scholarly journals Intravenous colistin combination is superior to monotherapy against carbapenem-resistant gram-negative bacterial infections: evidence from seven randomized controlled trials

2019 ◽  
Author(s):  
Zhong-dong Li ◽  
Genzhu Wang ◽  
Zhikun Xun ◽  
Xiaoying Wang ◽  
Qiang Sun ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Randomized Controlled Trials ◽  
Subgroup Analysis ◽  
Bacterial Infections ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Combination Regimen ◽  
Gram Negative ◽  
Randomized Controlled ◽  
Carbapenem Resistant

Abstract Background Previous meta-analysis based on five randomized controlled trials (RCTs) did not display that intravenous colistin-based combination therapy is more efficacious than monotherapy against carbapenem resistant gram- negative bacterial infections. This meta-analysis aimed to further elucidate the efficacy.Methods PubMed, Embase, and Cochrane databases were searched up to March 2019 and only RCTs evaluating the combination therapy versus monotherapy against carbapenem or even colistin-resistant gram-negative bacteria infections were included. RevMan 5.3 was used to perform meta-analysis.Results Seven RCTs involving 859 patients were included. Total analysis showed that the combination therapy had a trend towards higher microbial response (RR, 1.21; 95% CI, 0.98 –1.51), lower infection-related mortality (RR, 0.75; 95% CI, 0.53–1.05), and significantly lower nephrotoxicity (RR, 0.77; 95% CI, 0.60 – 0.98) than monotherapy. Subgroup analysis on carbapenem-resistant A. baumannii infections displayed that the combination therapy had significantly higher microbiological response (RR, 1.39; P <0.001; 95% CI, 1.19–1.61). Another subgroup analysis on combination regimen for colistin plus rifampicin showed that the combination therapy had significantly higher eradication rate to carbapenem -resistant A. baumannii (RR, 1.35; 95% CI, 1.08–1.68). However, total and subgroup analysis showed no significant difference in all-cause mortality.Conclusions The present study suggests that intravenous colistin-based combination regimen, especially colistin plus rifampicin, may be superior to colistin alone against gram-negative bacterial infections, especially A. baumannii infection

scholarly journals Intravenous Colistin Monotherapy versus Combination Therapy against Carbapenem-Resistant Gram-Negative Bacteria Infections: Meta-Analysis of Randomized Controlled Trials

2018 ◽  
Vol 7 (8) ◽  
pp. 208 ◽  
Author(s):  
I-Ling Cheng ◽  
Yu-Hung Chen ◽  
Chih-Cheng Lai ◽  
Hung-Jen Tang
Keyword(s):  
Combination Therapy ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Randomized Controlled ◽  
Carbapenem Resistant ◽  
Significant Difference ◽  
All Cause Mortality

This meta-analysis aims to compare intravenous colistin monotherapy and colistin-based combination therapy against carbapenem-resistant gram-negative bacteria (GNB) infections. PubMed, Embase, and Cochrane databases were searched up to July 2018. Only randomized controlled trials (RCTs) evaluating colistin alone and colistin-based combination therapy in the treatment of carbapenem-resistant GNB infections were included. The primary outcome was all-cause mortality. Five RCTs including 791 patients were included. Overall, colistin monotherapy was associated with a risk ratio (RR) of 1.03 (95% confidence interval (CI), 0.89–1.20, I2 = 0%) for all-cause mortality compared with colistin-based combination therapy. The non-significant difference was also detected in infection-related mortality (RR, 1.23, 95% CI, 0.91–1.67, I2 = 0%) and microbiologic response (RR, 0.86, 95% CI, 0.72–1.04, I2 = 62%). In addition, no significant difference was observed in the subgroup analysis—high or low dose, with or without a loading dose, carbapenem-resistant Acinetobacter baumannii infections, and in combination with rifampicin. Finally, colistin monotherapy was not associated with lower nephrotoxicity than colistin combination therapy (RR, 0.98; 95% CI, 0.84–1.21, I2 = 0%). Based on the analysis of the five RCTs, no differences were found between colistin monotherapy and colistin-based combination therapy against carbapenem-resistant GNB infections, especially for A. baumannii infections.

