Comparison of safety between high and low doses of sulbactam/ampicillin: A retrospective observational study in Japanese patients with pneumonia

Imanishi, Kaori; Nakakura, Ichiro; Miyabe, Takashi; Sako, Rumi; Yamauchi, Koh-en

doi:10.1016/j.jiac.2020.06.004

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…Besides, a meta-analysis demonstrated that high-dose sulbactam (≥6 g/day) combining with other antibacterial medications such as colistin might might be a potential therapy for MDR-AB or XDR-AB infections 27 . But limited evidence on the safety of high-dose sulbactam therapy, existing ndings indicate that high-dose ampicillin-sulbactam (sulbactam component 12 g/day) has caused no relevant adverse effects 28 , while, another analysis suggested that patients treated with a daily dose of sulbactam/ampicillin of ≥9 g (sulbactam component 6 g/day) were more likely to experience an increase in alanine aminotransferase grade 29 . There is still a debate about safety of SBT.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of the efficacy of sulbactam in the treatment of patients with extensively drug-resistant Acinetobacter baumannii infections

Yu,

Zhang,

Yang

et al. 2024

Preprint

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Purpose Sulbactam (SBT) is one of the most significant treatments for patients with extensively drug-resistant Acinetobacter baumannii (XDR-AB). However, the efficacy and safety of SBT and its high dose regimen has not been well documented. This retrospective study aimed to assess the efficacy and safety of SBT-based treatment, particularly at high-dose (≥ 6g/day), for XDR-AB infection. Method A total of 52 XDR-AB infected patients treated with intravenous SBT at Peking Union Medical College Hospital were included. The primary outcome was 28-day all-cause mortality, while the secondary outcome was 14-day clinical response and the time of response. Results Among the patients, the 28-day all-cause mortality rate was 36.5% (19/52), and the favorable 14-day clinical response rate was 59.6% (31/52). The 28-day mortality was independently associated coinfection with gram-positive bacteria (GPB) and a shorter duration of therapy. Patients with intracranial infection might have a longer survival time. A favorable 14-day clinical response was associated with high dose SBT, and a longer treatment duration. However, the higher creatinine clearance (CrCl) associated with a worse clincal response. In addition, a higher SBT dosage was significantly correlated with a quicker clinical response. No adverse effects related were reported. Conclusion The single-agent formulation of SBT emerges as a promising alternative for the treatment of XDR-AB infection, such as intracranial infection, particularly at high doses (≥ 6g/day). Besides, longer duration of treatment correlates with higher survival rate and better favorable clinical response. Higher CrCl negatively correlates with favorable clinical response.

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Section: Discussionmentioning

confidence: 99%

A retrospective study of the efficacy of sulbactam in the treatment of patients with extensively drug-resistant Acinetobacter baumannii infections

Yu,

Zhang,

Yang

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Ampicillin CL decreases to 0.6-0.7-hold in elderly patients compared with that of non-elderly adult patients, and the halflife and area under the curve (AUC) are also prolonged (t 1/2 ; 1.6-hold, AUC; 1.6-hold) by decreased renal function. 23,24) Maicher-Peszynska et al 25) found that the calculated fT > MIC (MIC 90 = 1 mg/L for Streptococcus pneumoniae) for ampicillin was 75-100% in geriatric patients following intravenous (i.v.) administration of 2 g ampicillin thrice daily, which was similar to our study.…”

Section: Discussionmentioning

confidence: 99%

Dosing Optimization of Ampicillin-Sulbactam Based on Cystatin C in Elderly Patients with Pneumonia

Matsubara

Matsumoto

Yokoyama

et al. 2021

Biological & Pharmaceutical Bulletin

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Ampicillin-sulbactam is a first-line therapy for pneumonia and is mainly excreted by the kidney. It is important to optimize the dose and dosing interval of ampicillin-sulbactam because in patients with decreased renal function and low skeletal muscle mass, such as the elderly, excess drug may burden renal function. In this study, we evaluated indices of renal function and optimized the dose and dosing interval of ampicillin-sulbactam based on pharmacokinetics (PK) and pharmacodynamics theory in elderly patients. The serum concentrations of ampicillin and sulbactam were measured by HPLC, and PK parameters were calculated. Correlations between the clearance of ampicillin or sulbactam and renal function were evaluated, and dosing optimization was calculated based on PK parameters. The PK parameters of ampicillin were CL 6.5 4.0 L/h, Vd 19.3 0.2 L, Ke 0.4 0.2, and t 1/2 2.7 1.6 h. The most correlated renal function index was estimated glomerular filtration rate (eGFRcys-c) calculated by serum cystatin-c (r 0.7374, correlation formula; CL of ampicillin 0.1937 eGFRcys-c 0.6726). Based on this formula, we calculated the clearance of ampicillin and developed dosing regimens for the elderly. Serum cystatin-c concentration is an ideal index to optimize ampicillin-sulbactam antimicrobial therapy in elderly patients with pneumonia.

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A retrospective study of the efficacy of sulbactam in the treatment of patients with extensively drug-resistant Acinetobacter baumannii infections

Yu,

Zhang,

Yang

et al. 2024

Infection

View full text Add to dashboard Cite

Purpose Sulbactam (SBT) is one of the most significant treatments for patients with extensively drug-resistant Acinetobacter baumannii (XDR-AB). However, the efficacy and safety of SBT and its high dose regimen has not been well documented. This retrospective study aimed to assess the efficacy and safety of SBT-based treatment, particularly at high-dose (≥ 6 g/day), for XDR-AB infection. Method A total of 52 XDR-AB infected patients treated with intravenous SBT at Peking Union Medical College Hospital were included. The primary outcome was 28-day all-cause mortality, while the secondary outcome was 14-day clinical response and the time of response. The formulation of SBT in our study is 0.5 g per vial. Results Among the patients, the 28-day all-cause mortality rate was 36.5% (19/52), and the favorable 14-day clinical response rate was 59.6% (31/52). The 28-day mortality was independently associated coinfection with gram-positive bacteria (GPB) and a shorter duration of therapy. Patients with intracranial infection might have a longer survival time. A favorable 14-day clinical response was associated with the dose of SBT, and a longer treatment duration. However, the higher creatinine clearance (CrCl) associated with a worse clincal response. In addition, a higher SBT dosage was significantly correlated with a shorter time to clinical response. No adverse effects related were reported. Conclusion The single-agent formulation of SBT emerges as a promising alternative for the treatment of XDR-AB infection, such as intracranial infection, particularly at high doses (≥ 6 g/day). Besides, longer duration of treatment correlates with higher survival rate and better favorable clinical response. Higher CrCl negatively correlates with favorable clinical response.

show abstract

Comparison of safety between high and low doses of sulbactam/ampicillin: A retrospective observational study in Japanese patients with pneumonia

Cited by 5 publications

References 16 publications

A retrospective study of the efficacy of sulbactam in the treatment of patients with extensively drug-resistant Acinetobacter baumannii infections

A retrospective study of the efficacy of sulbactam in the treatment of patients with extensively drug-resistant Acinetobacter baumannii infections

Dosing Optimization of Ampicillin-Sulbactam Based on Cystatin C in Elderly Patients with Pneumonia

A retrospective study of the efficacy of sulbactam in the treatment of patients with extensively drug-resistant Acinetobacter baumannii infections

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