Systematic review and meta-analysis of the safety of antistaphylococcal penicillins compared to cefazolin

Khalid Eljaaly, Samah Alshehri, Brian L Erstad

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Recent studies and experience suggest that cefazolin might be equally as effective as antistaphylococcal penicillins for methicillin-susceptible Staphylococcus aureus (MSSA), with a better safety profile and lower cost. The objective of these meta-analyses was to compare the safeties of antistaphylococcal penicillins and cefazolin. The PubMed, Embase, and International Pharmaceutical Abstracts databases and websites for clinical trial registries through 23 June 2017 were searched. In addition, recent abstracts from infectious disease and pharmacy conferences were reviewed. We estimated Peto odds ratios (ORs) with 95% confidence intervals (CIs) using random-effects models. One analysis focused on hospitalized patients, and the other focused on outpatients. Eleven retrospective studies of hospitalized patients and three retrospective studies of outpatients were included. In hospitalized patients, lower rates of nephrotoxicity (Peto OR, 0.225; 95% CI, 0.127 to 0.513), acute interstitial nephritis (Peto OR, 0.189; 95% CI, 0.053 to 0.675), hepatotoxicity (Peto OR, 0.160; 95% CI, 0.066 to 0.387), and drug discontinuation due to adverse reactions (Peto OR, 0.192; 95% CI, 0.089 to 0.414) were found with cefazolin. In outpatients, lower rates of nephrotoxicity (Peto OR, 0.372; 95% CI, 0.192 to 0.722), hepatotoxicity (Peto OR, 0.313; 95% CI, 0.156 to 0.627), and hypersensitivity reactions (Peto OR, 0.372; 95% CI, 0.201 to 0.687) were observed with cefazolin. Compared to antistaphylococcal penicillins, cefazolin was associated with significant reductions in nephrotoxicity and hepatotoxicity in hospitalized patients and outpatients. Additionally, cefazolin was associated with lower likelihoods of discontinuation due to side effects in hospitalized patients and hypersensitivity reactions in outpatients. Cefazolin should be considered a first-line option for patients with MSSA infections for which efficacy is presumed to be similar to that of antistaphylococcal penicillin therapy.

Original languageEnglish (US)
Article numbere01816-17
JournalAntimicrobial Agents and Chemotherapy
Volume62
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Cefazolin
Penicillins
Meta-Analysis
Odds Ratio
Confidence Intervals
Safety
Outpatients
Methicillin
Staphylococcus aureus
Hypersensitivity
Retrospective Studies
Pharmaceutical Databases
Interstitial Nephritis
PubMed
Communicable Diseases
Registries
Clinical Trials
Costs and Cost Analysis

Keywords

  • Antistaphylococcal penicillins
  • Cefazolin
  • MSSA
  • Nafcillin
  • Oxacillin

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Systematic review and meta-analysis of the safety of antistaphylococcal penicillins compared to cefazolin. / Eljaaly, Khalid; Alshehri, Samah; Erstad, Brian L.

In: Antimicrobial Agents and Chemotherapy, Vol. 62, No. 4, e01816-17, 01.04.2018.

Research output: Contribution to journalReview article

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abstract = "Recent studies and experience suggest that cefazolin might be equally as effective as antistaphylococcal penicillins for methicillin-susceptible Staphylococcus aureus (MSSA), with a better safety profile and lower cost. The objective of these meta-analyses was to compare the safeties of antistaphylococcal penicillins and cefazolin. The PubMed, Embase, and International Pharmaceutical Abstracts databases and websites for clinical trial registries through 23 June 2017 were searched. In addition, recent abstracts from infectious disease and pharmacy conferences were reviewed. We estimated Peto odds ratios (ORs) with 95{\%} confidence intervals (CIs) using random-effects models. One analysis focused on hospitalized patients, and the other focused on outpatients. Eleven retrospective studies of hospitalized patients and three retrospective studies of outpatients were included. In hospitalized patients, lower rates of nephrotoxicity (Peto OR, 0.225; 95{\%} CI, 0.127 to 0.513), acute interstitial nephritis (Peto OR, 0.189; 95{\%} CI, 0.053 to 0.675), hepatotoxicity (Peto OR, 0.160; 95{\%} CI, 0.066 to 0.387), and drug discontinuation due to adverse reactions (Peto OR, 0.192; 95{\%} CI, 0.089 to 0.414) were found with cefazolin. In outpatients, lower rates of nephrotoxicity (Peto OR, 0.372; 95{\%} CI, 0.192 to 0.722), hepatotoxicity (Peto OR, 0.313; 95{\%} CI, 0.156 to 0.627), and hypersensitivity reactions (Peto OR, 0.372; 95{\%} CI, 0.201 to 0.687) were observed with cefazolin. Compared to antistaphylococcal penicillins, cefazolin was associated with significant reductions in nephrotoxicity and hepatotoxicity in hospitalized patients and outpatients. Additionally, cefazolin was associated with lower likelihoods of discontinuation due to side effects in hospitalized patients and hypersensitivity reactions in outpatients. Cefazolin should be considered a first-line option for patients with MSSA infections for which efficacy is presumed to be similar to that of antistaphylococcal penicillin therapy.",
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