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OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1476-1480. [DOI: 10.1093/jac/dkac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/21/2022] [Indexed: 11/14/2022] Open
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Saleem N, Ryckaert F, Chandos Snow TA, Satta G, Singer M, Arulkumaran N. Mortality and clinical cure rates for pneumonia: A systematic review, meta-analysis, and trial sequential analysis of randomized control trials comparing bactericidal and bacteriostatic antibiotic treatments. Clin Microbiol Infect 2022; 28:936-945. [DOI: 10.1016/j.cmi.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/07/2021] [Accepted: 12/25/2021] [Indexed: 11/03/2022]
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Ben Mabrouk A, Ben Brahim H, Kooli I, Marrakchi W, Aouam A, Loussaief C, Toumi A, Chakroun M. [Off label uses of tigecycline]. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 79:244-254. [PMID: 33289663 DOI: 10.1016/j.pharma.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tigecycline is a relatively new antibiotic that have very limited valid indications. When no other alternative is available, this drug is widely used off label with promising results. The objective of this study is to summarize the different off label uses of tigecycline so that we can decide when and how to prescribe it in the absence of guidelines. MATERIAL AND METHODS This study a revue of the literature collecting all the articles concerning the off label uses of tigecycline. RESULTS Tigecycline was widely prescribed, off label, to treat infections with controversial results. Randomised clinical trials were conducted to evaluate its use to treat pneumonia. The results for this indication have a respectable level of evidence. For the other indications, the data collected was insufficient to support tigecycline prescription. In fact, different protocols were used which makes it hard to evaluate the efficacy and to conclude to the best treatment regimen. A tendency to prescribe high doses of the molecule was noted in different studies. When prescribed off label, tigecycline prescriptions were associated with a higher mortality and incidence of side effects. CONCLUSION The tigecycline remains a valid option for the treatment of infections dues to multi-resistant bacteria especially when other alternatives are scarce or in cases of renal failure.
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Affiliation(s)
- A Ben Mabrouk
- University Hospital Fattouma Bourguiba of Monastir, Infectious Diseases Department, 5019 Monastir, Tunisie.
| | - H Ben Brahim
- University Hospital Fattouma Bourguiba of Monastir, Infectious Diseases Department, 5019 Monastir, Tunisie
| | - I Kooli
- University Hospital Fattouma Bourguiba of Monastir, Infectious Diseases Department, 5019 Monastir, Tunisie
| | - W Marrakchi
- University Hospital Fattouma Bourguiba of Monastir, Infectious Diseases Department, 5019 Monastir, Tunisie
| | - A Aouam
- University Hospital Fattouma Bourguiba of Monastir, Infectious Diseases Department, 5019 Monastir, Tunisie
| | - C Loussaief
- University Hospital Fattouma Bourguiba of Monastir, Infectious Diseases Department, 5019 Monastir, Tunisie
| | - A Toumi
- University Hospital Fattouma Bourguiba of Monastir, Infectious Diseases Department, 5019 Monastir, Tunisie
| | - M Chakroun
- University Hospital Fattouma Bourguiba of Monastir, Infectious Diseases Department, 5019 Monastir, Tunisie
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Wald-Dickler N, Holtom P, Spellberg B. Busting the Myth of "Static vs Cidal": A Systemic Literature Review. Clin Infect Dis 2019; 66:1470-1474. [PMID: 29293890 DOI: 10.1093/cid/cix1127] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/22/2017] [Indexed: 01/19/2023] Open
Abstract
We sought to determine if clinical data validate the dogma that bactericidal antibiotics are more clinically effective than bacteriostatic agents. We performed a systematic literature review of published, randomized, controlled trials (RCTs) that compared a bacteriostatic agent to a bactericidal agent in the treatment of clinical, bacterial infections. Of 56 identified trials published since 1985, 49 found no significant difference in efficacy between bacteriostatic and bactericidal agents. In 6 trials it was found that the bacteriostatic agent was superior to the bactericidal agent in efficacy. Only 1 trial found that the bactericidal agent was superior; in that case, the inferiority of the static agent was explainable by underdosing of the drug based on pharmacokinetic-pharmacodynamic analysis. Thus, virtually all available data from high-quality, RCTs demonstrate no intrinsic superiority of bactericidal compared to bacteriostatic agents. Other drug characteristics such as optimal dosing, pharmacokinetics, and tissue penetration may be more important efficacy drivers.
