactam-aminoglycoside combination therapy. Broad spectrum β lactams as monotherapy should be regarded as the standard of care for such patients.Keywords
This publication has 15 references indexed in Scilit:
- 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with CancerClinical Infectious Diseases, 2002
- Single versus combination intravenous antibiotic therapy for people with cystic fibrosisPublished by Wiley ,2001
- Empirical Evidence of BiasJAMA, 1995
- Ceftazidime Combined with a Short or Long Course of Amikacin for Empirical Therapy of Gram-Negative Bacteremia in Cancer Patients with GranulocytopeniaNew England Journal of Medicine, 1987
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986
- A Randomized Trial Comparing Ceftazidime Alone with Combination Antibiotic Therapy in Cancer Patients with Fever and NeutropeniaNew England Journal of Medicine, 1986
- Randomized comparison between two ceftazidime-containing regimens and cephalothin-gentamicin-carbenicillin in febrile granulocytopenic cancer patientsAntimicrobial Agents and Chemotherapy, 1986
- Prospective randomized comparison of three antibiotic regimens for empirical therapy of suspected bacteremic infection in febrile granulocytopenic patientsAntimicrobial Agents and Chemotherapy, 1986
- In vitro synergistic activities of aminoglycosides and new beta-lactams against multiresistant Pseudomonas aeruginosaAntimicrobial Agents and Chemotherapy, 1984
- Empiric Therapy with Carbenicillin and Gentamicin for Febrile Patients with Cancer and GranulocytopeniaNew England Journal of Medicine, 1971