Therapeutic efficacy of the combination of aztreonam with cefotaxime in the treatment of severe nosocomial pneumonia. Comparative study against amikacin combined with cefotaxime.
The combination aztreonam + cefotaxime (AZ + CE) was compared to amikacin + cefotaxime (AM + CE) in the treatment of nosocomial pneumonia acquired at the intensive-care unit. This study included a total of 33 patients fulfilling criteria for nosocomial pneumonia. 16 of them were randomly allocated to the AZ + CE group and 17 to the AM + CE group. The empirical treatment was effective for 78% of AZ + CE cases and 92% of AM + CE cases (p = NS). Clinical care was observed in 77% of cases (10 out of 13 evaluable) in the AZ group and in 75% of the group treated with AM (12 cases out of 16 evaluable; p = NS). In the evaluable cases, treatment failure was associated with injections due to the following organisms: Acinetobacter calcoaceticus (1) and Pseudomonas aeruginosa (1) in the AZ group and A. calcoaceticus (1) in the AM group. Superinfections were observed only in the AM group P. aeruginosa. A. calcoaceticus, Streptococcus viridans, Candida albicans, Aspergillus fumigatus and Serratia marcescens. Both the peak and through serum concentrations of AZ and AM were maintained within normal ranges. Finally, an impairment of renal tubular function was observed in the group of patients treated with AM, as measured by urinary levels of N-acetyl-beta-D-glucosaminidase and leucine aminopeptidase sequentially during the treatment. These changes in renal functions alterations mentioned were not observed in the AZ group. It is concluded that the AZ + CE combination is an effective empirical and active antibiotic treatment against severe nosocomial pneumonia. Aztreonam has no renal toxicity, which is an advantage to take into account in patients with altered renal function.
Torres
A
A
Respiratory Diseases, Clinical Hospital of Barcelona, Spain.
de Celis
R
R
Rabinad
E
E
Marco
F
F
Almela
M
M
Deulofeu
R
R
Rodriguez-Roisin
R
R
Agusti Vidal
A
A
D000328:Adult; D000368:Aged; D000583:Amikacin / Q000008:administration & dosage*; D001398:Aztreonam / Q000008:administration & dosage / Q000627:therapeutic use*; D002439:Cefotaxime / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003428:Cross Infection / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*; D011897:Random Allocation
D000583:Amikacin; D001398:Aztreonam; D002439:Cefotaxime