PMID- 33120768
OWN - NLM
STAT- MEDLINE
DCOM- 20201119
LR  - 20221005
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 99
IP  - 43
DP  - 2020 Oct 23
TI  - Carbapenems versus alternative beta-lactams monotherapy or in combination for 
      febrile neutropenia: Systematic review and meta-analysis of randomized controlled 
      trial.
PG  - e22725
LID - 10.1097/MD.0000000000022725 [doi]
LID - e22725
AB  - BACKGROUND: Febrile neutropenia (FN) in cancer patients can be life threatening 
      and require the timely antimicrobial agents treatment. METHODS: To compare the 
      effectiveness and safety of carbapenems versus beta-lactams for FN. PubMed, Medline 
      (Ovid SP), Cochrane CENTRAL, and Embase were searched up to March 2019. FN in 
      patients due to undergoing chemotherapy and treated with carbapenems and 
      beta-lactams were included. Odds ratio (OR) and 95% confidence interval (CI) were 
      estimated. RESULTS: Fifty randomized controlled trials (RCTs) studies involving 
      10,995 participants were included. Carbapenems were more likely to experience 
      treatment success without modification (OR = 1.34, 95% CI = 1.24-1.46) compared 
      with beta-lactams. Meropenem (OR = 1.36, 95% CI = 1.18-1.56; OR = 1.24, 95% 
      CI = 1.01-1.53), imipenem/cilastatin (OR = 1.40, 95% CI = 1.19-1.65; OR = 1.31, 
      95% CI = 1.04-1.67) showed higher effectiveness from that by beta-lactams 
      monotherapy or in combination with aminoglycoside, respectively. 
      Carbapenems-aminoglycoside combination therapy does not provide an advantage over 
      carbapenems alone. Meropenem showed similar risk of adverse events (AEs) versus 
      beta-lactams. Imipenem/cilastatin was related to higher risk of AEs compared with 
      beta-lactams. There was no significant difference between carbapenems and beta-lactams 
      monotherapy or in combination. CONCLUSION: Meropenem and imipenem/cilastatin 
      monotherapy appears to be available treatment for FN compared with beta-lactams. 
      Imipenem/cilastatin was related to higher risk of AEs. Balancing the evidence for 
      drug efficacy and side effects, meropenem monotherapy appears to be available 
      treatment for FN. Individual centers should select the best matching therapy 
      regimens according to local epidemiology and susceptibility patterns.
FAU - Tang, Xiuge
AU  - Tang X
AD  - Department of Cardiovascular Medicine.
FAU - Chen, Lingyuan
AU  - Chen L
AD  - Department of Pharmacy.
FAU - Li, Yan
AU  - Li Y
AD  - Department of Pharmacy.
FAU - Jiang, Junsong
AU  - Jiang J
AD  - Department of Reproductive Medicine, The People's Hospital of Hechi, Hechi, 
      China.
FAU - Li, Xianshu
AU  - Li X
AD  - Department of Pharmacy.
FAU - Liang, Xueyan
AU  - Liang X
AD  - Department of Pharmacy.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Carbapenems)
RN  - 0 (beta-Lactams)
SB  - IM
MH  - Anti-Bacterial Agents/*administration & dosage
MH  - Carbapenems/*administration & dosage
MH  - Drug Therapy, Combination
MH  - Febrile Neutropenia/*drug therapy
MH  - Humans
MH  - *Randomized Controlled Trials as Topic
MH  - beta-Lactams/*administration & dosage
PMC - PMC7581108
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2020/10/31 06:00
MHDA- 2020/11/20 06:00
PMCR- 2020/10/23
CRDT- 2020/10/30 01:01
PHST- 2020/10/30 01:01 [entrez]
PHST- 2020/10/31 06:00 [pubmed]
PHST- 2020/11/20 06:00 [medline]
PHST- 2020/10/23 00:00 [pmc-release]
AID - 00005792-202010230-00044 [pii]
AID - MD-D-19-10269 [pii]
AID - 10.1097/MD.0000000000022725 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2020 Oct 23;99(43):e22725. doi: 
      10.1097/MD.0000000000022725.