Efficacy and Safety of Colistin Combination Therapy vs.Monotherapy:a Meta-Analysis

Objective: To evaluate the efficacy and safety of colistin in combination with other antibacterials(combination therapy) and its monotherapy(monotherapy). Methods: We searched clinical trials on comparing combination therapy with monotherapy from the Cochrane Library, Pubmed and Embase up to May 2013. System analysis was conducted by RevMan 5.0 software. Results: 14 controlled studies meeting the inclusion criteria were included, of which 5 studies were included in mortality rate outcomes, 11 studies in clinical response outcomes, 4 studys in microbiological outcome and 4 studies in nephrotoxic outcomes. Monotherapy had a higher mortality rate than combination therapy(OR=2.30, 95%CI [1.28, 4.13], P =0.005). The overall clinical response of monotherapy was superior to combination therapy(OR=1.59, 95%CI [1.03, 2.45], P =0.04),but subgroup analysis about prospective study design showed that clinical response did not differ significantly between monotherapy and combination therapy(OR=1.02, 95%CI [0.53, 1.94], P =0.96). Microbiological eradication had not difference significantly between monotherapy and combination therapy(OR=1.25, 95%CI [0.66, 2.36], P =0.50) and nephrotoxicity had also not difference(OR=0.90,95%CI [0.31, 2.61,P =0.85). Conclusion: combination therapy in the clinical response and microbiological eradication is similar to monotherapy, but in survivalrates better than monotherapy. Combination therapy does not increase the nephrotoxicity of polymyxin E.