scholarly journals Clarithromycin versus Amoxicillin alone or with Clavulanate in Acute Maxillary Sinusitis: A Meta-analysis of Clinical Trials

2021 ◽  
Vol 13 (1) ◽  
pp. 1-9
Author(s):  
Daryl J. Hoban ◽  
Jos Nauta
Keyword(s):  
Drug Treatment ◽  
Clinical Success ◽  
Maxillary Sinusitis ◽  
Meta Analysis ◽  
Study Drug ◽  
Total Daily Dose ◽  
Success Rates ◽  
Rate Difference ◽  
Daily Dose ◽  
Cure Rates

Objective: A meta-analysis was performed to explore the relative effects of clarithromycin and amoxicillin (with or without clavulanate potassium) in the treatment of acute maxillary sinusitis. Methods: Six studies were identified in the peer-reviewed literature. All were randomized single-blind (investigator-blind) or open-label trials in outpatients diagnosed with acute maxillary sinusitis. A total of 1580 patients were enrolled, of whom 1194 were clinically evaluable. The total daily dose of clarithromycin was 1000 mg; the total daily dose of amoxicillin (with or without clavulanate potassium) was either 1500 or 2000 mg. The duration of study drug treatment varied from 8 to 14 days. Endpoints comprised clinical and radiological success within 48 h of the end of study drug treatment plus bacteriologic cure and eradication. Success and cure rate differences were analyzed using fixed- and random-effect models. The absence of between-study heterogeneity was tested using Cochran’s Q-test. Results: Clinical success rates varied between 85.8% and 97.9% for clarithromycin and between 84.2% and 96.8% for amoxicillin. The combined rate difference in clinical success rates between clarithromycin and amoxicillin was +1.9% (P=0.14). Radiological success rates (four studies) varied from 78.2% to 94.0% for clarithromycin and 79.7% to 95.0% for amoxicillin, with a combined rate difference of zero (P=1.00). Bacteriologic cure rates (four studies) were 87.1–94.6% for clarithromycin, compared with 89.8–98.1% for amoxicillin, with a combined difference in cure rates of –3.2% (P=0.16). Overall bacterial eradication rates were comparable between the two treatments (clarithromycin, 89.3%; amoxicillin, 92.1%). Conclusion: These data, with their limitations properly acknowledged, identify clarithromycin as a valid and viable alternative to amoxicillin for the treatment of acute maxillary sinusitis in adults.

Efficacy and Safety of a Novel, Single-dose Azithromycin Microsphere Formulation Versus 10 Days of Levofloxacin for the Treatment of Acute Bacterial Sinusitis in Adults

2005 ◽  
Vol 133 (2) ◽  
pp. 194-200 ◽  
Author(s):  
John J. Murray ◽  
Paz Emparanza ◽  
Eugenijus Lesinskas ◽  
Margaret Tawadrous ◽  
Jeanne D. Breen
Keyword(s):  
Single Dose ◽  
Clinical Success ◽  
Maxillary Sinusitis ◽  
Efficacy And Safety ◽  
Success Rates ◽  
Radiographic Evidence ◽  
Double Blind ◽  
Acute Bacterial Sinusitis ◽  
Cure Rates ◽  
International Multicenter

Objective To compare the efficacy and safety of a single 2.0-g dose of a novel azithromycin microsphere formulation with that of 10 days of levofloxacin, 500 mg/d, when used to treat adults with uncomplicated acute bacterial maxillary sinusitis (ABS). Study Design and Setting An international, multicenter, randomized, double-blind, double-dummy trial. Eligible outpatients ≥18 years of age with clinical and radiographic evidence of ABS underwent maxillary sinus aspiration before randomization. Primary endpoint was clinical efficacy at the test-of-cure visit (day 17-24). Results Clinical success rates were 94.5% (242/256) in azithromycin-microspheres-treated patients and 92.8% (233/251) in the levofloxacin group. In patients with documented Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, clinical cure rates were 97.3% (36/37), 96.3% (26/27), and 100% (8/8), respectively, for the azithromycin group and 92.3% (36/39), 100% (30/30), and 90.9% (10/11), respectively, for the levofloxacin group. Conclusions Single-dose azithromycin microspheres provided clinical and bacteriologic efficacy and safety comparable to 10 days of levofloxacin. Significance A novel microsphere formulation of azithromycin given as a single dose was safe and effective for the treatment of ABS.

