Clinical Question: Is adding an aminogly-coside antibiotic to a beta-lactam antibiotic more effective than use of a beta-lactam antibiotic alone for treating sepsis in immu-nocompetent patients?

Setting: Inpatient (any location)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: The investigators of this meta-analysis combined the results of 64 studies enrolling 7,568 patients with sepsis caused by a variety of conditions, including pneumonia, urinary tract infections, and abdominal infections. The randomized or quasirandomized studies compared therapy with a beta-lactam antibiotic alone or in combination with an aminoglyco-side antibiotic. Results of 43 trials that included 5,527 patients showed no difference between monotherapy and combination therapy in all-cause mortality by the end of the study and for up to 30 days of follow-up. Treatment failure occurred less often with monotherapy (number needed to treat = 34; 95 percent confidence interval [CI], 20 to 147). Subgroup analysis found no difference when examining patients with documented Pseudomonas aeruginosa infection, any gram-negative infection, bacteremia, or nonurinary tract infections. Nephrotoxicity occurred significantly more often in patients treated with the aminoglycoside antibiotic (number needed to harm = 15; 95 percent CI, 14 to 17).

Bottom Line: When used alone, a beta-lactam antibiotic is as effective as a combination with an aminoglycoside antibiotic in the treatment of sepsis caused by a variety of infections in immunocompetent patients. (Level of Evidence: 1a)