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Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia Siempos II; Vardakas KZ; Manta KG; Falagas MEEur Respir J 2007[Mar]; 29 (3): 548-60The comparative effectiveness and safety of carbapenems with other beta-lactams and fluoroquinolones for the empirical treatment of patients with hospital-acquired pneumonia remains controversial. In the present study, a meta-analysis of 12 relevant randomised controlled trials was performed. Overall, carbapenems were associated with lower mortality than fluoroquinolones or beta-lactams, alone or in combination with aminoglycosides (odds ratio 0.72, 95% confidence interval 0.55-0.95). There was no difference between the compared antibiotics regarding treatment success (1.08, 0.91-1.29), microbiological success (1.04, 0.72-1.50) or development of adverse effects (0.81, 0.46-1.43). In the subset of patients with Pseudomonas aeruginosa pneumonia, carbapenems were associated with lower treatment success (0.42, 0.22-0.82) and lower eradication of P. strains (0.50, 0.24-0.89). Carbapenems are equivalent to fluoroquinolones or beta-lactams, alone or in combination with aminoglycosides, for the empirical treatment of immunocompetent adult patients with hospital-acquired pneumonia. However, there is limited evidence, based predominantly on unblinded randomised controlled trials, that carbapenems are associated with lower mortality than the comparators; this association was not observed in a subset analysis of randomised controlled trials with a high methodological quality score. In patients with Pseudomonas aeruginosa pneumonia, carbapenems are associated with worse outcomes than the comparators.|Acinetobacter Infections/drug therapy/immunology/mortality[MESH]|Acinetobacter baumannii[MESH]|Adult[MESH]|Aminoglycosides/adverse effects/therapeutic use[MESH]|Carbapenems/adverse effects/*therapeutic use[MESH]|Cross Infection/*drug therapy/immunology/mortality[MESH]|Drug Resistance, Multiple[MESH]|Drug Therapy, Combination[MESH]|Fluoroquinolones/adverse effects/therapeutic use[MESH]|Humans[MESH]|Immunocompetence/immunology[MESH]|Intensive Care Units[MESH]|Meropenem[MESH]|Pneumonia, Bacterial/*drug therapy/immunology/mortality[MESH]|Pseudomonas Infections/drug therapy/immunology/mortality[MESH]|Randomized Controlled Trials as Topic[MESH]|Respiration, Artificial[MESH]|Survival Rate[MESH]|Thienamycins/adverse effects/therapeutic use[MESH]|Treatment Outcome[MESH]|beta-Lactams/adverse effects/therapeutic use[MESH] |
