Ertapenem therapy for community-acquired pneumonia in the elderly.
OBJECTIVE
To compare the efficacy and safety of ertapenem, 1 g once a day, with ceftriaxone, 1 g once a day, for treatment of the subgroup of patients aged 65 and older with community-acquired pneumonia (CAP) requiring parenteral therapy.


METHODS
Combined data from patients aged 65 and older in two randomized, double-blind clinical trials.


METHODS
Eighty international centers.


METHODS
Eight hundred fifty-seven treated patients, of whom 351 were aged 65 and older.


METHODS
Intravenous or intramuscular ertapenem or ceftriaxone with the option to switch to oral amoxicillin-clavulanate after at least 3 days of parenteral therapy.


METHODS
Clinical efficacy was assessed at completion of parenteral therapy and 7 to 14 days after all therapy had been completed (test of cure (TOC) assessment). Bacterial eradication was assessed at the TOC visit. Safety was assessed daily during study therapy and for 14 days thereafter.


RESULTS
One hundred forty-eight clinically evaluable patients aged 65 and older were treated with ertapenem and 125 with ceftriaxone. Pathogens were identified in 157 (57.5%) patients (the most common being Streptococcus pneumoniae), most of which were penicillin-susceptible. Clinical cure rates were 95.9% for patients in the ertapenem group and 92.7% for patients in the ceftriaxone group at completion of parenteral therapy and 93.9% and 90.4%, respectively, at the TOC assessment. Overall bacterial eradication rates were 92.8% (77 of 83) for patients treated with ertapenem and 93.2% (69 of 74) for those treated with ceftriaxone. The most common drug-related adverse experiences in both treatment groups were diarrhea and mild to moderate elevation of serum aminotransferase levels.


CONCLUSIONS
Ertapenem 1 g once a day was highly effective for treatment of elderly patients with CAP requiring parenteral therapy and was as effective as ceftriaxone. Ertapenem was generally well tolerated, with an overall safety profile similar to ceftriaxone.
Woods
Gail L
GL
Merck Research Laboratories, West Point, Pennsylvania 19422, USA.
Isaacs
Robin D
RD
McCarroll
Kathleen A
KA
Friedland
Ian R
IR
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D004311:Double-Blind Method; D000077727:Ertapenem; D005260:Female; D006801:Humans; D007769:Lactams / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome; D047090:beta-Lactams
D000900:Anti-Bacterial Agents; D007769:Lactams; D047090:beta-Lactams; D002443:Ceftriaxone; D000077727:Ertapenem