An indirect comparison of efficacy and safety of ceftolozane/tazobactam, ceftazidime/avibactam versus meropenem in complicated intra-abdominal infections

• Autores: Rafael Ferriols Lisart, Alejandro Pérez Pitarch, Francisco Ferriols Lisart, Manuel Alós Almiñana
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 20, Nº. 2, 2018, págs. 63-71
• Idioma: inglés
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• Resumen

  • Objective. The aim of this study was to perform an indirect comparison to assess the comparative efficacy and safety of ceftolozane/tazobactam plus metronidazole, ceftazidime/avibactam plus metronidazole and meropenem in monotherapy in hospitalized adult patients diagnosed of complicated intra-abdominal infection.

    Method. Databases consulted were MEDLINE, Institute of Science Information Web of Science, EMBASE, Índice Médico Español and . Two independent reviewers extracted relevant data and assessed risk of bias. Pairwise treatment effects were estimated using a random effects meta-analysis and reported as odds ratios (OR) with 95% confidence interval (95% CI).

    Results. Five publications were included. Three studies compared ceftazidime/ avibactam plus metronidazole vs. meropenem, and the other two, ceftolozane/tazobactam plus metronidazole vs. meropenem. The trials showed a high methodological quality. Ceftazidime/avibactam was statistically inferior to meropenem in the microbiologically intention to treat population (OR = 0.72; 95% CI: 0.53-0.97) but achieved no clinical relevance. All other pairwise comparisons showed no differences in the efficacy or safety. Indirect comparison between ceftazidime/avibactam and ceftolozane/tazobactam showed no difference in efficacy (OR = 1.05; 95% CI:

    0.64-1.69) or safety (OR =1.29; 95% CI: 0.77-2.32). No heterogeneity was found in the whole network. Publication bias was not statistically significant.

    Conclusion. Efficacy and safety of the treatment of complicated intra-abdominal infections in adult patients with ceftazidime/avibactam or ceftolozane/tazobactam plus metronidazole is not better than meropenem in monotherapy. The choice between ceftazidime/avibactam or ceftolozane/tazobactam should be made according to other criteria than efficacy or safety