Cochrane · systematic review · CD009880
A comparison of different antibiotic regimens for the treatment of infective endocarditis
Martí-Carvajal, AJ, Dayer, M, Conterno, LO, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
42
current version
GRADE rated
18
No studies
24
Included studies
NR
No studies 24 · 57.1%Ungraded 0 · 0%Very low 15 · 35.7%Low 3 · 7.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyLevofloxacin compared with standard treatment for Staphylococcus aureus endocarditis
Population: people with Staphylococcus aureus endocarditis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality during hospital stay and all‐cause mortality at 1 year Levofloxacin vs standard treatment | RR 1.12 [0.49, 2.56] | 1 study · 70 participants | Very low Downgraded: risk of bias, imprecision |
Cure4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Adverse events4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Congestive heart failure4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Septic embolism4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Need for cardiac surgical interventions4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Uncontrolled infection4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Lipopeptide antibiotic (daptomycin) versus aminoglycoside (low‐dose gentamicin) plus antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or glycopeptide antibiotic (vancomycin) for Staphylococcus aureus endocarditis
Population: people with endocarditis caused by Staphylococcus aureus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality during hospital stay and all‐cause mortality at 1 year1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Cure Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or glycopeptide antibiotic (vancomycin) | RR 0.89 [0.42, 1.89] | 1 study · 53 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Congestive heart failure1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Septic embolism1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Need for cardiac surgical interventions1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Uncontrolled infection1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) compared with beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) for Staphylococcus aureus endocarditis in drug abusers
Population: people with endocarditis due to Staphylococcus aureus in drug abusers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality during hospital stay and all‐cause mortality at 1 year Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | no estimate extracted | NR | No studies |
Cure Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | RR 0.59 [0.4, 0.85] | 1 study · 34 participants | Low Downgraded: risk of bias, imprecision |
Adverse events Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | RR 5.5 [0.33, 91.44] | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision |
Congestive heart failure Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | no estimate extracted | NR | No studies |
Septic embolism Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | no estimate extracted | NR | No studies |
Need for cardiac surgical interventions Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | no estimate extracted | NR | No studies |
Uncontrolled infection Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | no estimate extracted | NR | No studies |
Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) versus beta‐lactam (ceftriaxone) for infective endocarditis due to penicillin‐susceptible streptococci
Population: people with infective endocarditis due to penicillin‐susceptible streptococci
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality during hospital stay and all‐cause mortality at 1 year Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | no estimate extracted | NR | No studies |
Cure Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | RR 0.69 [0.44, 1.1] | 1 study · 67 participants | Low Downgraded: risk of bias, imprecision |
Adverse events Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | RR 0.58 [0.15, 2.24] | 1 study · 67 participants | Very low Downgraded: risk of bias, imprecision |
Congestive heart failure Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | no estimate extracted | NR | No studies |
Septic embolism Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | no estimate extracted | NR | No studies |
Need for cardiac surgical interventions Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | RR 1.75 [0.65, 4.67] | 1 study · 67 participants | Very low Downgraded: risk of bias, imprecision |
Uncontrolled infection Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | RR 0.97 [0.06, 14.88] | 1 study · 67 participants | Very low Downgraded: risk of bias, imprecision |
Fosfomycin plus imipenem compared with vancomycin for infective endocarditis due to methicillin‐resistant Staphylococcus aureus
Population: people with infective endocarditis due to methicillin‐resistant Staphylococcus aureus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality during hospital stay and all‐cause mortality at 1 year Fosfomycin plus imipenem vs vancomycin | RR 7 [0.47, 103.27] | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision |
Cure Fosfomycin plus imipenem vs vancomycin | RR 0.5 [0.07, 3.55] | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Fosfomycin plus imipenem vs vancomycin | RR 1 [0.25, 4] | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision |
Congestive heart failure Fosfomycin plus imipenem vs vancomycin | RR 9 [0.64, 126.85] | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision |
Septic embolism Fosfomycin plus imipenem vs vancomycin | no estimate extracted | NR | No studies |
Need for cardiac surgical interventions Fosfomycin plus imipenem vs vancomycin | RR 2 [0.28, 14.2] | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision |
Uncontrolled infection Fosfomycin plus imipenem vs vancomycin | no estimate extracted | NR | No studies |
Partial oral treatment compared with conventional intravenous treatment of endocarditis on the left side of the heart (on native or prosthetic valves) and bacteraemia for Streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase‐negative staphylococci
Population: people with endocarditis on the left side of the heart (on native or prosthetic valves) with bacteraemia for Streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase‐negative staphylococci
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality during hospital stay and all‐cause mortality at 1 year Partial oral treatment vs conventional intravenous treatment of endocarditis on the left side of the heart (on native or prosthetic valves) and bacteraemia | RR 0.53 [0.22, 1.31] | 1 study · 400 participants | Very low Downgraded: risk of bias, imprecision |