scholarly journals Evaluating the clinical effectiveness of new beta-lactam/beta-lactamase inhibitor combination antibiotics: A systematic literature review and meta-analysis

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Geneva M. Wilson ◽  
Margaret A. Fitzpatrick ◽  
Kyle Walding ◽  
Beverly Gonzalez ◽  
Marin L. Schweizer ◽  
...  
Keyword(s):  
Clinical Success ◽  
Meta Analysis ◽  
Strong Association ◽  
Study Drug ◽  
Clinical Effectiveness ◽  
Multidrug Resistant ◽  
New Combination ◽  
Beta Lactam ◽  
Combination Antibiotics ◽  
Lactamase Inhibitor

Abstract Background: Ceftazidime/avibactam (C/A), ceftolozane/tazobactam (C/T), imipenem/relebactam (I/R), and meropenem/vaborbactam (M/V) combine either a cephalosporin (C/T and C/A) or a carbapenem antibiotic (M/V and I/R) with a β-lactamase inhibitor. They are used to treat carbapenem-resistant Enterobacterales (CRE) and/or multidrug-resistant Pseudomonas aeruginosa (MDRPA). Objective: We compared the pooled clinical success of these medications to older therapies. Methods: PubMed and EMBASE were searched from January 1, 2012, through September 2, 2020, for C/A, C/T, I/R, and M/V studies. The main outcome was clinical success, which was assessed using random-effects models. Stratified analyses were conducted for study drug, sample size, quality, infection source, study design, and multidrug-resistant gram-negative organism (MDRGNO) population. Microbiological success and 28- and 30-day mortality were assessed as secondary outcomes. Heterogeneity was determined using I2 values. Results: Overall, 25 articles met the inclusion criteria; 8 observational studies and 17 randomized control trials. We detected no difference in clinical success comparing new combination antibiotics with standard therapies for all included organisms (pooled OR, 1.21; 95% CI, 0.96–1.51). We detected a moderate level of heterogeneity among the included studies I2 = 56%. Studies that focused on patients with CRE or MDRPA infections demonstrated a strong association between treatment with new combination antibiotics and clinical success (pooled OR, 2.20; 95% CI, 1.60–3.57). Conclusions: C/T, C/A, I/R, and M/V are not inferior to standard therapies for treating various complicated infections, but they may have greater clinical success for treating MDRPA and CRE infections. More studies that evaluate the use of these antibiotics for drug-resistant infections are needed to determine their effectiveness.

scholarly journals Telavancin versus Standard Therapy for Treatment of Complicated Skin and Skin Structure Infections Caused by Gram-Positive Bacteria: FAST 2 Study

2006 ◽  
Vol 50 (3) ◽  
pp. 862-867 ◽  
Author(s):  
Martin E. Stryjewski ◽  
Vivian H. Chu ◽  
William D. O'Riordan ◽  
Brian L. Warren ◽  
Lala M. Dunbar ◽  
...  
Keyword(s):  
Standard Therapy ◽  
Clinical Success ◽  
Therapy Group ◽  
Success Rates ◽  
Standard Therapy Group ◽  
Gram Positive ◽  
Double Blind ◽  
Skin Structure ◽  
Complicated Skin ◽  
Cure Rates

