Once-Daily Aminoglycosides: A Meta-Analysis of Nonneutropenic and Neutropenic Adults

1998 ◽  
Vol 14 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Pramodini B Kale-Pradhan ◽  
Suzette R Habowski ◽  
Heather C Chase ◽  
Frank C Castronova
Keyword(s):  
Risk Ratio ◽  
Clinical Cure ◽  
Meta Analysis ◽  
Similar Efficacy ◽  
Separate Analysis ◽  
Once Daily ◽  
Medline Search ◽  
Neutropenic Patients ◽  
Vestibular Toxicity ◽  
To Receive

Objective: To compare the efficacy, nephrotoxicity, and ototoxicity of once-daily dosing of aminoglycosides versus conventional dosing. Design: Meta-analysis of 14 randomized trials identified through a MEDLINE search (January 1965-May 1996). Patients: Neutropenic and nonneutropenic adults. Interventions: Patients were randomly selected to receive an aminoglycoside once daily or in multiple daily doses. Measurements and Main Outcomes: The outcomes considered were clinical cure, bacteriologic cure, nephrotoxicity, auditory toxicity, and vestibular toxicity. The data were analyzed in the following subgroups: (1) all trials, (2) nonneutropenic patients, (3) neutropenic patients, and (4) patients with undefined neutrophil status. For all trials the pooled risk ratio was 1.268 (95% CI 0.828 to 1.939) for clinical cure, and was 1.390 (95% CI 1.350 to 1.392) for bacteriologic cure. Nephrotoxicity had a pooled risk ratio of 0.765 (95% CI 0.468 to 1.252), that for auditory toxicity was 1.117 (95% CI 0.151 to 5.636), and that for vestibular toxicity was 1.155 (95% CI 0.221 to 6.039). Analysis of the subgroups, including a separate analysis of neutropenic patients, demonstrated similar results. Conclusions: When all trials were considered, once-daily administration of aminoglycosides had similar efficacy and no increase in nephrotoxicity or ototoxicity compared with conventional aminoglycoside dosing.

scholarly journals Efficacy of antifibrotic drugs, nintedanib and pirfenidone, in treatment of progressive pulmonary fibrosis in both idiopathic pulmonary fibrosis (IPF) and non-IPF: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
James Patrick Finnerty ◽  
Aravind Ponnuswamy ◽  
Prosjenjit Dutta ◽  
Ammar Abdelaziz ◽  
Hafiz Kamil
Keyword(s):  
Pulmonary Fibrosis ◽  
Risk Ratio ◽  
Lung Fibrosis ◽  
Meta Analysis ◽  
Similar Efficacy ◽  
Separate Analysis ◽  
Antifibrotic Therapy ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Meta Analyses

Abstract Background Research questions To compare the efficacy of nintedanib and pirfenidone in the treatment of progressive pulmonary fibrosis; and to compare the efficacy of anti-fibrotic therapy (grouping nintedanib and pirfenidone together) in patients with IPF versus patients with progressive lung fibrosis not classified as IPF. Study design and methods A search of databases including MEDLINE, EMBASE, PubMed, and clinicaltrials.gov was conducted. Studies were included if they were randomised controlled trials of pirfenidone or nintedanib in adult patients with IPF or non-IPF patients, and with extractable data on mortality or decline in forced vital capacity (FVC). Random effects meta-analyses were performed on changes in FVC and where possible on mortality in the selected studies. Results 13 trials of antifibrotic therapy were pooled in a meta-analysis (with pirfenidone and nintedanib considered together as anti-fibrotic therapy). The change in FVC was expressed as a standardised difference to allow pooling of percentage and absolute changes. The mean effect size in the IPF studies was − 0.305 (SE 0.043) (p < 0.001) and in the non-IPF studies the figures were − 0.307 (SE 0.063) (p < 0.001). There was no evidence of any difference between the two groups for standardised rate of FVC decline (p = 0.979). Pooling IPF and non-IPF showed a significant reduction in mortality, with mean risk ratio of 07.01 in favour of antifibrotic therapy (p = 0.008). A separate analysis restricted to non-IPF did not show a significant reduction in mortality (risk ratio 0.908 (0.547 to 1.508), p = 0.71. Interpretation Anti-fibrotic therapy offers protection against the rate of decline in FVC in progressive lung fibrosis, with similar efficacy shown between the two anti-fibrotic agents currently in clinical use. There was no significant difference in efficacy of antifibrotic therapy whether the underlying condition was IPF or non-IPF with progressive fibrosis, supporting the hypothesis of a common pathogenesis. The data in this analysis was insufficient to be confident about a reduction in mortality in non-IPF with anti-fibrotic therapy. Trial Registration PROSPERO, registration number CRD42021266046.

