Monotherapy or aminoglycoside-containing combinations for empirical antibiotic treatment of febrile neutropenic patients: a meta-analysis

We set out to compare the efficacy of antibiotic monotherapy with that of combination therapy including an aminoglycoside for empirical treatment of febrile neutropenic cancer patients. We did a meta-analysis of 29 randomised clinical trials pooling data from 4795 febrile episodes and a subset of 10...

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Bibliographic Details
Published in:The Lancet infectious diseases 2002-04, Vol.2 (4), p.231-242
Main Authors: Furno, Paolo, Bucaneve, Giampaolo, Del Favero, Albano
Format: Article
Language:English
Subjects:
Aminoglycosides - administration & dosage
Aminoglycosides - therapeutic use
Anti-Bacterial Agents - therapeutic use
Bacteremia - drug therapy
Bacteremia - etiology
Drug Therapy, Combination
Fever - drug therapy
Fever - etiology
Humans
Infectious diseases
Neoplasms - complications
Neoplasms - drug therapy
Neutropenia - drug therapy
Neutropenia - etiology
Odds Ratio
Randomized Controlled Trials as Topic
Treatment Outcome
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Summary:We set out to compare the efficacy of antibiotic monotherapy with that of combination therapy including an aminoglycoside for empirical treatment of febrile neutropenic cancer patients. We did a meta-analysis of 29 randomised clinical trials pooling data from 4795 febrile episodes and a subset of 1029 bacteraemic episodes by both fixed and random effects models. Outcome measure was clinical failure of antibiotic treatment, defined as modification of the initially allocated regimen or death during treatment. In febrile episodes, the pooled odds ratio (OR) of clinical failure with monotherapy versus combination therapy was 0·88, with 95% CI from 0·78 to 0·99 by the fixed effects model, and 0·87 with 95% CI from 0·75 to 1·01 by the more conservative random effects model. For bacteraemic episodes, the pooled OR of failure with monotherapy was 0·70 (0·54 to 0·92) by the fixed effects model, and 0·72 (0·54 to 0·95) by the random effects model. We conclude that monotherapy has been as effective as aminoglycoside–containing combinations for empirical treatment of febrile neutropenia.
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(02)00241-4