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Affiliation(s)
- Noah Wald-Dickler
- Los Angeles County + University of Southern California Medical Center.,Division of Infectious Diseases, Keck School of Medicine at the University of Southern California, Los Angeles
| | - Paul Holtom
- Los Angeles County + University of Southern California Medical Center.,Division of Infectious Diseases, Keck School of Medicine at the University of Southern California, Los Angeles
| | - Brad Spellberg
- Los Angeles County + University of Southern California Medical Center.,Division of Infectious Diseases, Keck School of Medicine at the University of Southern California, Los Angeles
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Avni T, Shiver-Ofer S, Leibovici L, Tacconelli E, DeAngelis G, Cookson B, Pagani L, Paul M. Participation of elderly adults in randomized controlled trials addressing antibiotic treatment of pneumonia. J Am Geriatr Soc 2015; 63:233-43. [PMID: 25688601 DOI: 10.1111/jgs.13250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine how relevant current evidence on antibiotic treatment of pneumonia is for elderly adults. DESIGN Systematic review. SETTING Randomized controlled trials (RCTs; N = 43) comparing different antibiotics and prospective observational studies (N = 182) published since 2005. PARTICIPANTS Adults with community-acquired (CAP), healthcare-associated (HCAP), hospital-acquired (HAP), or ventilator-associated (VAP) pneumonia. MEASUREMENTS Exclusion criteria that could preferentially limit participation of elderly adults were examined, subgroup or other adjusted analyses were searched for according to age, and treatment effects in participants younger than 65 in RCTs were compared with those in participants aged 65 and older. Mean participant ages in RCTs and observational studies were compared. Risk ratios (RRs) with 95% confidence intervals (CIs) for differences between older and younger adults were pooled using a fixed effect metaanalysis. RESULTS No RCT reported exclusion based on an upper age limit; 100% of community CAP trials, 90% of hospitalized CAP trials, and 76% of HAP and VAP trials excluded individuals based on comorbidities. None of the RCTs reported a subgroup analysis for mortality according to age. The RR for the pooled difference in treatment failure rates between participants younger than 65 and those aged 65 and older was 1.25 (95% CI = 0.94-1.65, 12 RCTs) and between participants younger than 75 and aged 75 and older was 1.43 (95% CI = 0.98-2.09, 7 RCTs). RCT participants were significantly younger (54.0 ± 9.6) than those in observational studies of CAP (66.2 ± 8.1, P < .001). Age differences were not significant for HCAP, HAP, and VAP. CONCLUSION Elderly adults are often excluded from RCTs of bacterial pneumonia. No data were found on the comparative efficacy of antibiotic treatment in elderly adults and the general population.
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Affiliation(s)
- Tomer Avni
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Assessment of bias in outcomes reported in trials on pneumonia: a systematic review. Eur J Clin Microbiol Infect Dis 2013; 33:969-74. [PMID: 24352842 DOI: 10.1007/s10096-013-2034-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/08/2013] [Indexed: 10/25/2022]
Abstract
Subjective outcomes may exaggerate intervention effects compared to objectively measured outcomes. We compared effect estimates for clinical failure and all-cause mortality clinical trials of antibiotic treatment for pneumonia. A systematic review of randomized controlled trials assessing adults with pneumonia, comparing different antibiotics, published between 2005 and 2012 was undertaken. We compared the intervention to the control arm. The all-cause mortality in the intention-to-treat population and clinical failure as defined by the study investigators for the primary analyzed population were the primary outcomes examined. Risk ratios (RRs) with 95 % confidence intervals (CIs) were pooled, using a fixed effect model. Meta-regression was used to examine the impact of clinical failure on the mortality effect size. Thirty-six trials were included, of which 30 were industry-sponsored and 30 were non-inferiority trials. There was no difference between the effect on mortality for intervention versus control (RR 1.02, 95 % CI 0.91-1.16) and clinical failure (RR 1.01, 95 % CI 0.93-1.10), without significant heterogeneity in both analyses. In double-blind trials with adequate sequence generation and concealment, there was a significant advantage to the intervention for clinical failure (RR 0.86, 95 % CI 0.76-0.98), but not for mortality (RR 0.96, 95 % CI 0.76-1.21). RRs for clinical failure did not explain the variability in the RRs for mortality significantly, with a meta-regression coefficient of 0.32 (95 % CI -0.21-0.85). In non-inferiority trials of antibiotic treatment for pneumonia, we did not find evidence for bias induced by the use of a subjective outcome overall. The small number of trials without sponsorship precludes an adequate assessment of sponsorship effects.