ABSTRACT Telavancin is a bactericidal lipoglycopeptide with a multifunctional mechanism of action. We conducted a randomized, double blind, active-control phase II trial. Patients ≥18 years of age with complicated skin and skin structure infections caused by suspected or confirmed gram-positive organisms were randomized to receive either telavancin at 10 mg/kg intravenously every 24 h (q24h) or standard therapy (antistaphylococcal penicillin at 2 g q6h or vancomycin at 1 g q12h). A total of 195 patients were randomized and received at least one dose of study medication. Clinical success rates were similar in all analysis populations at test of cure. In microbiologically evaluable patients with Staphylococcus aureus at baseline (n = 91), 96% of the telavancin group and 90% of the standard-therapy group were cured. Among patients with methicillin-resistant S. aureus (MRSA) at baseline (n = 45), clinical cure rates were also 96% for telavancin and 90% for standard therapy. Microbiologic eradication in patients with S. aureus infection was better with telavancin compared to standard therapy (92% versus 78%, P = 0.07) and significantly better in patients with MRSA (92% versus 68%; P = 0.04). Therapy was discontinued for an adverse event (AE) in 6% and 3% of the patients receiving telavancin and standard therapy, respectively. Except for two cases of rash in the telavancin group, these AEs were similar in type and severity in the two groups. The overall incidences and severities of AEs and laboratory abnormalities were similar between the two groups. These data support the ongoing studies assessing the efficacy and safety of telavancin in the treatment of serious gram-positive infections, particularly involving MRSA.

Meta-Analysis of Parenteral Clindamycin Dosing Regimens

1995 ◽  
Vol 29 (9) ◽  
pp. 852-858 ◽  
Author(s):  
John P Rovers ◽  
A Lane Ilersich ◽  
Thomas R Einarson
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
Patient Specific ◽  
Success Rates ◽  
Cure Rate ◽  
Data Synthesis ◽  
Study Selection ◽  
Dosing Regimens ◽  
Definition Of ◽  
Cure Rates

Objective: We used meta-analysis to compare clinical cure and success rates for parenteral clindamycin 600 mg q8h or 900 mg q8h therapy to treat adult intraabdominal or female pelvic infections. Data Sources: We located English-language articles describing clindamycin use in humans using MEDLINE, International Pharmaceutical Abstracts, and Embase and from personal and drug information center files, plus all article references. Study Selection: Eligible studies used parenteral clindamycin 600 mg q8h or 900 mg q8h to treat intraabdominal or pelvic infection in at least I aim of a study and provided a definition of clinical outcome. Accepted were comparative trials in adults who were not critically ill or expected to die. Data Synthesis: The DerSimonian and Laird method was used to calculate weighted overall success rates for cure and success (cure plus improved) rates along with 95% confidence intervals for each dosage in intraabdominal and pelvic infections. Regimens were compared with respect to both cure and success rates using the Mann-Whitney U test. Main Results: Twenty-three articles were eligible for inclusion. Abdominal cure rates were 75.6% and 90.5% for clindamycin 600 mg q8h and 900 mg q8h, respectively (p = 0.03); success rates were 89.8% and 92.5%, respectively (p = 0.29). Pelvic cure rates were 82.8% and 89.4%, respectively (p = 0.51); success rates were 87.2% and 89.9%, respectively (p = 0.51). Conclusions: In pelvic infections, a dosage of clindamycin 600 mg q8h appears to be clinically acceptable for all patients. Although clinical outcomes for intraabdominal infections are generally similar for both regimens, the significantly higher cure rate with a dosage of clindamycin 900 mg q8h suggests that dosage recommendations should be patient specific.

Efficacy of Clarithromycin vs. Amoxicillin/Clavulanate in the Treatment of Acute Maxillary Sinusitis

1993 ◽  
Vol 72 (12) ◽  
pp. 804-810 ◽  
Author(s):  
Jacques Dubois ◽  
Claude Saint-Pierre ◽  
Chantal Tremblay
Keyword(s):  
Staphylococcus Aureus ◽  
Streptococcus Pneumoniae ◽  
Moraxella Catarrhalis ◽  
Clinical Success ◽  
Maxillary Sinusitis ◽  
Signs And Symptoms ◽  
Amoxicillin Clavulanate ◽  
Clinically Significant ◽  
Cure Rates ◽  
Single Blind

