Ceftazidime Monotherapy vs. Ceftriaxone/Tobramycin for Serious Hospital-Acquired Gram-Negative Infections

Rubinstein, Ethan; Lode, H.; Grassi, C

doi:10.1093/clinids/20.5.1217

Cited by 75 publications

(41 citation statements)

References 16 publications

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“…Similarly, in a prospective study of 189 consecutive episodes of P. aeruginosa bacteremia, the investigators found that survival was no greater in patients who received two or more antibiotics with in vitro activity against P. aeruginosa (therapies not specified) than in patients who received a single agent with in vitro activity (246). A prospective, randomized clinical trial comparing ceftazidime monotherapy with ceftriaxone and tobramycin for serious infections with Gram-negative bacteria, including Pseudomonas spp., showed similar mortality between the groups (211). The authors' definition of combination therapy was essentially aminoglycoside monotherapy for Pseudomonas spp.…”

Section: Pseudomonas Aeruginosa Infectionsmentioning

confidence: 87%

“…The ability of this organism to simultaneously express multiple mechanisms of resistance adds to the challenge of effectively treating it (104,157). Several studies evaluating morbidity and mortality with dual and single antipseudomonal agents for the treatment of P. aeruginosa infections have been conducted, as outlined below (7,15,44,70,112,152,180,211,224,227,228,246).…”

Section: Pseudomonas Aeruginosa Infectionsmentioning

confidence: 99%

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Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

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SUMMARY Combination antibiotic therapy for invasive infections with Gram-negative bacteria is employed in many health care facilities, especially for certain subgroups of patients, including those with neutropenia, those with infections caused by Pseudomonas aeruginosa , those with ventilator-associated pneumonia, and the severely ill. An argument can be made for empiric combination therapy, as we are witnessing a rise in infections caused by multidrug-resistant Gram-negative organisms. The wisdom of continued combination therapy after an organism is isolated and antimicrobial susceptibility data are known, however, is more controversial. The available evidence suggests that the greatest benefit of combination antibiotic therapy stems from the increased likelihood of choosing an effective agent during empiric therapy, rather than exploitation of in vitro synergy or the prevention of resistance during definitive treatment. In this review, we summarize the available data comparing monotherapy versus combination antimicrobial therapy for the treatment of infections with Gram-negative bacteria.

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Section: Pseudomonas Aeruginosa Infectionsmentioning

confidence: 87%

Section: Pseudomonas Aeruginosa Infectionsmentioning

confidence: 99%

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

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“…The debate is still in place, since clinical studies were not able to demonstrate the superiority of synergistic effect on clinical outcomes. [21][22][23] Other potential disadvantages of combination therapy mainly consist of increasing toxicity, costs and possible emergence of multiple resistance and risk of bacterial and fungal superinfections. 24 Current guidelines suggest empirical combination therapy with two or more antibacterial agents for neutropenic patients, for those at risk of multiple drugs resistant pathogens and for those with severe pneumonia and septic shock.…”

Section: What Does Appropriate Antimicrobial Therapy Mean and How To mentioning

confidence: 99%

Appropriate antibiotic therapy in critically ill patients

2016

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Severe sepsis and septic shock are leading causes of morbidity and mortality in critically ill patients in and outside Intensive Care Units. Early hemodynamic and respiratory support, along with prompt appropriate antimicrobial therapy and source control of the infectious process are cornerstone management strategies to improve survival. Antimicrobial therapy should be as much appropriate as possible, since inappropriate initial antimicrobial therapy is associated with poorer outcome in different clinical settings. When prescribing antibiotic therapy, drug's characteristics, along with dosing, pharmacokinetics, and pharmacodynamic properties related to the drug and to the clinical scenario should be well kept in mind in order to achieve maximal success.

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“…It was concluded that combination therapy using a fourth-generation cephalosporin with either an aminoglycoside or a fluoroquinolone was not associated with a clinical or biological benefit when compared with cephalosporin monotherapy for common, susceptible pathogens causing VAP [5]. Of the many comparative studies for the treatment of VAP, six are summarised in table 2 [6][7][8][9][10][11]. Perhaps the best of these studies compared imipenem alone with the combination of imipenem and netilmicin [8].…”

Section: Monotherapy Versus Combination Therapy: Comparisons Of Efficacymentioning

confidence: 99%

Combination versus monotherapy for nosocomial pneumonia

Lode¹

2007

European Respiratory Review

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Combination antibiotic therapy of nosocomial pneumonia is sometimes appropriate and desirable; however, it should be used judiciously. When pneumonia appears in the first 5 days following hospital admission and in the absence of other risk factors for infection by multidrug-resistant pathogens, the infection is likely to be due to a pathogen acquired in the community and is likely to be sensitive to most antibiotics.These infections should generally be treated with monotherapy. However, pathogens resistant to multiple drugs are increasingly common in the hospital and intensive care unit setting. In the presence of risk factors for such pathogens, any single drug may prove ineffective; treatment with two or more drugs theoretically increases the likelihood that the pathogen will be sensitive to at least one of them. However, combination therapy also increases the cost and the likelihood of adverse effects, as well as the possibility of drug interactions, if the two are not chosen wisely.The crucial question is whether combination antibiotic therapy actually improves clinical outcome. Most clinical trials suggest that monotherapy and combination therapy provide equivalent efficacy. However, these studies have uniformly excluded the most seriously ill patients: those with Acute Physiology and Chronic Evaluation-II scores .20.It is concluded that available studies provide no concrete evidence to support the use of combination therapy in moderately ill patients and provide no data for the treatment of seriously ill patients who might be most likely to benefit.

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Ceftazidime Monotherapy vs. Ceftriaxone/Tobramycin for Serious Hospital-Acquired Gram-Negative Infections

Cited by 75 publications

References 16 publications

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Appropriate antibiotic therapy in critically ill patients

Combination versus monotherapy for nosocomial pneumonia

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