Infections in patients in intensive care units: can the combination of a monobactam and a penicillin replace the classic combination of a beta-lactam agent and an aminoglycoside?
An open, comparative, randomized study was performed in two medical intensive care units to compare the efficacy of the combination of aztreonam and either cloxacillin or oxacillin [(cl)oxacillin] with that of the combination of tobramycin and a cephalosporin. Of the 92 patients who were included in the study, 76 were evaluable. All patients suffered from severe, mostly pulmonary, infections and received ventilatory support. The aztreonam combination yielded an 80% rate of clinical cure; mortality was 15%. Use of the aminoglycoside combination resulted in a 51% rate of clinical cure; mortality was 23%. The difference in cure rate between the two combinations was statistically significant. Adverse effects were negligible in patients who received the aztreonam combination, and superinfection was seen in only 2%. Of the patients who received the aminoglycoside combination, 20% developed a superinfection and 11% developed a new renal insufficiency. Therefore, the combination of aztreonam and (cl)oxacillin is a valuable alternative to the combination of an aminoglycoside and a cephalosporin.
Colardyn
F
F
Department of Intensive Care, University Hospital, Gent, Belgium.
Gala
J L
JL
Verschraegen
G
G
Wauters
G
G
Vogelaers
D
D
Dive
A
A
Claeys
G
G
Magis
A
A
Vandercam
B
B
Mahieu
P
P
D000328:Adult; D000368:Aged; D001398:Aztreonam / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002439:Cefotaxime / Q000009:adverse effects / Q000627:therapeutic use*; D002444:Cefuroxime / Q000009:adverse effects / Q000627:therapeutic use; D003023:Cloxacillin / Q000009:adverse effects / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010068:Oxacillin / Q000009:adverse effects / Q000627:therapeutic use*; D015163:Superinfection / Q000209:etiology; D014031:Tobramycin / Q000009:adverse effects / Q000627:therapeutic use*
D001398:Aztreonam; D002439:Cefotaxime; D002444:Cefuroxime; D003023:Cloxacillin; D010068:Oxacillin; D014031:Tobramycin