Ceftazidime/Avibactam and Ceftolozane/Tazobactam for Severe Pediatric Infections: A Systematic Review, Meta-analysis, and Evidence Map
Abstract
BACKGROUND
The growing prevalence of multidrug-resistant Gram-negative bacilli (MDR-GNB) poses major challenges to the management of severe pediatric infections. Ceftazidime/avibactam (CZA) and ceftolozane/tazobactam (C/T) are newer β-lactam/β-lactamase inhibitor combinations with established efficacy in adults.
OBJECTIVE
To synthesize current evidence on the efficacy, effectiveness, and safety of CZA and C/T in hospitalized children with severe infections.
METHODS
We conducted a systematic review, meta-analysis, and evidence map (PROSPERO CRD420251025715). Searches were performed in PubMed, Scopus, CENTRAL, Epistemonikos, LILACS, SciELO, and Web of Science. Eligible designs included randomized controlled trials (RCTs), cohort studies, case series, and case reports evaluating CZA or C/T for complicated intra-abdominal infections (cIAI), complicated urinary tract infections (cUTI), pneumonia, or bacteremia in patients aged 0-18 years. The primary outcome was 30-day mortality; secondary outcomes were clinical and microbiological cure and adverse events.
RESULTS
Nineteen studies (4 RCTs, 9 case series, 6 case reports) involving 472 patients were included. Sixteen studies evaluated CZA and three evaluated C/T. All RCTs were phase II, industry-sponsored, and excluded critically ill children and carbapenem-resistant infections. According to the updated RoB 2 assessment, two trials had overall low risk of bias, and two presented some concerns, mainly related to missing outcome…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 472 participants or records.
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