Combination versus monotherapy for nosocomial pneumonia

Abstract

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.

Comparative Study of CSE 1034 and Ceftriaxone in Pneumonia Induced Rat

“…Combination therapy of drug is more effective than individual due to their synergistic effect. Various studies have been reported that a combination therapy is most effective in pneumonia infection [23,24]. Ceftriaxone is third generation class of beta lactam antibiotic while CSE 1034 is a combination of third generation β-lactam antibiotic with sulbactam beta lactamase inhibitor.…”

Antibiotic Therapy, Antibiotic Resistance, Drug-Induced Pathomorphosis, and Evolutionary Medicine

“…We already distinguish patients with a severe infection; there is evidence that the prognosis in these patients is worse than in patients with a relatively non-severe disease. At the same time, the benefits of, for example, combination antibiotic therapy have not been fully identified [47,48,49,50]. Patients in intensive care units are considered separately, and we recognize that this may not be the severe course of the infection itself, but simply patients in a severe condition by their baseline status, and the infection only makes its own special contribution to the severity of the condition and, of course, to the efficacy of treatment and prognosis.…”

10 Recomendaciones para Tratar Neumonía Nosocomial

“…El tratamiento combinado es utilizado especialmente en pacientes de alto riesgo o que están gravemente enfermos (6).…”