A new macrolide drug, clarithromycin (Biaxin®) was compared with amoxicillin/clavulanate (Augmentin®) in a single-blind (investigator-blind), randomized, multicenter study of 497 outpatients with acute maxillary sinusitis; treatment was 500 mg clarithromycin bid (n = 246) or 500 mg amoxicillin/clavulanate tid (n = 251). Pathogens included Streptococcus pneumoniae in 22% of patients, Staphylococcus aureus in 16%, Haemophilus influenzae in 10%, and Moraxella catarrhalis in 7%. For evaluable patients, clinical success (cure or improvement) was noted for 97% (128/132) of clarithromycin recipients and 93% (119/128) amoxicillin/clavulanate recipients. Clinically significant improvement in signs and symptoms was comparable between groups. Bacteriologic cure rates were 87% (115/132) and 90% (115/128), respectively. Respective pathogen eradication rates were 87% (125/143) and 90% (125/139). Adverse events not due to concurrent conditions occurred in 41% of the former and 46% of the latter group; most were mild to moderate gastrointestinal upsets (21% and 38%, respectively; P ≤ 0.001). We conclude that clarithromycin appears to be as effective as amoxicillin/clavulanate in acute maxillary sinusitis and may cause fewer gastrointestinal upsets.

Oral vancomycin prophylaxis for the prevention of Clostridium difficile infection: A systematic review and meta-analysis

2020 ◽  
Vol 41 (11) ◽  
pp. 1302-1309
Author(s):  
Sumbal Babar ◽  
Bara El Kurdi ◽  
Mahmoud El Iskandarani ◽  
Ibrahim Haddad ◽  
Zaid Imam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clostridium Difficile ◽  
Meta Analysis ◽  
Total Daily Dose ◽  
Oral Vancomycin ◽  
Daily Dose ◽  
Risk Patients ◽  
At Risk Populations ◽  
Vancomycin Resistant ◽  
Egger Test

AbstractObjective:Recently, oral vancomycin prophylaxis (OVP) has been suggested for the prevention of Clostridium difficile infection (CDI). We conducted a systematic review and meta-analysis to investigate the efficacy and safety of this approach.Design:Systematic review and meta-analysis.Methods:We conducted a computerized search of MEDLINE, EMBASE, and Cochrane databases from inception to March 2019 for publications investigating OVP for CDI prevention. Results were screened for eligibility. Relevant data were extracted and analyzed. Publication bias was assessed using the Egger test.Results:Ultimately, 8 retrospective studies and 1 prospective study examining 2174 patients, published between 2016 and 2019 were included in the review. OVP was associated with decreased CDI (odds ratio, 0.263; 95% confidence interval, 0.13–0.52) with considerable heterogeneity (I2 = 61%). Meta-regression showed that total daily dose of OVP correlated with CDI, explaining 100% of heterogeneity between studies. Furthermore, 3 studies evaluated the risk of vancomycin-resistant enterococci (VRE) infection after OVP and found no significant increase.Conclusion:Our results suggest that OVP might decrease CDI rates in at-risk populations, although this conclusion should be interpreted with caution. Higher daily doses of OVP might increase CDI. Although the use of OVP in high-risk patients may reduce CDI, this suggestion has yet to be validated by prospective blinded randomized controlled trials.

scholarly journals 1619. Meta-analysis of Randomized Control Trials Evaluating New Beta-Lactamase Combination Antibiotics

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S802-S802
Author(s):  
Geneva M Wilson ◽  
Margaret A Fitzpatrick ◽  
Kyle Walding ◽  
Beverly Gonzalez ◽  
Katie J Suda ◽  
...  
Keyword(s):  
Observational Studies ◽  
Clinical Success ◽  
Meta Analysis ◽  
New Combination ◽  
Randomized Control Trials ◽  
Beta Lactamase ◽  
Success Rates ◽  
Beta Lactam ◽  
Randomized Control ◽  
Tract Infections