Metoclopramide versus setrons in delayed emesis in moderate emetogenic chemotherapy: A meta-analysis

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20538-e20538
Author(s):  
K. Jordan ◽  
F. Mueller ◽  
A. Hinke ◽  
T. Behlendorf ◽  
P. Feyer ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Final Analysis ◽  
Similar Efficacy ◽  
Emetogenic Chemotherapy ◽  
Delayed Response ◽  
Apparent Difference ◽  
Delayed Emesis ◽  
Medline Search ◽  
Study Results ◽  
Antiemetic Guidelines

e20538 Background: In the actual antiemetic ASCO and MASCC guidelines 5-HT3-RAs but not metoclopramide (MCP) are recommended as prophylaxis option for delayed emesis (DE) in moderate emetogenic chemotherapy (MEC). However, MCP was part of the former guidelines in this setting. As there are no clear study results showing a consistent advantage of 5-HT3-RAs over MCP in delayed emesis a metaanalysis would give more conclusive informations. Methods: In a Medline search 15 potential studies comparing a 5-HT3-RA vs. MCP in DE in patients receiving MEC were identified. Efficacy was classified as complete delayed response (no vomiting 24h-120h after chemotherapy). In 4 studies insufficient data for discrimination of acute and delayed emesis were given and in 5 studies additional antiemetics in one arm or MCP/ 5-HT3-RA were administerd only on demand. For each indivudual study odds ratio was calculated. Combined odds ratios were generated according to the methods developed by the Peto group. Results: Six studies (N=700) could be included in the final analysis. The comparison of 5-HT3-RAs and MCP revealed similar efficacy in the prevention of DE in patients receiving MEC (OR fixed 1.01, 95% CI: 0.75, 1.36, OR random 1.26, 95% CI: 0.64, 2.46). A second analysis (N=895) including the study with additional dexamethasone application in the DE phase confirms no advantage of one drug over the another (OR fixed 1.02, 95% CI: 0.79, 1.22, OR random 1.19, 95% CI: 0.70, 2.04). Conclusions: This is the first meta-analysis of all available randomized trials comparing 5-HT3-RAs and MCP in the delayed phase of MEC demonstrating no apparent difference in efficacy. MCP is a less expensive alternative to setrons in this setting. However, the results of this meta-analysis have to be interpreted with cautious due to the potential carry over effect from the acute phase and heterogeneity of the included studies. Despite these limitations, it should be discussed to recommend MCP again for the propyhlaxis of delayed emesis for MEC when preparing the new antiemetic guidelines. No significant financial relationships to disclose.

Chrono-Pharmacological Study of Once Daily Curative Dose of a Low Molecular Weight Heparin (200IU antiXa/kg of Dalteparin) in Ten Healthy Volunteers

1995 ◽  
Vol 74 (02) ◽  
pp. 660-666 ◽  
Author(s):  
P Mismetti ◽  
J Reynaud ◽  
B Tardy-Poncet ◽  
S Laporte-Simitsidis ◽  
M Scully ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Healthy Volunteers ◽  
Low Molecular Weight Heparin ◽  
Pharmacological Study ◽  
Area Under The Curve ◽  
Factor Xa ◽  
Similar Efficacy ◽  
Low Molecular Weight ◽  
Thrombin Time ◽  
Once Daily

SummaryLow molecular weight heparin (LMWH) is currently prescribed for the treatment of deep vein thrombosis at the dose of 100 IU antiXa/kg twice daily or at a dose of 175 IU antiXa/kg once daily with a similar efficacy. We decided to study the chrono-pharmacology of curative dose of LMWH once daily administrated according to the one previously described with unfractionated heparin (UFH).Ten healthy volunteers participated in an open three-period crossover study according to three 24 h cycles, separated by a wash-out interval lasting 7 days: one control cycle without injection, two cycles with subcutaneous injection of 200 IU antiXa/kg of Dalteparin (Fragmin®) at 8 a.m. or at 8 p.m. Parameters of heparin activity were analysed as maximal values and area under the curve.Activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin time (PT) and tissue factor pathway inhibitor (TFPI) were higher after 8 p.m. injection than after 8 a.m. injection (p <0.05) while no chrono-pharmacological variation of anti factor Xa (AXa) activity was observed. Thus the biological anticoagulant effect of 200 IU antiXa/kg of Dalteparin seems to be higher after an evening injection than after a morning injection.A chrono-therapeutic approach with LMWH, as prescribed once daily, deserves further investigation since our results suggest that a preferential injection time may optimise the clinical efficacy of these LMWH.

scholarly journals Comparison of clinical efficacy and safety between dexmedetomidine and propofol among patients undergoing gastrointestinal endoscopy: a meta-analysis

2021 ◽  
Vol 49 (7) ◽  
pp. 030006052110327
Author(s):  
Weihua Liu ◽  
Wenli Yu ◽  
Hongli Yu ◽  
Mingwei Sheng
Keyword(s):  
Clinical Efficacy ◽  
Lower Risk ◽  
Gastrointestinal Endoscopy ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Similar Efficacy ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Inclusion Criteria ◽  
Weighted Mean

