TITLE

Ciprofloxacin vs an Aminoglycoside in Combination With a β-Lactam for the Treatment of Febrile Neutropenia: A Meta-analysis of Randomized Controlled Trials

AUTHOR(S)
Bliziotis, Ioannis A.; Michalopoulos, Argyris; Kasiakou, Sofia K.; Samonis, George; Christodoulou, Christos; Chrysanthopoulou, Stavroula; Falagas, Matthew E.
PUB. DATE
September 2005
SOURCE
Mayo Clinic Proceedings;Sep2005, Vol. 80 Issue 9, p1146
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: To compare the effectiveness and toxicity of ciprofloxacin vs an aminoglycoside, both in combination with a β-lactam, for the treatment of febrile neutropenia in the inpatient setting. METHODS: For this meta-analysis of randomized controlled trials (RCTs) that compared the ciprofloxacin/β-lactam combination vs an aminoglycoside/β-lactam combination for the treatment of febrile neutropenia and reported data on effectiveness, mortality, and/or toxicity, we searched PubMed (1950–2004), Current Contents, Cochrane Central Register of Controlled Trials, and reference lists of retrieved articles, including review articles, as well as abstracts presented at international conferences. Data for 3 primary and 2 secondary outcomes were extracted by 2 investigators. RESULTS: Eight RCTs were included in the analysis. Comparable or better outcomes were observed with the ciprofloxacin/β-lactam combination vs an aminoglycoside/β-lactam combination: clinical cure without modification of the initial regimen (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.00–1.74; P=.05), clinical cure in the subset of patients with documented Infections (OR, 1.56; 95% CI, 1.05–2.31; P=.03), all-cause mortality (OR, 0.85; 95% CI, 0.54–1.35; P=.49), withdrawal of the study drugs due to toxicity (OR, 0.87; 95% CI, 0.57–1.32; P=.51), and nephrotoxicity (OR, 0.30; 95% CI, 0.16–0.59; P«.001). The ciprofloxacin/β-lactam combination was also associated with better clinical cure compared to the aminoglycoside/β-lactam combination In the subset of RCTs with non-low-risk patients (OR, 1.38; 95% CI, 1.01–1.88; P=.04), as well as In the subset of studies that Included the same β-lactam in both treatment arms (OR, 1.47; 95% CI, 1.06–2.05; P=.02). CONCLUSION: The combination of ciprofloxacin with a β-lactam antibiotic should be considered an important therapeutic option in hospitalized febrile neutropenic patients who have not received a quinolone for prevention of infections and in settings in which quinolone resistance is not common.
ACCESSION #
18184295

 

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