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Evidence summaries

Combination of Beta Lactam and Aminoglycoside Antibiotic Therapy for Sepsis

Adding an aminoglycoside to beta-lactams in the treatment of sepsis does not improve clinical efficacy achieved with the beta-lactam alone. Combination treatment carries a significant risk of nephrotoxicity. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 69 studies with a total of 7 863 subjects. Twenty-two trials compared the same beta lactam in both study arms, while the remaining trials compared different beta lactams using a broader-spectrum beta lactam in the monotherapy arm. In trials comparing the same beta lactam, we observed no difference between study groups with regard to all-cause mortality (RR 0.97, 95% CI 0.73 to 1.30) and clinical failure (RR 1.11, 95% CI 0.95 to 1.29). In studies comparing different beta lactams, we observed a trend for benefit with monotherapy for all-cause mortality (RR 0.85, 95% CI 0.71 to 1.01) and a significant advantage for clinical failure (RR 0.75, 95% CI 0.67 to 0.84). No significant disparities emerged from subgroup and sensitivity analyses, including assessment of participants with Gram-negative infection. Nephrotoxicity was significantly less frequent with monotherapy (RR 0.30, 95% CI 0.23 to 0.39).

    References

    • Paul M, Lador A, Grozinsky-Glasberg S et al. Beta lactam antibiotic monotherapy versus beta lactam-aminoglycoside antibiotic combination therapy for sepsis. Cochrane Database Syst Rev 2014;(1):CD003344. [PubMed]

Primary/Secondary Keywords