scholarly journals Carbapenems vs β-Lactam Monotherapy or Combination Therapy for the Treatment of Complicated Intra-abdominal Infections: Systematic Review and Meta-analysis of Randomized Controlled Trials

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Yan Li ◽  
Lingyuan Chen ◽  
Junsong Jiang ◽  
Xianshu Li ◽  
Tianguo Huang ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Treatment Success ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Antibacterial Resistance ◽  
Randomized Controlled ◽  
Carbapenem Resistant ◽  
Abdominal Infections

Abstract Background Complicated intra-abdominal infections (cIAIs) result in significant morbidity, mortality, and cost. Carbapenem-resistant sepsis has increased dramatically in the last decade, resulting in infections that are difficult to treat and associated with high mortality rates. To prevent further antibacterial resistance, it is necessary to use carbapenem selectively. The objective of this study was to compare the effectiveness and safety of carbapenems vs alternative β-lactam monotherapy or combination therapy for the treatment of cIAIs. Methods The PubMed, Embase, Medline (via Ovid SP), and Cochrane library databases were systematically searched. We included randomized controlled trials (RCTs) comparing carbapenems vs alternative β-lactam monotherapy or combination therapy for the treatment of cIAIs. Results Twenty-two studies involving 7720 participants were included in the analysis. There were no differences in clinical treatment success (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.71–1.05; I2 = 35%), microbiological treatment success (OR, 0.88; 95% CI, 0.71–1.09; I2 = 25%), adverse events (OR, 0.98; 95% CI, 0.87–1.09; I2 = 17%), or mortality (OR, 0.96; 95% CI, 0.68–1.35; I2 = 7%). Patients treated with imipenem were more likely to experience clinical or microbiological failure than those treated with alternative β-lactam monotherapy or combination therapy. Conclusions No differences in clinical outcomes were observed between carbapenems and noncarbapenem β-lactams in cIAIs. Patients treated with imipenem were more likely to experience clinical or microbiological failure than those treated with alternative β-lactam monotherapy or combination therapy.

A Meta-Analysis of randomized controlled trials: Efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section

2021 ◽  
Author(s):  
Guanghao Zheng ◽  
Jianpin Liu ◽  
Jieyu Zhang ◽  
Fei Cao
Keyword(s):  
Cesarean Section ◽  
Randomized Controlled Trials ◽  
Subgroup Analysis ◽  
Lower Incidence ◽  
Meta Analysis ◽  
Neuraxial Anesthesia ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Randomized Controlled Studies

Abstract Objective Although ondansetron was considered to prevent post-anesthesia shivering during cesarean section, its efficiency remained controversial. Our review was conducted to estimate the efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section. Methods: The literature were searched from their inception to October 2020 without restriction of language. All randomized controlled trials investigating the efficacy of ondansetron versus placebo in preventing shivering during cesarean section under neuraxial anesthesia were included. The meta-analysis was conducted using Stata software. Results: Eleven randomized controlled studies with a total of 748 individuals were finally included in our meta-analysis. Our results manifested that intravenous ondansetron compared with intravenous placebo significantly reduced the incidence of PAS (RR: 0.53, 95% CI: 0.14 to 0.68). Subgroup analysis according to doses of ondansetron indicated that the efficacy of 4 mg doses of ondansetron(RR: 0.37, 95% CI: 0.21 to 0.64) is equivalent to that of 8 mg doses of ondansetron(RR: 0.61, 95% CI: 0.47 to 0.81) in preventing PAS. In addition, the intravenous ondansetron led to a lower incidence of hypotension than intravenous placebo(OR: 0.47, 95% CI: 0.32 to 0.70). We could not demonstrate differences in the incidence of bradycardia between intravenous ondansetron and intravenous placebo. Conclusion: Our results found that intravenous ondansetron was effective in preventing shivering during cesarean section under neuraxial anesthesia, and had an advantage in reducing the incidence of hypotension compared with intravenous placebo.

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