Meta-análise Cochrane: teicoplanina versus vancomicina para infecções suspeitas ou confirmadas / Cochrane meta-analysis: teicoplanin versus vancomycin for proven or suspected infection

RESUMO

Objective: To compare efficacy and safety of vancomycin versus teicoplanin in patients with proven or suspected infection. Methods: Data Sources Cochrane Renal Group's Specialized Register, CENTRAL, MEDLINE, EMBASE, nephrology textbooks and review articles. Inclusion criteria Randomized controlled trials in any language comparing teicoplanin to vancomycin for patients with proven or suspected infection. Data extraction Two authors independently evaluated methodological quality and extracted data. Study investigators were contacted for unpublished information. A random effect model was used to estimate the pooled risk ratio (RR) with 95% confidence interval (CI). Results: A total of 24 studies (2,610 patients) were included. The drugs had similar rates of clinical cure (RR 1.03; 95%CI 0.98-1.08), microbiological cure (RR 0.98; 95%CI 0.93-1.03) and mortality (RR 1.02; 95%CI 0.79-1.30). Teicoplanin had lower rates of skin rash (RR 0.57; 95%CI 0.35-0.92), red man syndrome (RR 0.21; 95%CI 0.08-0.59) and total adverse events (RR 0.73; 95%CI 0.53-1.00). Teicoplanin reduced the risk of nephrotoxicity (RR 0.66; 95%CI 0.48-0.90). This effect was consistent for patients receiving aminoglycosides (RR 0.51; 95%CI 0.30-0.88) or having vancomycin doses corrected by serum levels (RR 0.22; 95%CI 0.10-0.52). There were no cases of acute kidney injury needing dialysis. Limitations: Studies lacked a standardized definition for nephrotoxicity. Conclusions: Teicoplanin and vancomycin are equally effective; however the incidence of nephrotoxicity and other adverse events was lower with teicoplanin. It may be reasonable to consider teicoplanin for patients at higher risk for acute kidney injury.