Ceftobiprole and pneumonia in adults admitted to the emergency department is it time to assess a new therapeutic algorithm?

Abstract

Objective: Ceftobiprole is an advance generation cephalosporin which has broad-spectrum bacterial activity (both against Gram-positive and negative pathogens) and was approved for the treatment of communityacquired pneumonia (CAP) and non-ventilated hospital-acquired pneumonia (HAP) in most European countries. We aimed to evaluate the efficacy and safety of ceftobiprole in the treatment of pneumonia in a cohort of severely ill patients admitted to the emergency department (ED). Methods: 1-year observational retrospective mono-centric study. Were defined two primary endpoints: first, to evaluate the clinical cure at the test-of-cure (TOC); the second, to evaluate the early improvement, defined as a reduction of symptoms and inflammatory parameters 72 hours after the start of treatment. The secondary endpoint is to evaluate the reduction of antibiotic "burden" using ceftobiprole despite standard of care in severe hospital-acquired pneumonia. Results: During the study period, a total of 48 patients with severe pneumonia received ceftobiprole: twenty-two patients (45.8%) as empiric therapy, 9 (18.5%) as a de-escalation option from previous combination therapies, 13 patients (27.1%) as an escalation therapy from ceftriaxone or amoxicillin/clavulanate and four patients (8.3%) as a targeted therapy based on microbiological results. Ceftobiprole mean duration therapy was 10.2 days. Forty-six patients with severe pneumonia had an early clinical improvement 72 hours after the start of treatment (95.8%). In general, ceftobiprole was well tolerated; only one patient suspended the drug because of poor tolerability. The clinical cure at TOC was 85.4% and 30-days crude mortality was 10.4%. Conclusions: This study confirms that ceftobiprole is effective in severely ill patients with pneumonia at risk of poor outcomes.

Real-World Experience of Ceftobiprole for Community- and Hospital-Acquired Pneumonia from a Stewardship Perspective

“…Of note, first-line treatment with ceftobiprole was associated with better survival than escalation or targeted second-line regimens were, although there were no significant differences in the primary outcome. This is a new finding compared to other real-life studies, in which ceftobiprole in pluripathological patients was mostly used as a rescue therapy or sequential treatment [31,36].…”

Community-Acquired Pneumonia in Canada During Coronavirus Disease 2019

“…Currently in Canada, ceftobiprole is primarily used as directed therapy for CAP patients with documented MRSA with or without bacteremia [ 18 ]. However, with its excellent activity against common bacterial CAP pathogens, ceftobiprole could also be considered for empirical use (along with a respiratory fluoroquinolone) to treat severe CAP patients with risk factors for either MRSA or P aeruginosa [ 19 ]. Combination therapy of IV amoxicillin-clavulanate plus a macrolide (eg, azithromycin) could be considered for hospitalized nonsevere CAP.…”

Drugs targeting CMPK2 inhibit pyroptosis to alleviate severe pneumonia caused by multiple respiratory viruses

“…These are all pathogenically responsible for the body's immune activation and persistent inflammatory responses. However, SARS‐CoV‐2 infection may cause an overactive inflammatory response in the host, characterized by high levels of circulating inflammatory cytokines and interleukin (IL)‐6 4 . The similarities and differences between SARS‐CoV‐2 and other respiratory viruses show molecular mechanisms that induce host diseases.…”

“…However, SARS-CoV-2 infection may cause an overactive inflammatory response in the host, characterized by high levels of circulating inflammatory cytokines and interleukin (IL)-6. 4 The similarities and differences between SARS-CoV-2 and other respiratory viruses show molecular mechanisms that induce host diseases. Understanding the genetic changes in the upper respiratory tract after the virus first enters the host is critical for the prevention and treatment of respiratory viral infection.…”