Objective To compare the clinical efficacy and safety of dexmedetomidine and propofol in patients who underwent gastrointestinal endoscopy. Methods Relevant studies comparing dexmedetomidine and propofol among patients who underwent gastrointestinal endoscopy were retrieved from databases such as PubMed, Embase, and Cochrane Library. Results Seven relevant studies (dexmedetomidine group, n = 238; propofol group, n = 239) met the inclusion criteria. There were no significant differences in the induction time (weighted mean difference [WMD] = 3.46, 95% confidence interval [CI] = −0.95–7.88, I2 = 99%) and recovery time (WMD = 2.74, 95% CI = −2.72–8.19, I2 = 98%). Subgroup analysis revealed no significant differences in the risks of hypotension (risk ratio [RR] = 0.56, 95% CI = 0.25–1.22) and nausea and vomiting (RR = 1.00, 95% CI = 0.46–2.22) between the drugs, whereas dexmedetomidine carried a lower risk of hypoxia (RR = 0.26, 95% CI = 0.11–0.63) and higher risk of bradycardia (RR = 3.01, 95% CI = 1.38–6.54). Conclusions Dexmedetomidine had similar efficacy and safety profiles as propofol in patients undergoing gastrointestinal endoscopy.

Quality of inpatient antimicrobial use in hematology and oncology patients

2021 ◽  
pp. 1-10
Author(s):  
Abby P. Douglas ◽  
Lisa Hall ◽  
Rodney S. James ◽  
Leon J. Worth ◽  
Monica A. Slavin ◽  
...  
Keyword(s):  
Marrow Transplant ◽  
Antifungal Prophylaxis ◽  
Neutropenic Fever ◽  
Antibacterial Prophylaxis ◽  
Separate Analysis ◽  
Prescribing Practices ◽  
Oncology Patients ◽  
Antimicrobial Prescribing ◽  
Using Data ◽  
To Receive

Abstract Objectives: To compare antimicrobial prescribing practices in Australian hematology and oncology patients to noncancer acute inpatients and to identify targets for stewardship interventions. Design: Retrospective comparative analysis of a national prospectively collected database. Methods: Using data from the 2014–2018 annual Australian point-prevalence surveys of antimicrobial prescribing in hospitalized patients (ie, Hospital National Antimicrobial Prescribing Survey called Hospital NAPS), the most frequently used antimicrobials, their appropriateness, and guideline concordance were compared among hematology/bone marrow transplant (hemBMT), oncology, and noncancer inpatients in the setting of treatment of neutropenic fever and antibacterial and antifungal prophylaxis. Results: In 454 facilities, 94,226 antibiotic prescriptions for 62,607 adult inpatients (2,230 hemBMT, 1,824 oncology, and 58,553 noncancer) were analyzed. Appropriateness was high for neutropenic fever management across groups (83.4%–90.4%); however, hemBMT patients had high rates of carbapenem use (111 of 746 prescriptions, 14.9%), and 20.2% of these prescriptions were deemed inappropriate. Logistic regression demonstrated that hemBMT patients were more likely to receive appropriate antifungal prophylaxis compared to oncology and noncancer patients (adjusted OR, 5.3; P < .001 for hemBMT compared to noncancer patients). Oncology had a low rate of antifungal prophylaxis guideline compliance (67.2%), and incorrect dosage and frequency were key factors. Compared to oncology patients, hemBMT patients were more likely to receive appropriate nonsurgical antibacterial prophylaxis (aOR, 8.4; 95% CI, 5.3–13.3; P < .001). HemBMT patients were also more likely to receive appropriate nonsurgical antibacterial prophylaxis compared to noncancer patients (OR, 3.1; 95% CI, 1.9–5.0; P < .001). However, in the Australian context, the hemBMT group had higher than expected use of fluoroquinolone prophylaxis (66 of 831 prescriptions, 8%). Conclusions: This study demonstrates why separate analysis of hemBMT and oncology populations is necessary to identify specific opportunities for quality improvement in each patient group.

scholarly journals 1578. Treatments for complicated urinary tract infections (cUTI) caused by multidrug resistant (MDR) Gram-negative (GN) pathogens- a systematic review and network meta-analysis (NMA)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S787-S787
Author(s):  
Tim Reason ◽  
Karan Gill ◽  
Christopher Longshaw ◽  
Rachael McCool ◽  
Katy Wilson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Economics ◽  
Meta Analysis ◽  
Treatment Options ◽  
Final Analysis ◽  
Similar Efficacy ◽  
Global Public Health ◽  
Efficacy And Safety ◽  
Support Unit ◽  
Tract Infections

