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Open Access Highly Accessed Research article

Ertapenem versus piperacillin/tazobactam for the treatment of complicated infections: a meta-analysis of randomized controlled trials

Mao Mao An1, Zui Zou2, Hui Shen3, Jun Dong Zhang4, Meng Li Chen1, Ping Liu1*, Rui Wang1 and Yuan Ying Jiang4*

Author Affiliations

1 Department of Clinical Pharmacology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, PR China

2 Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai, 200433, PR China

3 Chinese Acad Med Sci, Peking Union Med Coll, Fuwai Hosp & Cardiovasc Inst, 167 Beilishi Road, Beijing 100037, PR China

4 Department of Pharmacology, School of Pharmacy, Second Military Medical University, 325 Guo He Road, Shanghai 200433, PR China

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BMC Infectious Diseases 2009, 9:193  doi:10.1186/1471-2334-9-193

Published: 2 December 2009

Abstract

Background

Ertapenem, a new carbapenem with a favorable pharmacokinetic profile, has been approved for the treatment of complicated intra-abdominal Infections (cIAIs), acute pelvic infections (APIs) and complicated skin and skin-structure infections (cSSSIs). The aim of this study is to compare the efficacy and safety of ertapenem with piperacillin/tazobactam, which has been reported to possess good efficacy for the treatment of these complicated infections.

Methods

We performed a meta-analysis of randomized controlled trials identified in PubMed, Cochrane library and Embase that compared the efficacy and safety of ertapenem with piperacillin/tazobactam for the treatment of complicated infections including cIAIs, APIs, cSSSIs. The primary efficacy outcome was clinical treatment success assessed at the test-of-cure visit. The primary safety outcome was drug related clinical and laboratory adverse events occurred during the treatment and the post-treatment period.

Result

Six RCTs, involving 3161 patients, were included in our meta-analysis. Ertapenem was associated similar clinical treatment success with piperacillin/tazobactam for complicated infections treatment (clinically evaluable population, 1937 patients, odds ratios: 1.15, 95% confidence intervals: 0.89-1.49; modified intention to treat population, 2855 patients, odds ratios: 1.03, 95% confidence intervals: 0.87-1.22). All of secondary efficacy outcomes analysis obtained similar findings with clinical treatment success. No difference was found about the incidence of drug related adverse events between ertapenem and piperacillin/tazobactam groups.

Conclusion

This meta-analysis provides evidence that ertapenem 1 g once a day can be used as effectively and safely as recommended dose of piperacillin/tazobactam, for the treatment of complicated infections, particularly of mild to moderate severity. It is an appealing option for the treatment of these complicated infections.