Avoid adding aminoglycoside to beta-lactam
In the treatment of sepsis, adding an aminoglycoside to beta-lactams should be discouraged, say the authors of a systematic review and meta-analysis. “Fatality remains unchanged while the risk for adverse events is increased,” they comment.
The Israeli researchers reviewed 64 trials of beta-lactam monotherapy
compared with beta-lactam therapy combined with aminoglycoside. This
included data on 7,586 patients with sepsis but without neutropenia.
There was no difference in all cause mortality. The relative risk was
0.90 with monotherapy compared with combination therapy (95 per cent
confidence interval 0.77 to 1.06). Clinical failure was more common with
combination treatment overall (relative risk 0.87, 0.78 to 0.97) and
among studies comparing different beta-lactams.
Combination therapy showed no advantage among patients with Gram-negative
infections or Pseudomonas aeruginosa infections. There was also no difference
in the rate of development of resistance. Nephrotoxicity was significantly
more common with the combination therapy. Ototoxicity and vestibular
damage were not routinely examined, the authors say.
They comment that antibacterial treatment is almost always instituted
empirically and is often continued even without specific isolates to
guide therapy.
The authors say that novel beta-lactams should not be compared with older
generation beta-lactams or with penicillins combined with aminoglycosides.
They comment that the beta-lactam/ aminoglycoside combination is ingrained
in guidelines on treating Gram-positive infections. However, studies
they included did not point to a clinical benefit with the two agents
(BMJ 2004;328:668). |
The
Pharmaceutical Journal