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Published on:February 2021
Indian Journal of Pharmaceutical Education and Research, 2021; 55(1):288-303
Original Article | doi:10.5530/ijper.55.1.32

Re-Appraisal of the Effectiveness and Adverse Reaction between Cefazolin and Anti-Staphylococcal Penicillins for Treating Patients with Methicillin- Sensitive Staphylococcus aureus Bacteremia: Comprehensive Meta-analysis and Trial Sequential Analysis


Authors and affiliation (s):

Chang-Hua Chen1,6,7,*, Yu-Min Chen2, Hsien-Meng Chen1, Yu-Jun Chang3, Li-Jhen Lin4, Hua-Cheng Yen5

1Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, TAIWAN.

2Department of Pharmacy, Changhua Christian Hospital, Changhua, TAIWAN.

3Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, TAIWAN.

4Center for Infection Prevention and Control, Changhua Christian Hospital, Changhua, TAIWAN.

5Department of Neurosurgery, Changhua Christian Hospital, Changhua, TAIWAN.

6Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, TAIWAN.

7Rong Hsing Research Center For Translational Medicine, National Chung Hsing University, Taichung, TAIWAN.

Abstract:

Objectives: Patients with methicillin susceptible Staphylococcus aureus bacteremia (MsSaB) are treated by cefazolin (Cfz) or anti-staphylococcal penicillin’s (ASPs) as the preference drug, although they may be not equally effective in some clinical scenarios. We performed a comprehensive meta-analysis and trial sequential analysis to assess the updated evidence comparing Cfz with ASPs in patients with MsSaB. Methods: We searched the databases including PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and ClinicalTrials.gov from inception to July 2019 for studies investigating the effects of Cfz and ASP in patients with MsSaB. The primary endpoint was the 90-day all-cause mortality rate. Results: We included 16 studies with 13847 patients with MsSaB. Nine reports showed that the Cfz group might be associated with lower the 90-day all-cause mortality rate than ASP (odds ratio [OR], 0.675; 95% confidence interval [CI], 0.485–0.938; p=0.019, low quality of evidence). In addition, Cfz group might be associated with lower 30-day mortality rate (OR, 0.681; 95% CI, 0.533–0.869; p=0.002, low quality of evidence), lower incidence rate of treatment failure/relapse (OR, 0.644; 95% CI, 0.509–0.866; p=0.002, low quality of evidence) and less nephrotoxicity than ASP (OR, 0.296; 95% CI, 0.167–0.525; p<0.001, low quality of evidence). Conclusion: We concluded that Cfz and ASP were at least equally effective in patients with MsSaB according to the all-cause mortality rates and nephrotoxicity. Because of heterogeneity, underlying variance and inadequate information size, these results should be interpreted with caution.

Key words: Meta-analysis, Anti-staphylococcal penicillin, Cefazolin, Staphylococcus aureus, Bacteremia.

 




 

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The Official Journal of Association of Pharmaceutical Teachers of India (APTI)
(Registered under Registration of Societies Act XXI of 1860 No. 122 of 1966-1967, Lucknow)

Indian Journal of Pharmaceutical Education and Research (IJPER) [ISSN-0019-5464] is the official journal of Association of Pharmaceutical Teachers of India (APTI) and is being published since 1967.

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