International journal of antimicrobial agents
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Int. J. Antimicrob. Agents · Sep 2015
Review Meta Analysis Comparative StudyFluoroquinolones or macrolides alone versus combined with β-lactams for adults with community-acquired pneumonia: Systematic review and meta-analysis.
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality. This review compared two of the main treatment alternatives: quinolone or macrolide monotherapy versus their combination with β-lactams. A systematic review and meta-analysis of randomised controlled trials (RCTs) including adult inpatients and outpatients with CAP that compared treatment with any respiratory fluoroquinolone or macrolide administered as single agent with combination therapy of a β-lactam plus either a fluoroquinolone or a macrolide (four separate comparisons) were conducted. ⋯ In all comparisons, treatment discontinuation and diarrhoea were more frequent in patients receiving combination therapy with a β-lactam. Overall, there is no evidence for a benefit of β-lactam/macrolide or β-lactam/quinolone combination therapies over monotherapy with a respiratory fluoroquinolone. The ecological implications of selecting fluoroquinolone or β-lactam monotherapy as the preferred regimen for hospitalised CAP among adults should be further investigated.
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Int. J. Antimicrob. Agents · Sep 2015
Review Meta AnalysisVancomycin-associated nephrotoxicity: A meta-analysis of administration by continuous versus intermittent infusion.
Vancomycin is a glycopeptide antibiotic widely used in the management of meticillin-resistant Staphylococcus aureus (MRSA). Guidelines currently recommend vancomycin be administered by intermittent infusion, despite recent research suggesting that continuous infusion (CI) may be associated with lower rates of vancomycin-associated nephrotoxicity. In 2012, Cataldo et al. presented a meta-analysis supporting the use of CI. ⋯ Seven studies were included in the final analysis. Using a random-effects model, a non-significant trend of reduced nephrotoxicity in those who received vancomycin by CI (risk ratio=0.799, 95% confidence interval 0.523-1.220; P=0.299) was identified. A large, randomised controlled trial is necessary to confirm these results.
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Int. J. Antimicrob. Agents · Sep 2015
ReviewCeftolozane/tazobactam and ceftazidime/avibactam: two novel β-lactam/β-lactamase inhibitor combination agents for the treatment of resistant Gram-negative bacterial infections.
The rise in resistant Gram-negative bacteria is a major concern and has led to difficulty in treating multidrug-resistant (MDR) infections. Two recently approved combination antibiotics, ceftolozane/tazobactam and ceftazidime/avibactam, may be effective in treating these resistant infections. Ceftolozane is a novel cephalosporin that has been developed in combination with tazobactam, a recognised β-lactamase inhibitor (BLI). ⋯ Both agents have been approved for the indications of complicated intra-abdominal infection (with metronidazole) and complicated urinary tract infection, and have ongoing phase 3 trials for the treatment of ventilator-associated and nosocomial pneumonia. This manuscript will review current data available regarding the spectrum of activity and clinical trials that led to the US Food and Drug Administration (FDA) approval of these agents. Both agents appear to be well tolerated and show promise in the treatment of MDR Gram-negative infections.
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Int. J. Antimicrob. Agents · Sep 2015
Review Historical ArticleThe history and evolution of outpatient parenteral antibiotic therapy (OPAT).
Outpatient parenteral antibiotic therapy (OPAT) is now a widely accepted and safe therapeutic option for carefully selected patients. Benefits include cost savings and improved patient satisfaction; risks include failure to adhere to care, unexpected changes in the underlying infection, and adverse drug and intravenous access events. We report on our 40-year experience with OPAT in a single healthcare system in the USA and highlight OPAT developments in several countries. ⋯ OPAT was safe, with rehospitalisation rates of 6% and 1% in Periods 1 and 2, respectively. We recommend increased access to structured OPAT teams and the development of standard definitions and criteria for important outcome measures (e.g. clinical 'cure' and unplanned hospital re-admissions). These steps are critical for patient safety and financial stewardship of resources.