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Meta‐analysis: ertapenem for complicated intra‐abdominal infections
Author(s) -
FALAGAS M. E.,
PEPPAS G.,
MAKRIS G. C.,
KARAGEORGOPOULOS D. E.,
MATTHAIOU D. K.
Publication year - 2008
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2008.03642.x
Subject(s) - ertapenem , medicine , randomized controlled trial , adverse effect , ticarcillin , odds ratio , surgery , imipenem , antibiotics , antibiotic resistance , microbiology and biotechnology , biology
Summary Background Ertapenem is a new member of the carbapenem class of antibiotics, with a favourable pharmacokinetic profile, but a narrower spectrum of antimicrobial activity, compared with older representatives of this class. Aim To evaluate the effectiveness and safety of ertapenem for treatment of complicated intra‐abdominal infections. Methods We performed a meta‐analysis of randomized‐controlled trials identified in PubMed, Cochrane and Scopus that compared ertapenem with other antimicrobial regimens, in patients of all ages, with complicated intra‐abdominal infections. The primary outcomes evaluated were clinical success (cure or improvement) in the modified intention‐to‐treat population and clinical adverse events. Results Six randomized‐controlled trials involving patients with complicated intra‐abdominal infections, mainly of mild‐to‐moderate severity (three with a double‐blind design; one performed in children) that compared ertapenem treatment (once daily) against piperacillin/tazobactam, ceftriaxone plus metronidazole and ticarcillin/clavulanic acid (in three, two and one randomized‐controlled trials respectively) were included. No difference was found between adult patients with complicated intra‐abdominal infections treated with ertapenem vs. comparators, regarding clinical success (five randomized‐controlled trials, 2002 patients, fixed‐effect model, odds ratio: 1.11, 95% confidence interval (CI): 0.89–1.39); clinical adverse events (four randomized‐controlled trials, 1530 patients, fixed‐effect model, OR: 0.86, 95% CI: 0.61–1.20); microbiological success; mortality and withdrawals because of adverse events. Ertapenem was associated with more laboratory adverse events (four randomized‐controlled trials, 1530 patients, fixed‐effect model, OR: 1.73, 95% CI: 1.14–2.61), but none was reported as serious. Conclusion This meta‐analysis provides additional evidence that ertapenem can be used as effectively and safely, as other recommended antimicrobial regimens, for the treatment of complicated intra‐abdominal infections, particularly of mild‐to‐moderate severity.