Cochrane meta-analysis: teicoplanin versus vancomycin for proven or suspected infection

Einstein (São Paulo). 2011;9(3):265-282

 

Journal Homepage

Journal Title: Einstein (São Paulo)

ISSN: 1679-4508 (Print); 2317-6385 (Online)

Publisher: Instituto Israelita de Ensino e Pesquisa Albert Einstein

Society/Institution: Instituto Israelita de Ensino e Pesquisa Albert Einstein

LCC Subject Category: Medicine

Country of publisher: Brazil

Language of fulltext: English, Portuguese

Full-text formats available: PDF, HTML, XML

 

AUTHORS


Diogo Diniz Gomes Bugano

Alexandre Biasi Cavalcanti

Anderson Roman Goncalves

Claudia Salvini de Almeida

Eliézer Silva

EDITORIAL INFORMATION

Double blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 38 weeks

 

Abstract | Full Text

Objective: To compare efficacy and safety of vancomycin versusteicoplanin in patients with proven or suspected infection.Methods: Data Sources: Cochrane Renal Group’s SpecializedRegister, CENTRAL, MEDLINE, EMBASE, nephrology textbooksand review articles. Inclusion criteria: Randomized controlled trialsin any language comparing teicoplanin to vancomycin for patientswith proven or suspected infection. Data extraction: Two authorsindependently evaluated methodological quality and extracted data.Study investigators were contacted for unpublished information. Arandom effect model was used to estimate the pooled risk ratio (RR)with 95% confidence interval (CI). Results: A total of 24 studies (2,610patients) were included. The drugs had similar rates of clinical cure(RR: 1.03; 95%CI: 0.98-1.08), microbiological cure (RR: 0.98; 95%CI:0.93-1.03) and mortality (RR: 1.02; 95%CI: 0.79-1.30). Teicoplaninhad lower rates of skin rash (RR: 0.57; 95%CI: 0.35-0.92), red mansyndrome (RR: 0.21; 95%CI: 0.08-0.59) and total adverse events (RR:0.73; 95%CI: 0.53-1.00). Teicoplanin reduced the risk of nephrotoxicity(RR: 0.66; 95%CI: 0.48-0.90). This effect was consistent for patientsreceiving aminoglycosides (RR: 0.51; 95%CI: 0.30-0.88) or havingvancomycin doses corrected by serum levels (RR: 0.22; 95%CI:0.10-0.52). There were no cases of acute kidney injury needingdialysis. Limitations: Studies lacked a standardized definition fornephrotoxicity. Conclusions: Teicoplanin and vancomycin are equallyeffective; however the incidence of nephrotoxicity and other adverseevents was lower with teicoplanin. It may be reasonable to considerteicoplanin for patients at higher risk for acute kidney injury.