Reappraisal of clindamycin IV monotherapy for treatment of mild-to-moderate aspiration pneumonia in elderly patients.
BACKGROUND
As the number of elderly people has increased in Japan, the occurrence of aspiration pneumonia has also increased. Guidelines for the treatment of pneumonia have been proposed, in which the use of antibiotics, such as beta-lactam plus beta-lactamase inhibitor, clindamycin, and carbapenem, has been recommended as effective against anaerobic bacteria in the treatment of aspiration pneumonia. However, to our knowledge, a prospective comparison of these antibiotics regarding their clinical efficacy in aspiration pneumonia has not been performed.


OBJECTIVE
We compared the effects of IV administration of a half dose of ampicillin/sulbactam (SBT/ABPC), normal dose of SBT/ABPC, IV clindamycin, and IV panipenem/betamiprom (PAPM/BP) for treatment of mild-to-moderate aspiration pneumonia in elderly patients.


METHODS
Randomized prospective study.


METHODS
One hundred adult patients with compatible signs and symptoms of aspiration pneumonia.


METHODS
Patients were assessed before, during, and after treatment regarding symptoms, as well as results of laboratory values, chest radiograph examinations, and sputum bacterial cultures.


RESULTS
We found few differences between the groups regarding cure rate, duration of IV medication, and occurrence of adverse effects with the tested therapies. However, clindamycin therapy was less expensive and was associated with a lower rate of posttreatment occurrence of methicillin-resistant Staphylococcus aureus.


CONCLUSIONS
Clindamycin therapy for mild-to-moderate aspiration pneumonia is clinically effective, and provides economic advantages as compared to SBT/ABPC or PAPM/BP therapy.
Kadowaki
Maiko
M
Third Department of Internal Medicine, Medical Faculty, University of Fukui, 23 Shimoaiduki Matsuoka-cho, Fukui Prefecture, 910-1193, Japan. maik@fmsrsa.fukui-med.ac.jp
Demura
Yoshiki
Y
Mizuno
Shiro
S
Uesaka
Daisuke
D
Ameshima
Shingo
S
Miyamori
Isamu
I
Ishizaki
Takeshi
T
D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002981:Clindamycin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D011015:Pneumonia, Aspiration / Q000188:drug therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013407:Sulbactam / Q000008:administration & dosage*; D013845:Thienamycins / Q000008:administration & dosage*; D015091:beta-Alanine / Q000008:administration & dosage* / Q000031:analogs & derivatives
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D015091:beta-Alanine; C075316:panipenem-betamipron; D002981:Clindamycin; C035444:sultamicillin; D000667:Ampicillin; D013407:Sulbactam