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Valour F, Chebib N, Gillet Y, Reix P, Laurent F, Chidiac C, Ferry T. [Staphylococcus aureus broncho-pulmonary infections]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:368-382. [PMID: 24183294 DOI: 10.1016/j.pneumo.2013.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/30/2013] [Accepted: 08/05/2013] [Indexed: 06/02/2023]
Abstract
Staphylococcus aureus accounts for 2-5% of the etiologies of community-acquired pneumonia. These infections occur mainly in elderly patients with comorbidity, after a respiratory viral infection. S. aureus could also be responsible for necrotizing pneumonia, which occurs in young subjects, also after flu. Necrotizing pneumonia are associated with the production of a particular staphylococcal toxin called Panton-Valentine leukocidin, responsible for pulmonary focal necrosis, occurrence haemoptysis, leucopenia, and death. In Europe, these strains are still predominantly sensitive to anti-staphylococcal penicillin, which must be used at high dosage intravenously in combination with an antibiotic that reduces toxin production such as clindamycin, and intravenous immunoglobulin in severe cases. The mortality rate is estimated at 50%. In addition, S. aureus is one of the pathogens involved in early respiratory infections in cystic fibrosis patients, in whom methicillin resistance plays an important prognostic role. However, the involvement of S. aureus in COPD exacerbations is rare. Finally, S. aureus represents 20 to 30% of cases of hospital-acquired pneumonia, including ventilator-associated pneumonia. In these cases, methicillin-resistance is common and requires the use of glycopeptides or linezolid. The place of new anti-staphylococcal antibiotics such as new generation cephalosporins or tigecyclin remains to be defined.
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Affiliation(s)
- F Valour
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix-Rousse, groupement hospitalier Nord, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Inserm U1111, CNRS UMR5308, ENS de lyon, UCBL1, Centre international de recherche en infectiologie (CIRI), 69007 Lyon, France; Centre national de référence des staphylocoques, hospices civils de Lyon, 69008 Lyon, France
| | - N Chebib
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix-Rousse, groupement hospitalier Nord, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France
| | - Y Gillet
- Université Claude-Bernard Lyon 1, 69008 Lyon, France; Inserm U1111, CNRS UMR5308, ENS de lyon, UCBL1, Centre international de recherche en infectiologie (CIRI), 69007 Lyon, France; Centre national de référence des staphylocoques, hospices civils de Lyon, 69008 Lyon, France; Service d'urgences pédiatriques, hospices civils de Lyon, hôpital Femme-Mère-Enfant, 69500 Bron, France
| | - P Reix
- Université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de pneumologie, allergologie, mucoviscidose, hospices civils de Lyon, hôpital Femme-Mère-Enfant, 69500 Bron, France
| | - F Laurent
- Université Claude-Bernard Lyon 1, 69008 Lyon, France; Inserm U1111, CNRS UMR5308, ENS de lyon, UCBL1, Centre international de recherche en infectiologie (CIRI), 69007 Lyon, France; Centre national de référence des staphylocoques, hospices civils de Lyon, 69008 Lyon, France; Laboratoire de bactériologie, hospices civils de Lyon, groupement hospitalier Nord, 69004 Lyon, France
| | - C Chidiac
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix-Rousse, groupement hospitalier Nord, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Inserm U1111, CNRS UMR5308, ENS de lyon, UCBL1, Centre international de recherche en infectiologie (CIRI), 69007 Lyon, France; Centre national de référence des staphylocoques, hospices civils de Lyon, 69008 Lyon, France
| | - T Ferry
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix-Rousse, groupement hospitalier Nord, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Inserm U1111, CNRS UMR5308, ENS de lyon, UCBL1, Centre international de recherche en infectiologie (CIRI), 69007 Lyon, France; Centre national de référence des staphylocoques, hospices civils de Lyon, 69008 Lyon, France.
