Twelve RCTs were included in the review (n=3,607).
Severe infection
Only one trial compared carbapenems with 4GC. There were no significant differences between carbapenems and 4GC for any of the positive or negative outcomes assessed.
Seven trials compared carbapenems with APP. There was no significant difference in clinical response, clinical cure, bacteriologic response, serious adverse events overall or gastrointestinal-related serious adverse events between carbapenems and APP. But, there was a significant reduction in all-cause mortality (RR 0.62, 95% CI: 0.41, 0.95; five RCTs) and serious adverse events leading to withdrawal (RR 0.65, 95% CI: 0.45, 0.96; six RCTs) with carbapenems compared with APP. There was no evidence of significant statistical heterogeneity. There was no clear evidence of publication bias.
Febrile neutropenia
Two trials compared carbapenems with 4GC. There were no significant differences between carbapenems and 4GC for any of the positive or negative outcomes assessed. Statistical heterogeneity was significant for the outcomes clinical response and bacteriologic response.
Two trials compared carbapenems with APP. There was no significant difference in clinical response, all-cause mortality and serious adverse events overall between carbapenems and APP. But, there was a significant improvement in clinical response (within 72 hours) (RR 1.37, 95% CI: 1.09, 1.74; two RCTs) and bacteriologic response (RR 1.73, 95% CI: 1.03, 2.89; one RCT) with carbapenems compared with APP. There was no evidence of significant statistical heterogeneity.
Results for subgroup analyses and sensitivity analyses were also presented.