TY - JOUR
T1 - Empirical antibiotics against Gram-positive infections for febrile neutropenia
T2 - Systematic review and meta-analysis of randomized controlled trials
AU - Paul, Mical
AU - Borok, Sara
AU - Fraser, Abigail
AU - Vidal, Liat
AU - Leibovici, Leonard
N1 - Funding Information:
39. EORTC-1991. (1991). Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. European Organization for Research and Treatment of Cancer (EORTC) International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada—Clinical Trials Group. Journal of Infectious Diseases 163, 951–8.
PY - 2005/4
Y1 - 2005/4
N2 - Objectives: To assess the value of empirical anti-Gram-positive antibiotics for the treatment of febrile neutropenia. Methods: Systematic review and meta-analysis of randomized controlled trials comparing antibiotics with anti-Gram-positive spectrum to control or placebo, in addition to the same baseline antibiotic regimen in both arms. We searched MEDLINE, EMBASE, LILACS, the Cochrane Library, conference proceedings, and references. No restrictions on inclusion were imposed. Two reviewers independently applied selection criteria, carried out quality assessment, and extracted the data. Relative risks with 95% confidence intervals were pooled using the fixed effect model. The primary outcome assessed was all-cause mortality. Results: Thirteen studies met inclusion criteria, including 2392 participants. Glycopeptides were assessed in nine trials. Empirical anti-Gram-positive antibiotics were assessed for the initial treatment in 11 studies, and for persistent fever in two. No significant difference in all-cause mortality was seen [RR 0.86 (0.58-1.26), seven studies, 852 participants]. Overall failure at end of therapy occurred equally [RR 1.00 (0.79-1.27), six studies, 943 participants]. Failure associated with treatment modifications was more frequent in the control arm when empirical initial glycopeptides were assessed [RR 0.70 (0.61-0.80), five studies, 1178 participants]. Bacterial superinfections, mainly Gram-positive, were detected less frequently in the intervention arm. Adverse events were significantly more common with the additional antibiotic, and nephrotoxicity was significantly more common with additional glycopeptides [RR 1.88 (1.10-3.22), six studies, 1282 participants]. No significant heterogeneity was present in these comparisons. Conclusions: The use of glycopeptides can be safely deferred until the documentation of a resistant Gram-positive infection.
AB - Objectives: To assess the value of empirical anti-Gram-positive antibiotics for the treatment of febrile neutropenia. Methods: Systematic review and meta-analysis of randomized controlled trials comparing antibiotics with anti-Gram-positive spectrum to control or placebo, in addition to the same baseline antibiotic regimen in both arms. We searched MEDLINE, EMBASE, LILACS, the Cochrane Library, conference proceedings, and references. No restrictions on inclusion were imposed. Two reviewers independently applied selection criteria, carried out quality assessment, and extracted the data. Relative risks with 95% confidence intervals were pooled using the fixed effect model. The primary outcome assessed was all-cause mortality. Results: Thirteen studies met inclusion criteria, including 2392 participants. Glycopeptides were assessed in nine trials. Empirical anti-Gram-positive antibiotics were assessed for the initial treatment in 11 studies, and for persistent fever in two. No significant difference in all-cause mortality was seen [RR 0.86 (0.58-1.26), seven studies, 852 participants]. Overall failure at end of therapy occurred equally [RR 1.00 (0.79-1.27), six studies, 943 participants]. Failure associated with treatment modifications was more frequent in the control arm when empirical initial glycopeptides were assessed [RR 0.70 (0.61-0.80), five studies, 1178 participants]. Bacterial superinfections, mainly Gram-positive, were detected less frequently in the intervention arm. Adverse events were significantly more common with the additional antibiotic, and nephrotoxicity was significantly more common with additional glycopeptides [RR 1.88 (1.10-3.22), six studies, 1282 participants]. No significant heterogeneity was present in these comparisons. Conclusions: The use of glycopeptides can be safely deferred until the documentation of a resistant Gram-positive infection.
KW - Glycopeptides
KW - Neutropenic fever
KW - Staphylococcus aureus
KW - Vancomycin
UR - http://www.scopus.com/inward/record.url?scp=17444419077&partnerID=8YFLogxK
U2 - 10.1093/jac/dki028
DO - 10.1093/jac/dki028
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C2 - 15722392
AN - SCOPUS:17444419077
SN - 0305-7453
VL - 55
SP - 436
EP - 444
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
IS - 4
ER -