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Clinical Research in Cardiology

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Open Access 09-11-2021 | Ampicillin | Original Paper

Time to abandon ampicillin plus gentamicin in favour of ampicillin plus ceftriaxone in Enterococcus faecalis infective endocarditis? A meta-analysis of comparative trials

Authors: Moritz Mirna, Albert Topf, Lukas Schmutzler, Uta C. Hoppe, Michael Lichtenauer

Published in: Clinical Research in Cardiology | Issue 10/2022

Abstract

Background

Current guidelines recommend either ampicillin plus ceftriaxone (AC) or amoxicillin/ampicillin plus gentamicin (AG) with an equivalent class IB recommendation in Enterococcus faecalis endocarditis. However, previous observational studies suggest that AC might be favourable in terms of adverse events.

Objectives

To investigate whether AC is non-inferior to AG, and if it is associated with less adverse events.

Methods

In June 2021, a systematic literature search using the databases PubMed/MEDLINE, CDSR, CENTRAL, CCAs, EBM Reviews, Web of Science and LILACS was conducted by two independent reviewers. Studies were considered eligible if (P) patients included were ≥ 18 years of age and had IE with E. faecalis, (I) treatment with AC was compared to (C) treatment with AG and (O) outcomes on in-hospital mortality, nephrotoxicity and adverse events requiring drug withdrawal were reported. Odds ratios and 95% confidence intervals were calculated using random-effects models with the Mantel–Haenszel method, the Sidik–Jonkman estimator for τ² and the Hartung–Knapp adjustment.

Results

Treatment with AC was non-inferior to AG, as depicted by no significant differences in-hospital mortality, 3-month mortality, relapses or treatment failure. Furthermore, AC was associated with a lower prevalence of nephrotoxicity (OR 0.45 [0.26–0.77], p = 0.0182) and drug withdrawal due to adverse events (OR 0.11 [0.03–0.46], p = 0.0160) than AG.

Conclusions

Treatment with AC was non-inferior to treatment with AG, and it was associated with a reduced prevalence of nephrotoxicity and drug withdrawal due to adverse events. Thus, combination therapy with AC appears favourable over AG in patients with E. faecalis IE.

Graphical abstract

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Title: Time to abandon ampicillin plus gentamicin in favour of ampicillin plus ceftriaxone in Enterococcus faecalis infective endocarditis? A meta-analysis of comparative trials
Authors: Moritz Mirna
Albert Topf
Lukas Schmutzler
Uta C. Hoppe
Michael Lichtenauer
Publication date: 09-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Ampicillin
Gentamicin
Aminoglycoside
Ceftriaxone
Endocarditis
Published in: Clinical Research in Cardiology / Issue 10/2022
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-021-01971-3

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Time to abandon ampicillin plus gentamicin in favour of ampicillin plus ceftriaxone in Enterococcus faecalis infective endocarditis? A meta-analysis of comparative trials

Abstract

Background

Objectives

Methods

Results

Conclusions

Graphical abstract

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Abstract

Background

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Results

Conclusions

Graphical abstract

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