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Gupta D, Agarwal R, Aggarwal AN, Singh N, Mishra N, Khilnani GC, Samaria JK, Gaur SN, Jindal SK. Guidelines for diagnosis and management of community- and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations. Lung India 2012; 29:S27-62. [PMID: 23019384 PMCID: PMC3458782 DOI: 10.4103/0970-2113.99248] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Dheeraj Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - G. C. Khilnani
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - J. K. Samaria
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - S. N. Gaur
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - S. K. Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - for the Pneumonia Guidelines Working Group
- Pneumonia Guidelines Working Group Collaborators (43) A. K. Janmeja, Chandigarh; Abhishek Goyal, Chandigarh; Aditya Jindal, Chandigarh; Ajay Handa, Bangalore; Aloke G. Ghoshal, Kolkata; Ashish Bhalla, Chandigarh; Bharat Gopal, Delhi; D. Behera, Delhi; D. Dadhwal, Chandigarh; D. J. Christopher, Vellore; Deepak Talwar, Noida; Dhruva Chaudhry, Rohtak; Dipesh Maskey, Chandigarh; George D’Souza, Bangalore; Honey Sawhney, Chandigarh; Inderpal Singh, Chandigarh; Jai Kishan, Chandigarh; K. B. Gupta, Rohtak; Mandeep Garg, Chandigarh; Navneet Sharma, Chandigarh; Nirmal K. Jain, Jaipur; Nusrat Shafiq, Chandigarh; P. Sarat, Chandigarh; Pranab Baruwa, Guwahati; R. S. Bedi, Patiala; Rajendra Prasad, Etawa; Randeep Guleria, Delhi; S. K. Chhabra, Delhi; S. K. Sharma, Delhi; Sabir Mohammed, Bikaner; Sahajal Dhooria, Chandigarh; Samir Malhotra, Chandigarh; Sanjay Jain, Chandigarh; Subhash Varma, Chandigarh; Sunil Sharma, Shimla; Surender Kashyap, Karnal; Surya Kant, Lucknow; U. P. S. Sidhu, Ludhiana; V. Nagarjun Mataru, Chandigarh; Vikas Gautam, Chandigarh; Vikram K. Jain, Jaipur; Vishal Chopra, Patiala; Vishwanath Gella, Chandigarh
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Are Fluoroquinolones Superior Antibiotics for the Treatment of Community-Acquired Pneumonia? Curr Infect Dis Rep 2012; 14:317-29. [DOI: 10.1007/s11908-012-0251-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJM. Guidelines for the management of adult lower respiratory tract infections--summary. Clin Microbiol Infect 2012; 17 Suppl 6:1-24. [PMID: 21951384 DOI: 10.1111/j.1469-0691.2011.03602.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010. It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.
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Affiliation(s)
- M Woodhead
- Department of Respiratory Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, UK.
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Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJM. Guidelines for the management of adult lower respiratory tract infections--full version. Clin Microbiol Infect 2011; 17 Suppl 6:E1-59. [PMID: 21951385 PMCID: PMC7128977 DOI: 10.1111/j.1469-0691.2011.03672.x] [Citation(s) in RCA: 592] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010. It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. Background sections and graded evidence tables are also included. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.
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Affiliation(s)
- M Woodhead
- Department of Respiratory Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, UK.
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Shilo N, Quach C. Pulmonary infections and community associated methicillin resistant Staphylococcus aureus: a dangerous mix? Paediatr Respir Rev 2011; 12:182-9. [PMID: 21722847 DOI: 10.1016/j.prrv.2010.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The incidence of complicated pneumonias in children is increasing with a concurrent increase in the incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections. CA-MRSA is distinct from hospital associated MRSA [HA-MRSA] in regards to its genotype, epidemiology, and clinical course. Unlike HA-MRSA, CA-MRSA often strikes young, previously healthy children. Pneumonias caused by CA-MRSA have a rather distinct presentation. Because of its pore-forming toxins, namely Panton-Valentine leukocidin (PVL) and alpha-hemolysin, extensive necrotizing disease with corresponding hypoxaemia and hypercarbia is common. Other features include multilobar disease, leucopenia, haemoptysis, and high mortality rates. A previous influenza-like illness or skin and soft tissue infection [SSTI] often precede the development of pneumonia due to CA-MRSA. Vancomycin is recommended as first-line empiric therapy for suspected CA-MRSA infections. However, vancomycin is not an ideal agent for the treatment of pneumonia given its poor concentrating ability in alveolar fluid. Linezolid and clindamycin have also been used in the treatment of CA-MRSA pneumonia and ongoing research is looking for alternative antimicrobials. Recent studies have continued to report a lack of correlation between nasal colonization and active infections due to CA-MRSA. Given that the role of nasal colonization in CA-MRSA infection is not clear, the utility of decolonization treatment has been a point of debate. Finally, patients with cystic fibrosis are becoming increasingly colonized with MRSA as opposed to MSSA. There is some accumulating evidence that patients with MRSA show a more rapid deterioration in their degree of obstructive disease as measured by forced expiratory volume in one second (FEV(1)). However, it still is not clear whether MRSA is a marker for worsening disease or whether it actually is a cause of disease progression in cystic fibrosis. More longitudinal data is needed to understand how MRSA colonization impacts the course of disease in cystic fibrosis.
