Cefepime vs. meropenem for moderate-to-severe pneumonia in patients at risk for aspiration: An open-label, randomized study

Oi, Issei; Ito, Isao; Tanabe, Naoya; Konishi, Satoshi; Hamao, Nobuyoshi; Yasutomo, Yoshiro; Kadowaki, Seizo; Hirai, Toyohiro

doi:10.1016/j.jiac.2019.08.005

Cited by 11 publications

(23 citation statements)

References 26 publications

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“…However, in studies of aspiration pneumonia of varying severity, anti-anaerobic therapy was compared to antibiotics usually used for CAP. These studies showed equivalence between clindamycin, ampicillin/sulbactam, and a carbapenem (randomised, controlled trial of mild–moderate pneumonia) [ 112 ]; ampicillin/sulbactam and azithromycin (prospective cohort, non-randomised) [ 113 ]; meropenem and cefepime (open-label, randomised) [ 97 ]; ceftriaxone and ampicillin/sulbactam (retrospective, non-randomised) [ 114 ]; and moxifloxacin and levofloxacin/metronidazole (open-label, randomised) [ 115 ]. When taken collectively, there is no evidence to support that standard recommended therapy for sCAP would be less effective than any regimen specifically targeting anaerobes.…”

Section: Question 8: Do Patients With Scap and Aspiration Risk Factor...mentioning

confidence: 99%

ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

et al. 2023

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Purpose Severe community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and whilst European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP. Methods The European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and Latin American Thoracic Association (ALAT) launched a task force to develop the first international guidelines for sCAP. The panel comprised a total of 18 European and four non-European experts, as well as two methodologists. Eight clinical questions for sCAP diagnosis and treatment were chosen to be addressed. Systematic literature searches were performed in several databases. Meta-analyses were performed for evidence synthesis, whenever possible. The quality of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Evidence to Decision frameworks were used to decide on the direction and strength of recommendations. Results Recommendations issued were related to diagnosis, antibiotics, organ support, biomarkers and co-adjuvant therapy. After considering the confidence in effect estimates, the importance of outcomes studied, desirable and undesirable consequences of treatment, cost, feasibility, acceptability of the intervention and implications to health equity, recommendations were made for or against specific treatment interventions. Conclusions In these international guidelines, ERS, ESICM, ESCMID, and ALAT provide evidence-based clinical practice recommendations for diagnosis, empirical treatment, and antibiotic therapy for sCAP, following the GRADE approach. Furthermore, current knowledge gaps have been highlighted and recommendations for future research have been made. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07033-8.

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Section: Question 8: Do Patients With Scap and Aspiration Risk Factor...mentioning

confidence: 99%

ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

et al. 2023

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“…We also monitored the patients for lung lesion resolution (resolution of 90% of the lesions was scored as marked effectiveness; resolution of 50%–89% of the lesions was considered effective) using radiography. Thus, the total effectiveness rate was determined as the percentage of patients in each group demonstrating effective and markedly effective outcomes[ 11 ]. We also compared the baseline and post-treatment levels of serum inflammatory factors between the groups, including procalcitonin, interleukin-1β, tumor necrosis factor-α, and C-reactive protein; we also assessed the pre- and post-treatment clinical pulmonary infection scores (CPISs).…”

Section: Methodsmentioning

confidence: 99%

Teicoplanin combined with conventional vancomycin therapy for the treatment of pulmonary methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis infections

