Pharmacoepidemiology of Severe Systemic Infection and Need of Netilmicin Monotherapy or Combination Therapy: Systemic Review and Meta-Analysis

Abstract

In this systematic review and meta-analysis we compared the efficacy and safety in patient with severe systemic infection (SSF) who has been either on netilmicin (NL) monotherapy or combination of netilmicin with other antibiotics (NLC). A systematic review of the literature was performed in accordance with PRISMA guidelines in Medline and Embase. A comprehensive search was performed from 1978 to 2017. Total 17 studies were identified that include 976 randomized patients with SSF. 489 patients enrolled in 11 studies for NL while 487 in NLC group. The meta-analysis showed that there was a statistically significant difference in rate of clinical efficacy (rate of failure) between NL (13.09%) and comparator NLC (20.91%). Nephrotoxicity associated with the therapy showed minor difference between both group, NL (13.80%) and NLC (10.09%). The study was further compare on the basis of dose regimen viz once a day (OD) and three times a day (TID). 184 patients of 4 studies received once in a day netilmicin monotherapy (OD-NL) while 259 patients of 7 studies received three times a day netilmicin monotherapy (TID-NL). Result of dose regimen group showed 11.04% rate of failure and 11.78% incidence of nephrotoxicity in (OD-NL) and 12.5% and 13.84% respectively in (TID-NL). The paucity of data from this evidence based systematic review and meta-analysis, favors NL monotherapy, if the slightly more chances of nephrotoxicity than comparator NLC neglected.