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Affiliation(s)
- Natalie Shilo
- Division of Respirology, Department of Pediatrics, The Montreal Children’s Hospital, McGill University Health Center, McGill University, Québec, Canada
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Tasina E, Haidich AB, Kokkali S, Arvanitidou M. Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis. THE LANCET. INFECTIOUS DISEASES 2011; 11:834-44. [PMID: 21784708 DOI: 10.1016/s1473-3099(11)70177-3] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Multidrug resistance among bacteria increases the need for new antimicrobial drugs with high potency and stability. Tigecycline is one candidate drug, and a previous meta-analysis of only published randomised controlled trials suggested that it might as effective as comparator treatments; we did a meta-analysis to include new and unpublished trials to assess its efficacy for the treatment of adult patients with serious bacterial infection. METHODS We searched PubMed, Cochrane Central Register, and Embase up to March 30, 2011, to identify published studies, and we searched clinical trial registries to identify completed unpublished studies, the results of which were obtained through the manufacturer. Eligible studies were randomised trials assessing the clinical efficacy, safety, and eradication efficiency of tigecycline versus other antimicrobial agents for any bacterial infection. The primary outcome was treatment success in patients who received at least one dose of the study drug, had clinical evidence of disease, and had complete follow-up (the clinically assessable population). Meta-analysis was done with random-effects models because of heterogeneity across the trials. FINDINGS 14 randomised trials, comprising about 7400 patients, were included. Treatment success was lower with tigecycline than with control antibiotic agents, but the difference was not significant (odds ratio 0·87, 95% CI 0·74-1·02). Adverse events were more frequent in the tigecycline group than in the control groups (1·45, 1·11-1·88), with significantly more vomiting and nausea. All-cause mortality was higher in the tigecycline group than in the comparator groups, but the difference was not significant (1·28, 0·97-1·69). Eradication efficiency did not differ between tigecycline and control regimens, but the sample size for these comparisons was small. INTERPRETATION Tigecycline is not better than standard antimicrobial agents for the treatment of serious infections. Our findings show that assessment with unpublished studies is needed to make appropriate decisions about new agents. FUNDING None.
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Affiliation(s)
- Efthimia Tasina
- Department of Clinical Microbiology, Hippokration General Hospital, Thessaloniki, Greece
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14
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Yahav D, Lador A, Paul M, Leibovici L. Efficacy and safety of tigecycline: a systematic review and meta-analysis. J Antimicrob Chemother 2011; 66:1963-71. [PMID: 21685488 DOI: 10.1093/jac/dkr242] [Citation(s) in RCA: 196] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tigecycline is a novel glycylcycline that exhibits broad-spectrum antibacterial activity. Recently, the US FDA issued a warning concerning increased mortality with tigecycline in randomized controlled trials (RCTs). METHODS We conducted a systematic review and meta-analysis of RCTs that compared tigecycline with any other antibiotic regimen for the treatment of any infection. A comprehensive search, without publication status or other restrictions, was conducted. The primary outcome was overall 30 day mortality. The secondary outcome included clinical and microbiological failure, superinfections and adverse events (AEs). The trials' risks of bias and their effects on results were assessed. Two reviewers independently extracted the data. Individual trials' relative risks (RRs) were pooled using a fixed effect meta-analysis. RESULTS Fifteen trials (7654 patients) were included. Overall mortality was higher with tigecycline compared with other regimens [RR 1.29, 95% confidence interval (CI) 1.02-1.64, without heterogeneity]. The type of infection assessed and the trials' reported risks of bias did not affect this result. Clinical failure was significantly higher with tigecycline (RR 1.16, 95% CI 1.06-1.27) and non-statistically significant higher rates of microbiological failure were demonstrated (RR 1.13, 95% CI 0.99-1.30). Development of septic shock was significantly more frequent with tigecycline (RR 7.01, 95% CI 1.27-38.66). Superinfections were significantly more common with tigecycline and so were AEs, including all AEs and AEs requiring discontinuation. CONCLUSIONS In the light of the increased mortality, probably explained by decreased clinical and microbiological efficacy, clinicians should avoid tigecycline monotherapy in the treatment of severe infections and reserve it as a last-resort drug.