Abstract Background Ceftolozane/ Tazobactam (C/T), Ceftazidime/ Avibactam (C/A), Meropenem/ Vaborbactam (M/V) and Imipenem/ Relebactam (I/R) are new combination beta-lactam/ beta-lactamase inhibitor antibiotics primarily used to treat multidrug-resistant (MDR) Gram-negative infections. This study synthesized outcomes of comparative observational studies and randomized control trials (RCTs) that evaluated clinical success of these antibiotics compared to other therapies. Methods PubMed, EMBASE, and Google Scholar were searched from January 1st, 2013 through October 1st, 2019 for comparative observational studies and RCTs of C/T, C/A, M/V and I/R in patients with pneumonia, complicated intra-abdominal and urinary tract infections. Study and patient demographics were collected along with clinical and microbiological success rates. Meta-regression analysis was used to determine the pooled effectiveness of C/T, C/A, M/V, and I/R. Heterogeneity and publication bias were assessed via I2 values and funnel plots, respectively. Results Literature search returned 1,645 results. After exclusion criteria, 21 publications representing 6,246 patients were retained: 16 RCTs (8 C/A, 3 C/T, 3 I/R, 2 M/V) and 5 comparative observational studies (3 C/A, 2 C/T). Pooled risk ratios for clinical success showed that all four antibiotics were non-inferior to comparator antibiotics (0.99 (95% CI (0.97-1.01)). Eleven of the sixteen RCTs evaluated microbiological success; pooled risk ratio was 1.08 (95% CI 1.04-1.13), indicating that older therapies were more successful at microbiological eradication than newer antibiotics. Only 6 of the included studies (3 RCTs and 2 observational studies) focused on patients with MDR infections. Limiting the analysis to MDR RCTs did not change the overall conclusions. Conclusion Although older therapies had slightly higher microbiologic clearance, pooled clinical success rates for C/A, C/T, M/V, and I/R were non-inferior to older therapies, including in studies focused on patients with MDR infections. Additional studies are needed to further evaluate these drugs’ effectiveness for treatment of MDR infections. Disclosures All Authors: No reported disclosures

scholarly journals Different Catechol-O-Methyl Transferase Inhibitors in Parkinson's Disease: A Bayesian Network Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhaoming Song ◽  
Jie Zhang ◽  
Tao Xue ◽  
Yanbo Yang ◽  
Da Wu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cochrane Library ◽  
Total Daily Dose ◽  
Methyl Transferase ◽  
Comt Inhibitors ◽  
Daily Dose ◽  
Updrs Part

Parkinson's disease (PD) is a common, chronic, progressive, debilitating neurodegenerative disease. The current levodopa treatment requires the addition of other drugs, such as catechol-O-methyl transferase (COMT) inhibitors, to alleviate motor fluctuations in advanced PD. Therefore, a theoretical reference for treatment is urgently needed. In this study, an appropriate search strategy was used to screen eligible studies on different drugs to treat patients with PD from the Embase, PubMed, and Cochrane Library. The publication dates were from January 1990 to June 2021. We integrated eligible randomized controlled trials, and statistical analysis was performed on three kinds of effectiveness outcomes and two types of safety outcomes. We assessed the average difference or odds ratio between each drug and placebo and summarized them as the average and 95% confidence interval (CI), respectively. In terms of efficacy, entacapone (mean difference [MD], 0.64 h; 95% CI, 0.29–1.0), opicapone (MD, 0.92 h; 95% CI, 0.35–1.5), and tolcapone (MD, 3.2 h; 95% CI, 2.1–4.2) increased patients' total ON-time compared to placebo. Tolcapone (MD, −100 mg; 95% CI −160 to −45) reduced the total daily dose of levodopa therapy. None of these three drugs was found to have statistical significance in mean change from baseline in UPDRS part III scores when compared with others. In terms of safety, tolcapone (MD, 3.8; 95% CI, 2.1–6.8), opicapone (MD, 3.7; 95% CI, 2–7.2), and entacapone (MD, 2.2; 95% CI, 1.5–3.3) increased the number of cases of dyskinesia compared to placebo. Entacapone (MD, 1.7; 95% CI, 1.3–2.2) and tolcapone (MD, 4.3; 95% CI, 1.3–15) were more likely to cause adverse events than placebo. In conclusion, opicapone showed higher efficiency and fewer safety problems in five indicators we selected when compared with the other two drugs.