Wu¹,

Liu²,

Geng³

et al. 2021

WJCC

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BACKGROUND Vancomycin and teicoplanin are both antibiotics that have significant antimicrobial effects on Gram-positive cocci. AIM To explore the value of teicoplanin combined with conventional (vancomycin only) anti-infective therapy for the treatment of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis pulmonary infections. METHODS A total of 86 patients with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis pulmonary infections, treated in our hospital between January 2018 and February 2020, were assigned to the study and control groups using a random number table method, with 43 patients in each group. The control group received conventional treatment (vancomycin), and the study group received both teicoplanin and conventional treatment. The following indicators were assessed in both groups: the time required for symptom relief, treatment effectiveness, serum levels of inflammatory factors (procalcitonin, interleukin-1β, tumor necrosis factor-α, C-reactive protein), clinical pulmonary infection scores before and after treatment, and the incidence of adverse reactions. RESULTS Patients in the study group were observed to have faster cough and expectoration resolution, white blood cell count normalization, body temperature normalization, and rales disappearance than patients in the control group (all P < 0.05); the total rate of effectiveness was 93.02% in the study group, higher than the 76.74% in the control group ( P < 0.05). The pre-treatment serum levels of procalcitonin, interleukin-1β, tumor necrosis factor-α, and C-reactive protein as well as the clinical pulmonary infection scores were similar among the patients in both groups. However, the post-treatment serum levels of procalcitonin, interleukin-1β, tumor necrosis factor-α, and C-reactive protein as well as the clinical pulmonary infection scores were significantly lower in the study group than in the control group ( P < 0.05) . There was no significant difference in the incidence of adverse reactions between the groups. CONCLUSION Compared with conventional (vancomycin only) therapy, teicoplanin and vancomycin combination therapy for patients with pulmonary methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis infections can improve patient clinical symptoms, modulate serum inflammatory factor levels, and improve treatment efficacy, without increasing the risk of adverse reactions.

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“…The timely initiation of appropriate antimicrobial therapy is the cornerstone of initial management of severe infections [96]. Failure to initiate appropriate empirical therapy in patients with sepsis and septic shock has been associated with a substantial increase in morbidity and mortality [97]. Conversely, broad-spectrum antibiotics can promote antimicrobial resistance; their unnecessary use in CAP is associated with elevated mortality, longer hospital stay, higher costs and an increased risk of Clostridioides difficile infections [22].…”

Section: Evidence Overview and Rationalementioning

confidence: 99%

“…However, in studies of aspiration pneumonia of varying severity, anti-anaerobic therapy was compared to antibiotics usually used for CAP. These studies showed equivalence between clindamycin, ampicillin/sulbactam and a carbapenem (randomised, controlled trial of mild-moderate pneumonia) [112]; ampicillin/sulbactam and azithromycin (prospective cohort, non-randomised) [113]; meropenem and cefepime (open-label, randomised) [97]; ceftriaxone and ampicillin/sulbactam (retrospective, non-randomised) [114]; and moxifloxacin and levofloxacin/metronidazole (open-label, randomised) [115]. When taken collectively, there is no evidence to support that standard recommended therapy for sCAP would be less effective than any regimen specifically targeting anaerobes.…”

Section: Evidence Overview and Rationalementioning

confidence: 99%

ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

et al. 2023

View full text Add to dashboard Cite

BackgroundSevere community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and while European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP.Materials and methodologyThe European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Latin American Thoracic Association (ALAT) launched a task force to develop the first international guidelines for sCAP. The panel comprised a total of 18 European and four non-European experts, as well as two methodologists. Eight clinical questions for sCAP diagnosis and treatment were chosen to be addressed. Systematic literature searches were performed in several databases. Meta-analyses were performed for evidence synthesis, whenever possible. The quality of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Evidence to Decision frameworks were used to decide on the direction and strength of recommendations.ResultsRecommendations issued were related to diagnosis, antibiotics, organ support, biomarkers and co-adjuvant therapy. After considering the confidence in effect estimates, the importance of outcomes studied, desirable and undesirable consequences of treatment, cost, feasibility, acceptability of the intervention and implications to health equity, recommendations were made for or against specific treatment interventions.ConclusionsIn these international guidelines, ERS, ESICM, ESCMID and ALAT provide evidence-based clinical practice recommendations for diagnosis, empirical treatment and antibiotic therapy for sCAP, following the GRADE approach. Furthermore, current knowledge gaps have been highlighted and recommendations for future research have been made.

show abstract

Cefepime vs. meropenem for moderate-to-severe pneumonia in patients at risk for aspiration: An open-label, randomized study

Cited by 11 publications

References 26 publications

ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

Teicoplanin combined with conventional vancomycin therapy for the treatment of pulmonary methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis infections

ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

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