Beta-Lactam Monotherapy for Patients with Sepsis - July 1, 2004

Beta-Lactam Monotherapy for Patients with Sepsis

Clinical Question: Is adding an aminoglycoside antibiotic to a beta-lactam antibiotic more effective than use of a beta-lactam antibiotic alone for treating sepsis in immunocompetent patients?

Setting: Inpatient (any location)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: The investigators of this meta-analysis combined the results of 64 studies enrolling 7,568 patients with sepsis caused by a variety of conditions, including pneumonia, urinary tract infections, and abdominal infections. The randomized or quasirandomized studies compared therapy with a beta-lactam antibiotic alone or in combination with an aminoglycoside antibiotic. Results of 43 trials that included 5,527 patients showed no difference between monotherapy and combination therapy in all-cause mortality by the end of the study and for up to 30 days of follow-up.

Treatment failure occurred less often with monotherapy (number needed to treat = 34; 95 percent confidence interval [CI], 20 to 147). Subgroup analysis found no difference when examining patients with documented Pseudomonas aeruginosa infection, any gram-negative infection, bacteremia, or nonurinary tract infections. Nephrotoxicity occurred significantly more often in patients treated with the aminoglycoside antibiotic (number needed to harm = 15; 95 percent CI, 14 to 17).

Bottom Line: When used alone, a beta-lactam antibiotic is as effective as a combination with an aminoglycoside antibiotic in the treatment of sepsis caused by a variety of infections in immunocompetent patients. (Level of Evidence: 1a)

allen f. shaughnessy, pharm.d.

Study Reference: Paul M, et al. Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials. BMJ March 20, 2004;328:668-72 [published correction in BMJ April 10, 2004;328:884].

Used with permission from Shaughnessy AF. Beta-lactam monotherapy okay for sepsis. Accessed online April 29, 2004, at: http://www.InfoPOEMs.com.

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