Empiric treatment of hospital-acquired lower respiratory tract infections with meropenem or ceftazidime with tobramycin

Sieger, Barry; Berman, Steven; Geckler, Ronald W.; Farkas, Stephen A.

doi:10.1097/00003246-199710000-00015

Cited by 111 publications

(83 citation statements)

References 22 publications

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“…From these, 51 RCTs did not meet the inclusion criteria of the current meta-analysis for the reasons detailed in figure 1. Thus, 12 RCTs [64][65][66][67][68][69][70][71][72][73][74][75] were included in the current meta-analysis. Table 1 lists the characteristics of the 12 RCTs [64][65][66][67][68][69][70][71][72][73][74][75] included in the meta-analysis.…”

Section: Data Analysis and Statistical Methodsmentioning

confidence: 99%

“…The mean (range) quality score of the included RCTs was 2.42 (1-5), which was considered good. The quality of five RCTs [64][65][66][67]74] was high (o3), while the quality of seven [68][69][70][71][72][73]75] was low (f2). The proportion of patients under mechanical ventilation was 100% in three trials [67,68,71], .70% in five trials [64-66, 72, 74] and 50% in two RCTs [69,75], while the remaining RCTs [70,73] did not provide relevant data.…”

Section: Data Analysis and Statistical Methodsmentioning

confidence: 99%

“…The dosages of the administered drugs are shown in table 1. Imipenem/ cilastatin or meropenem was administered in eight [64-66, 68, 69, 71, 74, 75] and four RCTs [67,70,72,73], respectively. Imipenem/cilastatin was compared with fluoroquinolones in three RCTs (specifically, levofloxacin [65] and ciprofloxacin [68,74]) and with other b-lactams in five trials (specifically, piperacillin/tazobactam [64,69], aztreonam [71], cefepime [66] and ceftazidime [75]).…”

Section: Administration Of Study Drugsmentioning

confidence: 99%

See 2 more Smart Citations

Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia

Siempos

Vardakas²,

Manta³

et al. 2007

Eur Respir J

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The comparative effectiveness and safety of carbapenems with other b-lactams and fluoroquinolones for the empirical treatment of patients with hospital-acquired pneumonia remains controversial.In the present study, a meta-analysis of 12 relevant randomised controlled trials was performed. Overall, carbapenems were associated with lower mortality than fluoroquinolones or b-lactams, alone or in combination with aminoglycosides (odds ratio 0.72, 95% confidence interval 0.55-0.95). There was no difference between the compared antibiotics regarding treatment success (1.08, 0.91-1.29), microbiological success (1.04, 0.72-1.50) or development of adverse effects (0.81, 0.46-1.43). In the subset of patients with Pseudomonas aeruginosa pneumonia, carbapenems were associated with lower treatment success (0.42, 0.22-0.82) and lower eradication of P. strains (0.50, 0.24-0.89).Carbapenems are equivalent to fluoroquinolones or b-lactams, alone or in combination with aminoglycosides, for the empirical treatment of immunocompetent adult patients with hospitalacquired pneumonia. However, there is limited evidence, based predominantly on unblinded randomised controlled trials, that carbapenems are associated with lower mortality than the comparators; this association was not observed in a subset analysis of randomised controlled trials with a high methodological quality score. In patients with Pseudomonas aeruginosa pneumonia, carbapenems are associated with worse outcomes than the comparators.

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Section: Data Analysis and Statistical Methodsmentioning

confidence: 99%

Section: Data Analysis and Statistical Methodsmentioning

confidence: 99%

Section: Administration Of Study Drugsmentioning

confidence: 99%

See 1 more Smart Citation

Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia

Siempos

Vardakas²,

Manta³

et al. 2007

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…Based on these considerations and new data for noninfected lung tissue (14), we studied the technical feasibility of microdialysis and its ability to define the pharmacokinetic properties of antibiotics in interstitial pneumonic lung tissue in patients with pneumonia and undergoing surgery for consecutive episodes of metapneumonic empyema. The carbapenem meropenem was studied because it is a well-tolerated, broad-spectrum antibacterial agent which is well established for the empirical monotherapy of pneumonia, particularly in intensive care units (11,33), and has no significant protein binding.…”

mentioning

confidence: 99%

Penetration of Meropenem into Pneumonic Human Lung Tissue as Measured by In Vivo Microdialysis

Tomaselli

Maier

Matzi

et al. 2004

Antimicrob Agents Chemother

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Until recently, information on antibiotic pharmacokinetic properties in infected human lung tissue was limited. We therefore studied a microdialysis-based approach for measurement of the penetration of meropenem into the extracellular space fluid of human pneumonic lung parenchyma. The lung penetration of meropenem was determined for seven patients with pneumonia and metapneumonic pleural empyema treated by decortication. Intraoperatively, two microdialysis probes were inserted into pneumonic lung tissue and one was inserted into healthy skeletal muscle for reference values.

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“…It was concluded that combination therapy using a fourth-generation cephalosporin with either an aminoglycoside or a fluoroquinolone was not associated with a clinical or biological benefit when compared with cephalosporin monotherapy for common, susceptible pathogens causing VAP [5]. Of the many comparative studies for the treatment of VAP, six are summarised in table 2 [6][7][8][9][10][11]. Perhaps the best of these studies compared imipenem alone with the combination of imipenem and netilmicin [8].…”

Section: Monotherapy Versus Combination Therapy: Comparisons Of Efficacymentioning

confidence: 99%

Combinationversusmonotherapy for nosocomial pneumonia

Lode¹

2007

Eur Respir Rev

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Combination antibiotic therapy of nosocomial pneumonia is sometimes appropriate and desirable; however, it should be used judiciously. When pneumonia appears in the first 5 days following hospital admission and in the absence of other risk factors for infection by multidrug-resistant pathogens, the infection is likely to be due to a pathogen acquired in the community and is likely to be sensitive to most antibiotics.These infections should generally be treated with monotherapy. However, pathogens resistant to multiple drugs are increasingly common in the hospital and intensive care unit setting. In the presence of risk factors for such pathogens, any single drug may prove ineffective; treatment with two or more drugs theoretically increases the likelihood that the pathogen will be sensitive to at least one of them. However, combination therapy also increases the cost and the likelihood of adverse effects, as well as the possibility of drug interactions, if the two are not chosen wisely.The crucial question is whether combination antibiotic therapy actually improves clinical outcome. Most clinical trials suggest that monotherapy and combination therapy provide equivalent efficacy. However, these studies have uniformly excluded the most seriously ill patients: those with Acute Physiology and Chronic Evaluation-II scores .20.It is concluded that available studies provide no concrete evidence to support the use of combination therapy in moderately ill patients and provide no data for the treatment of seriously ill patients who might be most likely to benefit.

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Empiric treatment of hospital-acquired lower respiratory tract infections with meropenem or ceftazidime with tobramycin

Abstract: Meropenem is well tolerated and more efficacious than the combination of ceftazidime and tobramycin for the initial empiric treatment of hospital-acquired bacterial pneumonia.

Cited by 111 publications

References 22 publications

Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia

Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia

Penetration of Meropenem into Pneumonic Human Lung Tissue as Measured by In Vivo Microdialysis

Combinationversusmonotherapy for nosocomial pneumonia

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