Carbapenems in the Treatment of Severe Community-Acquired Pneumonia in Hospitalized Elderly Patients: A Comparative Study Against Standard Therapy

Abstract

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.

Imipenem resistance of Pseudomonas in pneumonia: a systematic literature review

“…Comparator drug subcategories included a β-lactam arm in 16 studies [39-46,48-51,53,54,56,58], fluoroquinolone in 5 studies [44,46,47,55,57], aminoglycoside in 2 studies [53,56], and vancomycin in 1 study [52]; 6 employed double coverage [44,45,52-54,56]. The primary outcome for 17 of these 20 studies was clinical success [39-52,54,57,58] and 16 of 20 included a microbiological response assessment for underlying pathogens [39-43,45-48,50,52-54,56-58] (Table 1). Ten of 20 studies provided information about the minimum number of imipenem and comparator doses required for inclusion in analysis, 7 of which included patients if they received at least 1 dose of either imipenem or the comparator [39,41,42,46,47,50,57], and 1 study each excluding patients receiving fewer than 5 [49], 6 [40], and 15 [55] doses (Table 2).…”

Antibiotic expected effectiveness and cost under real life microbiology: evaluation of ertapenem and ceftriaxone in the treatment of community-acquired pneumonia for elderly patients in Spain

“…It is important to note that data for the initial clinical efficacy of imipenem was obtained from a study where imipenem was administered at 1.5 g per day,18 but for cost calculations, the recommended dose of 3 g per day in Spanish guidelines was considered 6. The influence of imipenem cost was studied in the sensitivity analysis, and a very low impact on the base-case results was observed.…”

“…According to recommendations in Spanish guidelines for the empiric treatment of CAP, a second-line treatment with imipenem/cilastatin 1 g three times a day was considered in our model 6. The initial clinical efficacy of imipenem/cilastatin was extracted from a randomized prospective study conducted in elderly patients with CAP 18. It was assumed that failure of second-line therapy has a mortality rate of 0.9%, based on the Fine et al criteria mix of the population19 (Table 1).…”

Community-acquired pneumonia in elderly and very elderly patients

“…При этом назначение меропе нема было экономически наиболее оправданным (затраты на лечение 1 пациента составили в среднем 1 560, 1 620, 1 760 и 1 792 долл. США для меропенема, имипенема / циластатина, комбинации кларитроми цина с цефтриаксоном и кларитромицина с амика цином соответственно) [122].…”