Cure Partial oral treatment vs conventional intravenous treatment of endocarditis on the left side of the heart (on native or prosthetic valves) and bacteraemia | no estimate extracted | NR | No studies |
Adverse events Partial oral treatment vs conventional intravenous treatment of endocarditis on the left side of the heart (on native or prosthetic valves) and bacteraemia | RR 0.83 [0.36, 1.87] | 1 study · 400 participants | Low Downgraded: risk of bias, imprecision |
Congestive heart failure Partial oral treatment vs conventional intravenous treatment of endocarditis on the left side of the heart (on native or prosthetic valves) and bacteraemia | RR 0.33 [0.01, 8.05] | 1 study · 400 participants | Very low Downgraded: risk of bias, imprecision |
Need for cardiac surgicalinterventions Partial oral treatment vs conventional intravenous treatment of endocarditis on the left side of the heart (on native or prosthetic valves) and bacteraemia | RR 0.99 [0.32, 3.02] | 1 study · 400 participants | Very low Downgraded: risk of bias, imprecision |
Septic embolism Partial oral treatment vs conventional intravenous treatment of endocarditis on the left side of the heart (on native or prosthetic valves) and bacteraemia | RR 0.99 [0.2, 4.85] | 1 study · 400 participants | Very low Downgraded: risk of bias, imprecision |
Uncontrolled infection Partial oral treatment vs conventional intravenous treatment of endocarditis on the left side of the heart (on native or prosthetic valves) and bacteraemia | no estimate extracted | NR | No studies |
Levofloxacin compared with standard treatment for Staphylococcus aureus endocarditis
Population: people with Staphylococcus aureus endocarditis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality during hospital stay and all‐cause mortality at 1 year Levofloxacin vs standard treatment | RR 1.12 [0.49, 2.56] | 1 study · 70 participants | Very low Downgraded: risk of bias, imprecision |
Cure4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Adverse events4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Congestive heart failure4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Septic embolism4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Need for cardiac surgical interventions4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Uncontrolled infection4 Levofloxacin vs standard treatment | no estimate extracted | NR | No studies |
Lipopeptide antibiotic (daptomycin) versus aminoglycoside (low‐dose gentamicin) plus anti‐staphylococcal penicillin (nafcillin, oxacillin or flucloxacillin) or glycopeptide antibiotic (vancomycin) for Staphylococcus aureus endocarditis
Population: people with endocarditis caused by Staphylococcus aureus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality during hospital stay and all‐cause mortality at 1 year1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus anti‐staphylococcal penicillin (nafcillin, oxacillin or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Cure Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus anti‐staphylococcal penicillin (nafcillin, oxacillin or flucloxacillin) or glycopeptide antibiotic (vancomycin) | RR 0.89 [0.42, 1.89] | 1 study · 53 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus anti‐staphylococcal penicillin (nafcillin, oxacillin or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Congestive heart failure1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus anti‐staphylococcal penicillin (nafcillin, oxacillin or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Septic embolism1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus anti‐staphylococcal penicillin (nafcillin, oxacillin or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Need for cardiac surgical interventions1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus anti‐staphylococcal penicillin (nafcillin, oxacillin or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Uncontrolled infection1 Lipopeptide antibiotic (daptomycin) vs aminoglycoside (low‐dose gentamicin) plus anti‐staphylococcal penicillin (nafcillin, oxacillin or flucloxacillin) or glycopeptide antibiotic (vancomycin) | no estimate extracted | NR | No studies |
Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) compared with beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) for Staphylococcus aureus endocarditis in drug abusers
Population: people with endocarditis due to Staphylococcus aureus in drug abusers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality during hospital stay and all‐cause mortality at 1 year Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | no estimate extracted | NR | No studies |
Cure Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | RR 0.59 [0.4, 0.85] | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | RR 5.5 [0.33, 91.44] | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision |
Congestive heart failure Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | no estimate extracted | NR | No studies |
Septic embolism Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | no estimate extracted | NR | No studies |
Need for cardiac surgical interventions Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | no estimate extracted | NR | No studies |
Uncontrolled infection Glycopeptide (vancomycin or teicoplanin) plus aminoglycoside (gentamicin) vs beta‐lactam (cloxacillin) plus aminoglycoside (gentamicin) | no estimate extracted | NR | No studies |
Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) versus beta‐lactam (ceftriaxone) for infective endocarditis due to penicillin‐susceptible Streptococci
Population: people with infective endocarditis due to penicillin‐susceptible Streptococci
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality during hospital stay and all‐cause mortality at 1 year Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | no estimate extracted | NR | No studies |
Cure Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | RR 0.69 [0.44, 1.1] | 1 study · 67 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | RR 0.58 [0.15, 2.24] | 1 study · 67 participants | Very low Downgraded: risk of bias, imprecision |
Congestive heart failure Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | no estimate extracted | NR | No studies |
Septic embolism Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | no estimate extracted | NR | No studies |
Need for cardiac surgical interventions Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | RR 1.75 [0.65, 4.67] | 1 study · 67 participants | Very low Downgraded: risk of bias, imprecision |
Uncontrolled infection Beta‐lactam (ceftriaxone) plus aminoglycoside (gentamicin) vs beta‐lactam (ceftriaxone) | RR 0.97 [0.06, 14.88] | 1 study · 67 participants | Very low Downgraded: risk of bias, imprecision |