A randomized controlled trial of filgrastim as an adjunct to antibiotics for treatment of hospitalized patients with community-acquired pneumonia. CAP Study Group.
Because of the critical role of neutrophils in host defenses, it was hypothesized that stimulation of neutrophil production and function with Filgrastim would improve the outcome of hospitalized patients with community-acquired pneumonia. To test this hypothesis, a randomized, placebo-controlled, multicenter trial of Filgrastim (300 micrograms/day up to 10 days) as an adjunct to antibiotics was conducted for these patients. Outcome measures included time to resolution of morbidity (TRM, a composite measure of temperature, respiratory rate, blood oxygenation, and chest radiograph), 28-day mortality, length of stay, and adverse events. Filgrastim increased blood neutrophils 3-fold, but TRM, mortality, and length of hospitalization were not affected. Treatment, however, accelerated radiologic improvement and appeared to reduce serious complications (e.g., empyema, adult respiratory distress syndrome, and disseminated intravascular coagulation). Filgrastim administration was safe and well tolerated in these patients. Additional trials are needed to establish the value of this approach to treatment of infectious diseases.
Nelson
S
S
Division of Pulmonary Critical Care, Louisiana State University, New Orleans. snelso@lsumc.edu
Belknap
S M
SM
Carlson
R W
RW
Dale
D
D
DeBoisblanc
B
B
Farkas
S
S
Fotheringham
N
N
Ho
H
H
Marrie
T
T
Movahhed
H
H
Root
R
R
Wilson
J
J
D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D002170:Canada; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D003710:Demography; D004311:Double-Blind Method; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D018410:Pneumonia, Bacterial / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011994:Recombinant Proteins; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D014481:United States
D000900:Anti-Bacterial Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim