Meta-analysis of randomized controlled trials of vancomycin for the treatment of
patients with gram-positive infections: focus on the study design.
Author(s): Vardakas KZ, Mavros MN, Roussos N, Falagas ME.
Affiliation(s): Alfa Institute of Biomedical Sciences, Athens, Greece.
Publication date & source: 2012, Mayo Clin Proc. , 87(4):349-63
OBJECTIVE: To study the effectiveness and safety of vancomycin compared with that
of other antibiotics for the treatment of gram-positive infections.
METHODS: Major electronic databases were searched. Data from published randomized
controlled trials (January 1, 1950, to September 15, 2011) were pooled using a
meta-analytic method.
RESULTS: Fifty-three trials comparing vancomycin with linezolid, daptomycin,
quinupristin-dalfopristin, tigecycline, ceftaroline, ceftobiprole, telavancin,
teicoplanin, iclaprim, and dalbavancin were included in the meta-analysis.
Individual antibiotics were as effective as vancomycin, except for linezolid,
which was more effective than vancomycin for the treatment of skin and soft
tissue infections (odds ratio [OR], 1.61; 95% confidence interval [CI],
1.07-2.43). Comparators were as effective as vancomycin in the intent-to-treat
population (OR, 1.08; 95% CI, 0.98-1.18) but were more effective in the
clinically evaluable population (OR, 1.14; 95% CI, 1.02-1.27) when all infections
were pooled. When available data from all trials were pooled, no differences were
noted when patients with febrile neutropenia (OR, 1.07; 95% CI, 0.82-1.39),
pneumonia (OR, 1.10; 95% CI, 0.87-1.37), bacteremia (OR, 1.05; 95% CI,
0.76-1.45), and skin and soft tissue infections (OR, 1.11; 95% CI, 0.89-1.39)
were studied. Comparators were more effective in open-label (OR, 1.28; 95% CI,
1.08-1.50) but not in double-blind trials (OR, 1.04; 95% CI, 0.90-1.20). Total
adverse events attributed to studied antibiotics (OR, 1.07; 95% CI, 0.90-1.28)
and patients withdrawn from trials (OR, 0.86; 95% CI, 0.68-1.09) were similar in
the compared groups. Mortality was not different between vancomycin and
comparator antibiotics when all trials were included in the analysis (OR, 1.09;
95% CI, 0.96-1.23). Comparators were associated with higher mortality in
open-label (OR, 1.27; 95% CI, 1.05-1.54) but not double-blind trials (OR, 0.96;
95% CI, 0.80-1.14).
CONCLUSION: On the basis mainly of data from open-label trials, vancomycin is a
treatment choice that is as effective as other available antibiotics for patients
with gram-positive infections. Study design seems to make a major contribution to
the outcome.
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