title: Tazobactam/piperacillin for moderate-to-severe pneumonia in patients with risk for aspiration: comparison with imipenem/cilastatin.
abstract: BACKGROUND
  Treatment of aspiration pneumonia is becoming an important issue due to aging of populations worldwide. Effectiveness of tazobactam/piperacillin (TAZ/PIPC) in aspiration pneumonia is not clear.
  
  
  OBJECTIVE
  To compare clinical efficacy between TAZ/PIPC (1:4 compound) and imipenem/cilastatin (IPM/CS) in patients with moderate-to-severe aspiration pneumonia.
  
  
  METHODS
  In this open-label, randomized study either TAZ/PIPC 5 g or IPM/CS 1 g was intravenously administered every 12 h to patients with moderate-to-severe community-acquired aspiration pneumonia or nursing home-acquired pneumonia with risk for aspiration pneumonia for average 11 days. The primary outcome was clinical response rate at the end of treatment (EOT) in validated per-protocol (VPP) population. Secondary outcomes were clinical response during treatment (days 4 and 7) and at the end of study (EOS) in VPP population, and survival at day 30 in modified intention-to-treat (MITT) population.
  
  
  RESULTS
  There was no difference between the groups in primary or secondary outcome. However, significantly faster improvement as measured by axillary temperature (p < 0.05) and WBC count (p = 0.01) was observed under TAZ/PIPC treatment. In patients with gram-positive bacterial infection, TAZ/PIPC was more effective at EOT in VPP population (p = 0.03).
  
  
  CONCLUSIONS
  TAZ/PIPC is as effective and safe as IPM/CS in the treatment of moderate- to-severe aspiration pneumonia.
authors.affiliation: Department of Respiratory Medicine, Kyoto University Hospital, Sakyo, Kyoto, Japan. isaoito@kuhp.kyoto-u.ac.jp
authors.forename: Isao
authors.initials: I
authors.lastname: Ito
authors.forename: Seizo
authors.initials: S
authors.lastname: Kadowaki
authors.forename: Naoya
authors.initials: N
authors.lastname: Tanabe
authors.forename: Akane
authors.initials: A
authors.lastname: Haruna
authors.forename: Masahito
authors.initials: M
authors.lastname: Kase
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Yasutomo
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Tsukino
authors.forename: Asako
authors.initials: A
authors.lastname: Nakai
authors.forename: Hisako
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Akio
authors.initials: A
authors.lastname: Niimi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chin
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ichiyama
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015377:Cilastatin / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D004338:Drug Combinations; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D007275:Injections, Intravenous; D008297:Male; D009735:Nursing Homes; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D011015:Pneumonia, Aspiration / Q000188:drug therapy* / Q000382:microbiology; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use*; D000078142:Tazobactam; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D011480:Protease Inhibitors; D015377:Cilastatin; D015378:Imipenem; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin