KLJUCAR S, HEIMESAAT M, HALLE E, HEIZMANN WR; Interscience Conference on Antimicrobial Agents and Chemotherapy (42nd : 2002 : San Diego, Calif.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2002 Sep 27-30; 42: abstract no. K-1361.
DRK Kliniken Westend, Berlin, Germany.
BACKGROUND: Although Ciprofloxacin showed comparable results to imipenem in the treatment of severe pneumonia in mechanically ventilated ICU pts, there is no recommendation for monotherapy in the guidelines for emperic treatment of severe hospital acquired pneumonia (HAP). Patients and methods: In a controlled prospective randomized trial 51 pts with late onset NP (> 4 days after ICU admission) were treated either with monotherapy (ciprofloxacin 400 mg TID) (CIP) or an antibiotic combination (ceftazidime 2 g TID plus gentamicin 1 x 5 mg/kg/d) (CAZ/GTM) stratifying with regard to mechanical ventilation and APACHE II. Evaluating the safety and efficacy the treatment was initiated 9,5 days after ICU admission (mean). 71% of the CIP group and 68% of the CAZ/GTM group had antibiotic pretreatment. RESULTS: The clinical success rate was 48% (10/21 pts) for CIP and 79% (15/19 pts) for CAZ/GTM,15 pts were invalid for evaluation of efficacy. Most causative pathogens in late HAP were H. influenzae, S. pneumoniae, E. coli, Klebsiella spp., S. aureus and P. aeruginosa. CAZ/GTM yielded a significant higher elimination rate (82,1% vs. 47,6%), a higher presumed elimination rate (23,8% vs. 7,1%) and a lower persistance rate (7,1% vs. 19,1%) (p= 0,016, Wilcoxon). Superinfection with S. aureus was the reason for failure in 3 pts with CIP, but not observed with combination therapy. There was no significant difference according to adverse events, even the mortality rate in the CIP group was slightly higher (28,2% vs. 23,5%). Conclusion: Treatment of severe late onset HAP shows better clinical and microbiological results after antibiotic combination with CAZ/GTM. In this pattern S. aureus superinfection was one reason for CIP treatment failures. Further studies comparing betalactam/aminoglycoside with betalactam/ciprofloxacin should be performed in the treatment of severe late onset HAP.
Publication Types:
Keywords:
- APACHE
- Aminoglycosides
- Anti-Bacterial Agents
- Ceftazidime
- Ciprofloxacin
- Gentamicins
- Humans
- Imipenem
- Intensive Care Units
- Longitudinal Studies
- Pneumonia
- Respiration, Artificial
- Superinfection
Other ID:
UI: 102267620
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