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Affiliation(s)
- Dafna Yahav
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel.
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Falcó V, Sánchez A, Pahissa A, Rello J. Emerging drugs for pneumococcal pneumonia. Expert Opin Emerg Drugs 2011; 16:459-77. [DOI: 10.1517/14728214.2011.576669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bopp LH, Baltch AL, Ritz WJ, Michelsen PB, Smith RP. Activities of tigecycline and comparators against Legionella pneumophila and Legionella micdadei extracellularly and in human monocyte-derived macrophages. Diagn Microbiol Infect Dis 2011; 69:86-93. [PMID: 21146719 DOI: 10.1016/j.diagmicrobio.2010.08.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 08/03/2010] [Accepted: 08/25/2010] [Indexed: 11/15/2022]
Abstract
The activity of tigecycline against Legionellae, which are intracellular pathogens, was evaluated intracellularly in human phagocytes and extracellularly, and compared to the activities of erythromycin and levofloxacin. Clinical isolates of L. pneumophila serogroups 1, 5, and 6 and L. micdadei were tested in time-kill experiments. Extracellular experiments were done using buffered yeast extract broth. For intracellular assays, monolayers of human monocyte-derived macrophages (MDM) were infected with L. pneumophila or L. micdadei. Antibiotics (0.05-2.5 × MIC) were then added. MDM were lysed at 0, 24, 48, and 72 h and viable bacteria in the lysates were enumerated. Based on multiples of the MICs, tigecycline was less active extracellularly than levofloxacin or erythromycin. However, intracellular killing of both L. pneumophila and L. micdadei by tigecycline at 72 h was greater than for erythromycin or levofloxacin. Currently, evidence does not support the use of tigecycline as a first-line drug for treatment of Legionella infections. However, since Legionellae are intracellular pathogens, these results suggest that tigecycline should be effective for treatment of infections caused by these bacteria.
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Systematic review and meta-analysis of the effectiveness and safety of tigecycline for treatment of infectious disease. Antimicrob Agents Chemother 2010; 55:1162-72. [PMID: 21173186 DOI: 10.1128/aac.01402-10] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to compare the efficacy and safety of tigecycline, a newly developed glycylcycline antibiotic, with those of empirical antibiotic regimens which have been reported to possess good efficacy for complicated skin and skin structure infections (cSSSIs), complicated intra-abdominal infections (cIAIs), community-acquired pneumonia (CAP), and other infections caused by methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE). A meta-analysis of randomized controlled trials (RCTs) identified in PubMed, the Cochrane Library, and Embase was performed. Eight RCTs involving 4,651 patients were included in the meta-analysis. Compared with therapy with empirical antibiotic regimens, tigecycline monotherapy was associated with similar clinical treatment success rates (for the clinically evaluable [CE] population, odds ratio [OR] = 0.92, 95% confidence interval [CI] = 0.76 to 1.12, P = 0.42; for the clinical modified intent-to-treat [c-mITT] population, OR = 0.86, 95% CI = 0.74 to 1.01, P = 0.06) and similar microbiological treatment success rates (for the microbiologically evaluable [ME] population, OR = 0.86, 95% CI = 0.69 to 1.07, P = 0.19). The incidence of adverse events in the tigecycline group was significantly higher than that in the other therapy groups with a statistical margin (for the modified intent-to-treat [mITT] population, OR = 1.33, 95% CI = 1.17 to 1.52, P < 0.0001), especially in the digestive system (mITT population, OR = 2.41, 95% CI = 1.67 to 3.46, P < 0.00001). No difference regarding all-cause mortality and drug-related mortality between tigecycline and the other regimens was found, although numerically higher mortality was found in the tigecycline group. This meta-analysis provides evidence that tigecycline monotherapy may be used as effectively as the comparison therapy for cSSSI, cIAIs, CAP, and infections caused by MRSA/VRE. However, because of the high risk of mortality, AEs, and emergence of resistant isolates, prudence with the clinical use of tigecycline monotherapy in infections is required.
