• M E Falagas, D K Matthaiou, E A Karveli, and G Peppas.
• Alfa Institute of Biomedical Sciences, Athens, Greece. m.falagas@aibs.gr
• Aliment. Pharmacol. Ther. 2007 Mar 1; 25 (5): 537-56.

AimTo compare the effectiveness and safety of clindamycin/aminoglycoside with broad-spectrum beta-lactam monotherapy in patients with intra-abdominal infections by performing a meta-analysis of randomized controlled trials (RCTs).MethodsThe relevant 28 RCTS were retrieved from PubMed searches and reviewed by two reviewers independently.Resultsbeta-lactam monotherapy was more effective regarding cure of the infection than clindamycin/aminoglycoside (3177 clinically evaluable patients, fixed effects model, OR = 0.67, 95% CI: 0.55-0.81). The same result was found in several subset analyses. There was no difference in all-cause mortality and attributable-to-infection mortality [2382 intention-to-treat (ITT) patients, fixed effects model, OR = 1.25, 95% CI: 0.74-2.11 and 1976 ITT patients, OR = 1.19, 95% CI: 0.59-2.41, respectively]. There was no difference regarding overall adverse events and ototoxicity (1460 ITT patients, OR = 1.05, 95% CI: 0.80-1.37, and 1404 ITT patients, OR = 3.22, 95% CI: 0.72-14.45, respectively). However, treatment with clindamycin/aminoglycoside was more likely to be associated with nephrotoxicity compared to beta-lactam (3065 ITT patients, OR = 3.7, 95% CI: 2.09-6.57). Clindamycin/aminoglycoside was less likely to be associated with antibiotic-associated diarrhoea compared to beta-lactam (3050 ITT patients, OR = 0.68, 95% CI: 0.46-1.00).ConclusionThe results of our meta-analysis suggest that beta-lactams are more effective in the treatment of intra-abdominal infections compared with clindamycin/aminoglycoside.

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