Ampicillin + sulbactam vs. clindamycin ± cephalosporin for the treatment of aspiration pneumonia and primary lung abscess

Abstract

Aspiration pneumonia, necrotising pneumonia and primary lung abscess are complications arising from the aspiration of infectious material from the oral cavity or stomach. There is limited information on optimal antibacterial therapeutic regimens. Patients with pulmonary infection following aspiration (n = 95) were included in a prospective, open, randomised, comparative multicentre trial to compare the safety, clinical and bacteriological efficacy of ampicillin + sulbactam vs. clindamycin +/- cephalosporin. Treated patients (n = 70) received sequential antibiotic therapy with either ampicillin + sulbactam (n = 37) or clindamycin (n = 33), with or without a second- or third-generation cephalosporin, administered until the complete resolution of clinical and radiological abnormalities. Definite or presumptive pathogens were isolated from 58 patients. Mean duration of therapy was 22.7 days for ampicillin + sulbactam and 24.1 days for clindamycin. In patients treated with ampicillin + sulbactam, the clinical response was 73.0% at the end of therapy and 67.5% 7-14 days after therapy. For clindamycin, the rates were 66.7% and 63.5%, respectively. Bacteriological response was similar in both treatment arms. Nine patients died (12.9%), with a Simplified Acute Physiology Score of > 30 points being the only significant predictive factor for therapeutic failure. Ampicillin + sulbactam and clindamycin +/- cephalosporin were both well-tolerated and proved equally effective in the treatment of aspiration pneumonia and lung abscess.

Eficácia e segurança de Sultamicilina (Ampicilina/Sulbactam) e Amoxacilina/Clavulanato no tratamento das infecções de via aéreas superiores em adultos: um estudo multicêntrico, aberto e randomizado

“…Such results correlate to literature reports on the use of Ampicillin/Sulbactan combination in the treatment of both upper and lower airway infections [24][25][26] .…”

Etiology and Outcome of Community-Acquired Lung Abscess

“…Unfortunately, we did not perform quantitative cultures from the PSB specimens, so the number of bacteria in our study is unknown. However, previous reports have regarded all bacteria cultured from PSB specimens as the etiologic pathogens [9,21,22] and we have done the same. PUTA is also used to identify the etiology of infections, and contamination from the upper respiratory tract can be completely avoided.…”

Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment

“…26 In adult patients, although anaerobes occur in one-third of aspiration pneumonias, aerobic Gram-negative bacteria, including enteric bacteria (eg, Escherichia coli and Pseudomonas spp) and Gram-positive bacteria (eg, methicillin-sensitive and methicillinresistant Staphylococcus aureus), are recovered more often (ie, in 50% of cultures). [27][28][29][30] We are aware of only 1 randomized controlled trial that compared effectiveness of antibiotic treatment in hospitalized children with aspiration pneumonia; no difference in effectiveness between penicillin G and clindamycin was found. 31 Our study has several limitations in addition to those described earlier.…”