Which Antimicrobial Agent is Likely to be the Best for Treating Clostridium difficile Infections? A Bayesian Network Meta-Analysis of Randomized Clinical Trials.
Journal
Drug research
ISSN: 2194-9387
Titre abrégé: Drug Res (Stuttg)
Pays: Germany
ID NLM: 101602406
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
pubmed:
8
9
2018
medline:
23
7
2019
entrez:
8
9
2018
Statut:
ppublish
Résumé
Vancomycin, metronidazole, fidaxomicin, teicoplanin, fusidic acid and bacitracin have been recommended for the treatment of Clostridium difficile infections (CDI). We conducted a Bayesian network meta-analysis comparing all the antimicrobial agents used in CDI. Electronic databases were searched for randomized controlled trials comparing antimicrobial agents used for CDI. Risk of bias was assessed. Random effects model was used to derive the mixed treatment comparison estimates. Odds ratio with 95% confidence intervals was used as effect estimate. Seventeen studies were included in this meta-analysis. Teicoplanin was observed to perform better than vancomycin, metronidazole, fusidic acid and bacitracin to achieve the symptomatic cure. Teicoplanin was also associated with higher rates of bacteriological cure than vancomycin and metronidazole. Fidaxomicin is associated with significantly higher rates of symptomatic cure than vancomycin, bacitracin and metronidazole and is similar to teicoplanin. To conclude, teicoplanin and fidaxomicin have been observed to perform better than other antimicrobials for the treatment of CDI. We recommend conducting high quality randomized controlled clinical trials evaluating teicoplanin and fidaxomicin with other standard interventions for the management of CDI.
Sections du résumé
BACKGROUND
BACKGROUND
Vancomycin, metronidazole, fidaxomicin, teicoplanin, fusidic acid and bacitracin have been recommended for the treatment of Clostridium difficile infections (CDI). We conducted a Bayesian network meta-analysis comparing all the antimicrobial agents used in CDI.
METHODS
METHODS
Electronic databases were searched for randomized controlled trials comparing antimicrobial agents used for CDI. Risk of bias was assessed. Random effects model was used to derive the mixed treatment comparison estimates. Odds ratio with 95% confidence intervals was used as effect estimate.
RESULTS
RESULTS
Seventeen studies were included in this meta-analysis. Teicoplanin was observed to perform better than vancomycin, metronidazole, fusidic acid and bacitracin to achieve the symptomatic cure. Teicoplanin was also associated with higher rates of bacteriological cure than vancomycin and metronidazole. Fidaxomicin is associated with significantly higher rates of symptomatic cure than vancomycin, bacitracin and metronidazole and is similar to teicoplanin.
CONCLUSION
CONCLUSIONS
To conclude, teicoplanin and fidaxomicin have been observed to perform better than other antimicrobials for the treatment of CDI. We recommend conducting high quality randomized controlled clinical trials evaluating teicoplanin and fidaxomicin with other standard interventions for the management of CDI.
Substances chimiques
Anti-Infective Agents
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
194-200Informations de copyright
© Georg Thieme Verlag KG Stuttgart · New York.
Déclaration de conflit d'intérêts
Authors do not have any conflict of interest.