Tazobactam/piperacillin for moderate-to-severe pneumonia in patients with risk for aspiration: comparison with imipenem/cilastatin.
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.
Ito
Isao
I
Department of Respiratory Medicine, Kyoto University Hospital, Sakyo, Kyoto, Japan. isaoito@kuhp.kyoto-u.ac.jp
Kadowaki
Seizo
S
Tanabe
Naoya
N
Haruna
Akane
A
Kase
Masahito
M
Yasutomo
Yoshiro
Y
Tsukino
Mitsuhiro
M
Nakai
Asako
A
Matsumoto
Hisako
H
Niimi
Akio
A
Chin
Kazuo
K
Ichiyama
Satoshi
S
Mishima
Michiaki
M
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
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D011480:Protease Inhibitors; D015377:Cilastatin; D015378:Imipenem; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin