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Aminoglycosides for intra-abdominal infection: equal to the challenge?
Jeffrey A Bailey1, Katherine S Virgo, Joseph T DiPiro
1Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri 63110, USA. baileyja@slu.edu
Background:
Aminoglycosides, combined with antianaerobic agents, have been used widely for the treatment of intra-abdominal infection. However, some prospective randomized controlled trials and other data suggested that aminoglycosides were less efficacious than newer comparators for the treatment of these infections. We therefore performed a meta-analysis of all prospective randomized controlled trials utilizing aminoglycosides to reevaluate the efficacy of these agents for the treatment of intra-abdominal infection.
Methods:
Published English-language prospective randomized controlled trials comparing aminoglycosides with other agents for treatment of intra-abdominal infection were identified by MEDLINE search. For each study, data were collected regarding the number of patients enrolled and evaluated, their basic demographic characteristics, the sources of the intra-abdominal infections, the number of failures as determined by the study investigators, quality score, and the use of serum drug concentrations to monitor aminoglycoside therapy. These data were combined to calculate odds ratios for risk of therapeutic failure, which were assessed for significance using Chi-square analysis.
Results:
Forty-seven prospective randomized controlled trials comparing aminoglycosides to other agents were identified. These were published between 1981 and 2000, and included a total of 5,182 evaluable patients. Analysis of all studies combined revealed an odds ratio that slightly, but significantly, favored the comparators. After excluding six trials using comparators that lacked accepted antianaerobic efficacy, the odds ratio more strongly favored comparators. Trials published since 1990 also notably favored comparators. Analyzing results by quality score or the use of aminoglycoside monitoring did not alter these findings.
Conclusions:
In this meta-analysis, aminoglycosides were less efficacious than newer comparators for the treatment of intra-abdominal infection. Given the well-known toxicities of these agents, we conclude that they should not be used as first-line therapy for these infections.
Insights
Aminoglycosides are less effective than newer treatments for intra-abdominal infections. Due to their toxicity, these antibiotics should not be a primary choice for treating these serious infections.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Aminoglycosides combined with antianaerobic agents are common for intra-abdominal infections.
- Emerging data suggest aminoglycosides may be less effective than newer treatments.
- A meta-analysis was conducted to re-evaluate aminoglycoside efficacy.
Purpose of the Study:
- To systematically re-evaluate the efficacy of aminoglycosides for intra-abdominal infections.
- To compare aminoglycosides against newer therapeutic agents.
- To inform clinical guidelines regarding first-line treatment options.
Main Methods:
- A meta-analysis of prospective randomized controlled trials was performed.
- Studies were identified via MEDLINE search, focusing on English-language publications.
- Data on patient numbers, infection sources, treatment failures, and monitoring were analyzed using odds ratios and Chi-square analysis.
Main Results:
- Forty-seven trials including 5,182 patients were analyzed.
- Aminoglycosides showed significantly lower efficacy compared to newer agents.
- Excluding trials with inadequate antianaerobic comparators strengthened this finding; recent trials also favored comparators.
Conclusions:
- Aminoglycosides are less efficacious than newer comparators for intra-abdominal infections.
- Considering their known toxicities, aminoglycosides should not be considered first-line therapy.
- This meta-analysis supports a shift towards alternative treatments for intra-abdominal infections.