TY - JOUR

T1 - The effects of adding quinolones to beta-lactam antibiotics for sepsis

AU - Korang, Steven K.

AU - Maagaard, Mathias

AU - Feinberg, Joshua B.

AU - Perner, Anders

AU - Gluud, Christian

AU - Jakobsen, Janus C.

N1 - Publisher Copyright: © 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd

PY - 2021

Y1 - 2021

N2 - Background: Sepsis is common, deadly, and a major challenge to treat. Quinolones added to beta-lactam antibiotics are currently recommended as a second-line empiric regimen in sepsis, but the evidence regarding their benefits and harms is unclear. Objective: To assess the benefits and harms of adding quinolones to standard care for sepsis. Data sources: We conducted a systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis. We searched CENTRAL, MEDLINE, Embase, LILACS, SCI-Expanded, and BIOSIS. Study selection: Randomized clinical trials assessing the effects of adding any quinolone to standard care for children and adults with sepsis. Data extraction and synthesis: Two independent reviewers screened studies and extracted data. The certainty of the evidence was assessed by GRADE. Results: We included three trials randomizing 995 adults. All trials were at overall “high risk of bias.” All trials compared a quinolone (moxifloxacin, levofloxacin, or ciprofloxacin) and a beta-lactam antibiotic versus the same beta-lactam antibiotic. We found no evidence of an effect of adding quinolones to beta-lactam antibiotics when assessing all-cause mortality (RR 1.07, 95% CI 0.86 to 1.33; 2 trials; 915 participants; very low certainty of evidence) and serious adverse events (RR 1.00, 95% CI 0.67 to 1.50; 977 participants; two trials; very low certainty of evidence). No trials reported on quality of life. Conclusions: The effects of adding quinolones to beta-lactam antibiotics for the treatment of sepsis were unclear for all outcomes. Additional trial data are warranted to support the recommendation of empirical use of quinolones for sepsis.

AB - Background: Sepsis is common, deadly, and a major challenge to treat. Quinolones added to beta-lactam antibiotics are currently recommended as a second-line empiric regimen in sepsis, but the evidence regarding their benefits and harms is unclear. Objective: To assess the benefits and harms of adding quinolones to standard care for sepsis. Data sources: We conducted a systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis. We searched CENTRAL, MEDLINE, Embase, LILACS, SCI-Expanded, and BIOSIS. Study selection: Randomized clinical trials assessing the effects of adding any quinolone to standard care for children and adults with sepsis. Data extraction and synthesis: Two independent reviewers screened studies and extracted data. The certainty of the evidence was assessed by GRADE. Results: We included three trials randomizing 995 adults. All trials were at overall “high risk of bias.” All trials compared a quinolone (moxifloxacin, levofloxacin, or ciprofloxacin) and a beta-lactam antibiotic versus the same beta-lactam antibiotic. We found no evidence of an effect of adding quinolones to beta-lactam antibiotics when assessing all-cause mortality (RR 1.07, 95% CI 0.86 to 1.33; 2 trials; 915 participants; very low certainty of evidence) and serious adverse events (RR 1.00, 95% CI 0.67 to 1.50; 977 participants; two trials; very low certainty of evidence). No trials reported on quality of life. Conclusions: The effects of adding quinolones to beta-lactam antibiotics for the treatment of sepsis were unclear for all outcomes. Additional trial data are warranted to support the recommendation of empirical use of quinolones for sepsis.

KW - adults

KW - quinolones

KW - sepsis

KW - septic shock

KW - systematic review

KW - trial sequential analysis

U2 - 10.1111/aas.13831

DO - 10.1111/aas.13831

M3 - Review

C2 - 33864250

AN - SCOPUS:85105173383

VL - 65

SP - 1023

EP - 1032

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 8

ER -