Monotherapy is appropriate for nosocomial pneumonia in the intensive care unit.
The antibiotic therapy of pneumonia in the patient receiving intensive care has traditionally required the use of two agents, usually a beta-lactam or other broad spectrum agent and an aminoglycoside. A large body of data is now available indicating that initial empiric therapy with a broad spectrum agent (third-generation cephalosporin, carbapenem or fluoroquinolone) is as efficacious as combination therapy in the treatment of critically ill patients with pneumonia. If Pseudomonas aeruginosa is isolated, a second antibiotic may need to be added. Overall, approximately 60% of patients can be successfully treated with any of these regimens. The historic reasons that established antibiotic combinations as the standard for therapy are critically examined and put into perspective. Studies of pharmacokinetics, experimental pneumonia and clinical trials completed in the last decade show that for most cases of nosocomial pneumonia, monotherapy is an acceptable regimen.
Arbo
M D
MD
Department of Medicine, New England Medical Center, Boston, MA 02111.
Snydman
D R
DR
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D003428:Cross Infection / Q000188:drug therapy*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents