Article type
Year
Abstract
Introduction:
Objectives: To conduct a meta-analysis of randomized controlled trials (RCTs) comparing sequential therapy with amoxicillin/clavulanate (AMC) versus other switch therapies in the treatment of lower respiratory tract infections (LRTI).
Methods: A systematic literature search covering the years January 1980 through September 1998 was performed in Medline, Current Contents, Cochrane Databases, JADE, and the reference lists of literature on hand. All RCTs comparing AMC and other sequential therapies in adults with LRTI were selected. Trial methodological quality was assessed independently by 2 reviewers; outcomes were extracted as the number of treatment failures. The relative risk for therapeutic failure was calculated across all trials and studies grouped by antibiotic used for comparison, type of LRTI, Jadad score, and intent-to-treat analysis.
Results: Seven studies involving 1,616 patients (AMC: 814; control group: 802) met the inclusion criteria and had extractable data. The summary relative risk of treatment failure was comparable for AMC and the controls (fixed effects model: RR, 0.91; 95% CI, 0.75-1.1, n.s.; random effects model: RR, 0.92; 95% CI, 0.74-1.13, n.s.). The shape of the funnel plot indicated a lack of small studies with superior results in AMC patients (Egger test: p=0.07). In patients with pneumonia (n=491; 4 studies), the risk for therapeutic failure was 33% higher for AMC than for controls (fixed effects model: RR, 1.33; 95% CI, 0.9-1.95, n.s.). In patients with acute exacerbations of chronic bronchitis (AECB; n=344; 2 studies), the risk of failure (fixed effects model) was significantly lower in the AMC group (- 48%) than for controls (RR, 0.52; 95% CI, 0.29-0.92). The result of the random effects model was similar but not significant (RR, 0.51; 95% CI, 0.24-1.11). Further subgroup analyses showed deviation from the main analyses but no significant heterogeneity.
Discussion: The evaluated literature suggests no differences between AMC and other sequential therapies with respect to LRTI in general and pneumonia. Subgroup analyses indicate that AMC sequential therapy may be superior to other sequential therapies in the treatment of AECB. This hypothesis has to be examined in future RCTs.
Objectives: To conduct a meta-analysis of randomized controlled trials (RCTs) comparing sequential therapy with amoxicillin/clavulanate (AMC) versus other switch therapies in the treatment of lower respiratory tract infections (LRTI).
Methods: A systematic literature search covering the years January 1980 through September 1998 was performed in Medline, Current Contents, Cochrane Databases, JADE, and the reference lists of literature on hand. All RCTs comparing AMC and other sequential therapies in adults with LRTI were selected. Trial methodological quality was assessed independently by 2 reviewers; outcomes were extracted as the number of treatment failures. The relative risk for therapeutic failure was calculated across all trials and studies grouped by antibiotic used for comparison, type of LRTI, Jadad score, and intent-to-treat analysis.
Results: Seven studies involving 1,616 patients (AMC: 814; control group: 802) met the inclusion criteria and had extractable data. The summary relative risk of treatment failure was comparable for AMC and the controls (fixed effects model: RR, 0.91; 95% CI, 0.75-1.1, n.s.; random effects model: RR, 0.92; 95% CI, 0.74-1.13, n.s.). The shape of the funnel plot indicated a lack of small studies with superior results in AMC patients (Egger test: p=0.07). In patients with pneumonia (n=491; 4 studies), the risk for therapeutic failure was 33% higher for AMC than for controls (fixed effects model: RR, 1.33; 95% CI, 0.9-1.95, n.s.). In patients with acute exacerbations of chronic bronchitis (AECB; n=344; 2 studies), the risk of failure (fixed effects model) was significantly lower in the AMC group (- 48%) than for controls (RR, 0.52; 95% CI, 0.29-0.92). The result of the random effects model was similar but not significant (RR, 0.51; 95% CI, 0.24-1.11). Further subgroup analyses showed deviation from the main analyses but no significant heterogeneity.
Discussion: The evaluated literature suggests no differences between AMC and other sequential therapies with respect to LRTI in general and pneumonia. Subgroup analyses indicate that AMC sequential therapy may be superior to other sequential therapies in the treatment of AECB. This hypothesis has to be examined in future RCTs.