Carbapenems in the treatment of severe community-acquired pneumonia in hospitalized elderly patients: a comparative study against standard therapy.
In this open, prospective, study were enrolled 204 hospitalized elderly patients with severe (88 males, 116 females, age range 70-94). Patients were randomized to receive one of the following antibiotic treatment regimens: meropenem 500 mg i.v. t.i.d. (52); imipenem/cilastatin 500 mg i.v. t.i.d. (51), clarithromycin 500 mg + ceftriaxone 1 g i.v. b.i.d. (52), clarithromycin 500 mg + amikacin 250 mg i.v. b.i.d. (49). In 99 cases causative germs were isolated (24 meropenem, 26 imipenem, 23 clarithromycin + ceftriaxone, 26 ceftriaxone + amikacin). A satisfactory clinical, bacteriological response was achieved respectively in 86.5% 77% in meropenem; 86.3% 71% in imipenem/cilastatin; 69% 61% in ceftriaxone + clarithromycin and in 85.7% 77% in clarithromycin + amikacin. The mean total cost for each patient was $1,560; $1,620; $1,760 and $1,792 in meropenem, imipenem/cilastatin, clarithromycin + ceftriaxone and clarithromycin + amikacin respectively. This study shows that treatment with either meropenem or imipenem is as efficacious as conventional therapy in the treatment of community acquired pneumonia (CAP), and that meropenem is the most cost-effective.
Romanelli
G
G
Department of Internal and Geriatric Medicine, University of Brescia, Italy. gr.università@libero.it
Cravarezza
P
P
Pozzi
A
A
Franchino
L
L
Ravizzola
G
G
Zulli
R
R
Donati
P
P
Prometti
P
P
Grassi
V
V
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D015780:Carbapenems / Q000191:economics / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000191:economics / Q000627:therapeutic use; D015377:Cilastatin / Q000191:economics / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D017291:Clarithromycin / Q000191:economics / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000191:economics; D003365:Costs and Cost Analysis / Q000191:economics; D004338:Drug Combinations; D016527:Drug Costs; D004359:Drug Therapy, Combination / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015378:Imipenem / Q000191:economics / Q000627:therapeutic use; D008297:Male; D000077731:Meropenem; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics; D011446:Prospective Studies; D013845:Thienamycins / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D004338:Drug Combinations; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D002443:Ceftriaxone; D000077728:Cilastatin, Imipenem Drug Combination; D000077731:Meropenem; D017291:Clarithromycin