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Jones RN, Jacobs MR, Sader HS. Evolving trends in Streptococcus pneumoniae resistance: implications for therapy of community-acquired bacterial pneumonia. Int J Antimicrob Agents 2010; 36:197-204. [PMID: 20558045 DOI: 10.1016/j.ijantimicag.2010.04.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 04/07/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
Abstract
Pneumonia is a major infectious disease associated with significant morbidity, mortality and utilisation of healthcare resources. Streptococcus pneumoniae is the predominant pathogen in community-acquired pneumonia (CAP), accounting for 20-60% of bacterial cases. Emergence of multidrug-resistant S. pneumoniae has become a significant problem in the management of CAP. Although pneumococcal conjugate vaccine usage in children has led to significant decreases in morbidity and mortality due to S. pneumoniae in all age groups, disease management has been further complicated by the unexpected increase in resistant serotypes, such as 19A, in some regions. Until rapid and accurate diagnostic tests become available, initial treatment of CAP will remain empirical. Thus, selection of appropriate antimicrobial therapy for CAP must be based on prediction of the most likely pathogens and their local antimicrobial susceptibility patterns. This article reviews information on antimicrobial resistance patterns amongst S. pneumoniae and implications for managing CAP.
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Affiliation(s)
- Ronald N Jones
- JMI Laboratories, 345 Beaver Kreek Centre, Ste A, North Liberty, IA 52317, USA.
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Cunha BA. Legionnaires' disease: clinical differentiation from typical and other atypical pneumonias. Infect Dis Clin North Am 2010; 24:73-105. [PMID: 20171547 PMCID: PMC7127122 DOI: 10.1016/j.idc.2009.10.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, 259 First Street, Mineola, Long Island, NY 11501, USA
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Falagas ME, Metaxas EI. Tigecycline for the treatment of patients with community-acquired pneumonia requiring hospitalization. Expert Rev Anti Infect Ther 2010; 7:913-23. [PMID: 19803699 DOI: 10.1586/eri.09.73] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pneumonia, along with influenza, is the leading cause of mortality associated with infectious diseases in the USA. Tigecycline is a novel antimicrobial agent that is active against a broad spectrum of pathogens. Our objective is to review the literature about the efficacy of tigecycline in community-acquired pneumonia (CAP). Data from various sources, including Pubmed, the European Medicines Agency (EMEA) and the US FDA were appraised. Tigecycline was found to be noninferior compared with levofloxacin for the treatment of patients with bacterial CAP requiring hospitalization. Recently, the drug was approved for the treatment of these patients by the FDA, but owing to some concerns, its application in the EMEA has been withdrawn. In addition, in a recent study concerns were expressed about the efficacy of tigecycline in the lungs using the current dosage. More data are needed about the pharmacokinetics of tigecycline in the lungs and its efficacy in severe CAP.
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Affiliation(s)
- Matthew E Falagas
- Alfa Institute of Biomedical Sciences, 15123 Marousi, Athens, Greece.
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Determination of tigecycline in human skin using a novel validated LC–MS/MS method. Bioanalysis 2010; 2:81-94. [DOI: 10.4155/bio.09.159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: To develop and validate a sensitive and novel bioanalytical method for measuring tigecycline concentrations in human skin using LC–MS/MS. Results: The method utilizes addition of a stabilizing agent to the human skin or surrogate (human liver or rat skin), homogenization of human skin in a strong acidic-methanol extraction solvent, centrifugation of the skin suspension, filtration of the skin suspension supernatant, separation by LC (Polaris™ C18-A 50 × 2.0 mm), and detection of tigecycline by MS/MS. Linearity was 50–20,000 ng/g, using a sample size of 100 mg. The intra-and inter-day accuracy and precision of the assay met acceptance criteria. Conclusion: This method has been successfully applied to 17 incurred human skin samples from volunteers with surgical infections who received intravenous doses of tigecycline (100 mg initial loading dose and 50 mg every 12 h for at least 2 days). Tigecycline concentrations in these samples ranged from 185 to 2853 ng/g.
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