Abstract Background Antimicrobial resistance is a major and growing threat to global public health. Cefiderocol (CFDC) is a new siderophore-cephalosporin with a wide activity spectrum covering all aerobic GN pathogens including all WHO critical priority pathogens, that was recently approved by FDA for the treatment of GN cUTI in susceptible organisms. We aim to understand the relative efficacy and safety of current treatment options for cUTI caused by MDR GN pathogens. Methods We conducted a systematic review to identify all relevant trials that investigated the efficacy and safety of antimicrobial regimens, for the treatment of GN pathogens in cUTI. Outcomes of interest included clinical cure and microbiological eradication (ME) at time of cure (TOC) and sustained follow up (SFU), and safety. Evidence networks were constructed using data for outcomes of interest and analyses were conducted in a frequentist framework using NMA methods outlined by the NICE decision support unit using the netmeta package in R. Results A total of 5 studies, 6 interventions and 2,349 randomised patients were included in the final analysis. Interventions included CFDC, imipenem-cilastatin (IPM-CIL), ceftazidime-avibactam (CAZ/AVI), doripenem (DOR), levofloxacin and ceftolozane-tazobactam (CEF/TAZ). Trials included predominantly Enterobacterales, and Pseudomonas aeruginosa and very few Acinetobacter baumannii. The patient population presented some clinical differences across trials, which were not adjusted for the NMA. Overall, there were numerical differences (especially in endpoints at SFU favouring CFDC), but all treatments showed similar efficacy and safety, with exception of higher ME rate at TOC for CFDC vs IPM, Table 1, also observed at SFU, consistent with the data from the individual clinical trial. Table 1- Results for microbiological eradication Table 1- Results for microbiological eradication Conclusion This NMA, showed superiority of CFDC vs IPM-CIL in ME at TOC and SFU and similar efficacy and safety vs all other comparators, with numeric differences favouring CFDC for outcomes at SFU. These traditional methodologies for NMA, are only valid within a similar pathogens pool and population across the trials, and may not reflect the full value of breadth of coverage that new therapeutic options bring for the treatment of MDR GN pathogens. Disclosures Tim Reason, PhD, Shionogi (Consultant) Karan Gill, MSc, Shionogi BV (Employee) Christopher Longshaw, PhD, Shionogi B.V. (Employee) Rachael McCool, PhD, York Health Economics Consortium (Employee, YHEC was commissioned by Shionogi to conduct the systematic review) Katy Wilson, PhD, York Health Economics Consortium (Employee, Shionogi commissioned YHEC to conduct the systematic review) Sara Lopes, PharmD, Shionogi BV (Employee)

Apixaban versus enoxaparin in patients with total knee arthroplasty

2011 ◽  
Vol 105 (02) ◽  
pp. 245-253 ◽  
Author(s):  
Jiahao Huang ◽  
Cun Liao ◽  
Liucheng Wu ◽  
Yunfei Cao ◽  
Feng Gao
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Major Bleeding ◽  
Safety Profile ◽  
Meta Analysis ◽  
Group Versus ◽  
Cochrane Central Register ◽  
Once Daily ◽  
Subcutaneous Enoxaparin ◽  
Total Knee

SummaryIt was the objective of this study to systematically compare the effects of apixaban versus enoxaparin in patients following total knee arthroplasty (TKA). A systematic search of Medline, EMBASE, Cochrane Central Register of Controlled Trials was conducted. Eligible studies were prospective, randomised control trials (RCT) of apixaban therapy, comparing with enoxaparin, in patients who have a high risk of venous thromboembolism (VTE) after TKA. Three RCTs involving 7,337 individuals were identified, of whom 4,057 were treated with apixaban 2.5 mg once daily, and 3280 were subcutaneous enoxaparin (40 mg once-daily or 30 mg twice-daily). Meta-analysis demonstrated the odds ratio (OR) for the composite of major VTE (proximal deep-vein thrombosis and pulmonary embolism) for apixaban versus enoxaparin was 0.47 (95% confidence interval [CI]: 0.27 to 0.82, 0.6% vs. 1.2%) and 2.09 (95%CI: 0.99 to 4.45, 0.6% vs. 0.3%), respectively. All-cause mortality occurred in 0.2% of the apixaban group versus 0.09% of the enoxaparin group (OR=1.74; 95%CI, 0.51 to 5.95). With respect to safety outcomes, apixaban was associated with a lower major bleeding rate than enoxaparin (OR=0.55, 95%CI: 0.32 to 0.96). No significant differences were detected between two strategies in other endpoints of safety profile analysed: clinically relevant non-major bleeding, raised hepatic transaminase enzyme or bilirubin concentrations and arterial thromboembolic events. In conclusion, apixaban is non-inferior to subcutaneous enoxaparin when used for the same duration, with considerable advantage regarding safety profile of major bleeding after TKA.

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