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dc.creatorRyder, Jonathan H.
dc.creatorTong, Steven Y.C.
dc.creatorGallagher, Jason C.
dc.creatorMcDonald, Emily G.
dc.creatorThevarajan, Irani
dc.creatorLee, Todd C.
dc.creatorCortes-Penfield, Nicolas W.
dc.identifier.citationJonathan H Ryder, Steven Y C Tong, Jason C Gallagher, Emily G McDonald, Irani Thevarajan, Todd C Lee, Nicolás W Cortés-Penfield, Deconstructing the Dogma: Systematic Literature Review and Meta-analysis of Adjunctive Gentamicin and Rifampin in Staphylococcal Prosthetic Valve Endocarditis, Open Forum Infectious Diseases, Volume 9, Issue 11, November 2022, ofac583,
dc.description.abstractBackground: Based primarily on in vitro and animal models, with little data directly addressing patient outcomes, current guidelines recommend treating staphylococcal prosthetic valve endocarditis (PVE) with antibiotic combinations including gentamicin and rifampin. Here, we synthesize the clinical data on adjunctive rifampin and gentamicin in staphylococcal PVE. Methods: We conducted a systematic review and meta-analysis of PubMed- and Cochrane-indexed studies reporting outcomes of staphylococcal PVE treated with adjunctive rifampin, gentamicin, both agents, or neither (ie, glycopeptide or β-lactam monotherapy). We recorded outcomes including mortality, relapsed infection, length of stay, nephrotoxicity, hepatotoxicity, and important drug–drug interactions (DDIs). Results: Four relevant studies were identified. Two studies (n = 117) suggested that adding gentamicin to rifampin-containing regimens did not reduce clinical failure (odds ratio [OR], 0.98 [95% confidence interval {CI}, .39–2.46]), and 2 studies (n = 201) suggested that adding rifampin to gentamicin-containing regimens did not reduce clinical failure (OR, 1.29 [95% CI, .71–2.33]). Neither gentamicin nor rifampin was associated with reduced infection relapse; 1 study found that rifampin treatment was associated with longer hospitalizations (mean, 31.3 vs 42.3 days; P < .001). Comparative safety outcomes were rarely reported, but 1 study found rifampin to be associated with hepatoxicity, nephrotoxicity, and DDIs, leading to treatment discontinuation in 31% of patients. Conclusions: The existing clinical data do not suggest a benefit of either adjunctive gentamicin or rifampin in staphylococcal PVE. Given that other studies also suggest these agents add nephrotoxicity, hepatoxicity, and risk of DDIs without benefit in staphylococcal endovascular infections, we suggest that recommendations for gentamicin and rifampin in PVE be downgraded and primarily be used within the context of clinical trials.
dc.format.extent7 pages
dc.relation.ispartofFaculty/Researcher Works
dc.relation.haspartOpen Forum Infectious Diseases, Vol. 9, Iss. 11
dc.relation.isreferencedbyOxford University Press
dc.rightsAttribution-NonCommercial-NoDerivs CC BY-NC-ND
dc.subjectProsthetic valve
dc.titleDeconstructing the Dogma: Systematic Literature Review and Meta-analysis of Adjunctive Gentamicin and Rifampin in Staphylococcal Prosthetic Valve Endocarditis
dc.type.genreJournal article
dc.description.departmentPharmacy Practice
dc.ada.noteFor Americans with Disabilities Act (ADA) accommodation, including help with reading this content, please contact
dc.description.schoolcollegeTemple University. School of Pharmacy
dc.temple.creatorGallagher, Jason C.

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