Journal Article

The Safety and Efficacy of Ceftazidime-Avibactam Plus Metronidazole Versus Meropenem for Intra-abdominal Infections: A Systematic Review and Meta-Analysis

Badayyan, Samar Y, Karrar, Hani Raka, Shaikh, Lamer K, AlButi, Hala, Almuqati, Abdulrahman Olayan Mohammed, Alhendi, Rehab Salah Aldin, Aseeri, Hanin Ali, Hassan, Dina M, Algothmi, Mohannad A, Abdullah, Fai F, Alotaibi, Khloud Mubark, Alkhaifi, Nouran M, Nouh, Mahmoud Ismail, Al Ghamdi, Nourah A

2025

Overview

Intra-abdominal infections encompass a range of medical conditions categorized by their complexity. Uncomplicated infections involve inflammation or infection limited to a single abdominal organ, such as acute appendicitis or cholecystitis, without extending to the peritoneum, while complicated infections spread to the peritoneal cavity. The key associated microbiological agents include Gram-positive cocci, Gram-negative Enterobacteriaceae, and obligate anaerobes, with common pathogens being Escherichia coli, Klebsiella pneumoniae, Streptococcus species, and Bacteroides fragilis. Treatment options include well-established antibiotics and newer agents like meropenem, metronidazole, and ceftazidime/avibactam. Meropenem, a carbapenem antibiotic, is known for its broad-spectrum efficacy and low toxicity, making it suitable for severe infections. Ceftazidime, a third-generation cephalosporin, is effective against Pseudomonas aeruginosa, especially when paired with avibactam, a β-lactamase inhibitor, enhancing its effectiveness. Metronidazole disrupts bacterial DNA, targeting anaerobic bacteria and protozoa. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of the ceftazidime-avibactam plus metronidazole combination compared to meropenem for intra-abdominal infections. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a comprehensive search of databases such as PubMed, Web of Science, and the Cochrane Library was conducted. Results showed that the combination therapy had a slightly higher overall adverse event rate (5.57%) compared to meropenem (4.56%), although this difference was not statistically significant [risk ratio (RR): 1.22; 95% confidence interval (CI): 0.78-1.93; p = 0.39]. Meropenem demonstrated a significantly higher clinical response rate in ceftazidime-susceptible infections (89.93% vs. 85.88%; RR: 0.96; 95% CI: 0.93-0.99; p = 0.009). No significant differences were observed in ceftazidime-resistant infections. Overall, the findings suggest that ceftazidime-avibactam combined with metronidazole is a viable alternative to meropenem, highlighting the need for further research to optimize treatment strategies amid rising antibiotic resistance.

• Publisher: Springer Nature B.V
• Subject: Abdomen / Antibiotics / Bacteria / Bias / Clinical trials / Collaboration / Combination therapy / Cytotoxicity / Microorganisms / Nosocomial infections / Patients / Sensitivity analysis / Software reviews / Systematic review