Ceftazidim mit und ohne Tobramycin versus Azlocillin plus Tobramycin in der Therapie bronchopulmonaler Infektionen bei Intensivpatienten

Abstract

In a still ongoing open, randomized prospective trial the preliminary data of 50 intensive care patients on artificial ventilation were analysed. The evaluation included clinical and bacteriological efficacy and tolerance of ceftazidime alone or in combination with tobramycin versus azlocillin plus tobramycin. Artificially ventilated patients who had been treated in an intensive care unit for at least five days were selected to enter the study because of a high probability of colonisation with gram-negative bacteria. 16 patients were treated for bronchopulmonary infection with ceftazidime alone, and 17 each were treated with ceftazidime plus tobramycin or with azlocillin plus tobramycin. In the ceftazidime group nine patients were cured and three were improved (75% clinical success). Of the patients treated with ceftazidime plus tobramycin, 11 were cured and one was improved (75% clinical success); one patient died from very severe multiple trauma. In the azlocillin-tobramycin group, six patients were cured and two were improved (57% clinical success). Two patients from this group died from their underlying disease and another died from multiple organ failure due to septicemia.

Empiric antibiotic therapy for suspected ventilator-associated pneumonia: A systematic review and meta-analysis of randomized trials

“…Eleven trials compared monotherapy with combination therapy (16,43,45,48,54,63,69,70,74,80,81). Of the 1,805 patients in these trials, 85.1% were ventilated and 13.8% were infected with Pseudomonas spp.…”

“…Twenty-six studies enrolled ICU patients exclusively. Seventeen trials restricted entry to patients with suspected VAP (16,(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57); only two of these compared the same regimens-linezolid and vancomycin (46, 57). Late-onset pneumonia, with hospitalization or ICU stay Ͼ96 hrs, was evaluated in only two trials (16,45).…”

“…In two trials, Gram-positive coverage or Gram-negative coverage could be added as required (66,67). Criteria for discontinuation of therapy were specified in nine trials: In four trials, the aminoglycoside was discontinued if the culture results were negative for infection with Pseudomonas (47, 48, 68, 69); in a single trial, antibiotics were discontinued if there was no clinical improvement by day 3 (54); and in four trials, discontinuation of all antibiotic therapy was mandated if eventual culture results were negative (7,42,45,58).…”

Clinical implications of β-lactam–aminoglycoside synergism: systematic review of randomised trials

“…Most trials assessed empirical treatment. Five comparisons assessed definitive treatment [72,104,113,114] and four trials compared semi-empirical treatments following initial pathogen identification [77,95,96,112]. Aminoglycosides were administered once daily in six trials [78,93,94,99,102,115] and two to three times daily in all other trials.…”

“…1). The trials were divided into six major clinical categories based on the type of infection addressed (Table 1): febrile neutropenia (21 trials [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90]); pneumonia, including one trial with lower respiratory tract infection (8 trials [91][92][93][94][95][96][97][98]); abdominal or urinary tract infection (4 trials [99][100][101][102]); severe sepsis or bacteraemia (10 trials [73,[103][104][105][106][107][108][109][110][111]); endocarditis (4 trials [112][113][114][115]); and CF or bronchitis (8 trials [116][117]…”