scholarly journals Meta-analysis of Clinical Outcomes Using Ceftazidime/Avibactam, Ceftolozane/ Tazobactam, and Meropenem/ Vaborbactam for the Treatment of Multidrug Resistant Gram-Negative Infections

2021 ◽  
Author(s):  
Geneva Wilson ◽  
Margaret Fitzpatrick ◽  
Kyle Walding ◽  
Beverly Gonzalez ◽  
Marin L Schweizer ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Infection Type ◽  
Meta Analysis ◽  
Treatment Options ◽  
Clinical Success Rate ◽  
Multidrug Resistant ◽  
Success Rates ◽  
Beta Lactam ◽  
Review Reports

Abstract Ceftolozane-tazobactam (C/T), Ceftazidime-avibactam (C/A), and Meropenem/vaborbactam (M/V) are new beta-lactam/beta-lactamase combination antibiotics commonly used to treat multi-drug resistant Pseudomonas aeruginosa (MDRPA) and carbapenem-resistant Enterobacteriaceae (CRE) infections. This review reports the clinical success rates for C/T, C/A., and M/V. PubMed and EMBASE were searched from January 1 st, 2012 through September 2 nd, 2020 for publications detailing use of C/T, C/A, and M/V. Meta-analysis determined the pooled effectiveness of C/T, C/A, and M/V. The literature search returned 1,950 publications, 29 publications representing 1,620 patients were retained. Pneumonia was the predominant infection type (49.8%). MDRPA was the major pathogen treated (65.3%). The pooled clinical success rate was 73.3% (95% CI 68.9%-77.5%). C/T, C/A, or M/V resistance was reported in 8.9% of the population. These antibiotics had a high clinical success rate in patients with complicated infections and limited treatment options. Larger studies comparing C/T, C/A, and M/V against other antibiotic regimens are needed.

scholarly journals Endo-sponge in management of anastomotic colorectal leaks: a systematic review and meta-analysis

2021 ◽  
Vol 09 (09) ◽  
pp. E1342-E1349
Author(s):  
Banreet S. Dhindsa ◽  
Yassin Naga ◽  
Syed M. Saghir ◽  
Sarav Gunjit Singh Daid ◽  
Saurabh Chandan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Adverse Events ◽  
Clinical Success ◽  
Meta Analysis ◽  
Anastomotic Dehiscence ◽  
Vacuum Therapy ◽  
Success Rates ◽  
Technical Success ◽  
Generalized Peritonitis

Abstract Background and study aims Following colorectal surgery, anastomotic dehiscence and leak formation has an incidence of 2 % to 7 %. Endo-SPONGE has been applied in the management of anastomatic leaks (ALs) after colorectal surgery. This is the first systematic review and meta analysis to evaluate the efficacy and safety of Endo-SPONGE in the management of colorectal ALs. Patients and methods The primary outcomes assessed were the technical and clinical success of Endo-SPONGE placement in colorectal ALs. The secondary outcomes assessed were the overall adverse events (AEs) and the AE subtypes. Pooled estimates were calculated using random-effects models with 95 % confidence interval (C. I.). The statistical analysis was done using STATA v16.1 software (StataCorp, LLC College Station, Texas, United States). Results The analysis included 17 independent cohort studies with a total of 384 patients. The rate of technical success was 99.86 % (95 % CI: 99.2 %, 100 %; P = 0.00; I2  = 70.69 %) and the calculated pooled rate of clinical success was 84.99 % (95 % CI: 77.4 %, 91.41 %; P = 0.00; I2  = 68.02 %). The calculated pooled rate of adverse events was 7.6 % (95 % CI: 3.99 %, 12.21 %; P = 0.03; I2  = 42.5 %) with recurrent abscess formation and bleeding being the most common AEs. Moderate to substantial heterogeneity was noted in our meta-analysis. Conclusions Endoscopic vacuum therapy appears to be a minimally invasive, safe, and effective treatment modality for patients with a significant colorectal leak without any generalized peritonitis with high clinical and technical success rates and a low rate of adverse events. Further prospective or randomized controlled trials are needed to validate our findings.

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