Efficacy and safety of high-dose ampicillin/sulbactam vs. colistin as monotherapy for the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia

Betrosian, Alex P.; Frantzeskaki, Frantzeska; Xanthaki, Anna; Douzinas, Emmanuel E.

doi:10.1016/j.jinf.2008.04.002

Cited by 188 publications

(160 citation statements)

References 25 publications

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“…Furthermore, colistin proved to be a safe drug in our group of patients, given the low incidence of renal failure (11%) that did not differ from the one observed in the control group. Finally, our study affirmed the recently published data on colistin safety, however, also extended it to the group of patients that were not previously evaluated (4,5). We did notice a statistically significant rise in urea level post-therapy in the colistin group when compared to the control group.…”

Section: Discussionsupporting

confidence: 88%

“…Early in its clinical utilization, colistin was associated with significant nephrotoxicity, with rates of up to 20.2% and 36% in general population and patient with pre-existing renal disease, respectively (3). However, recent studies have shown lower incidence of renal toxicity (4), with one study reporting nephrotoxicity not greater than one associated with ampicillin/sulbactam use (5).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Colistin in the Treatment of Infections Caused by Multidrug-resistant Pseudomonas aeruginosa in Patients with Hematologic Malignancy: A Matched Pair Analysis

et al. 2011

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Objective A rise in infections with multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is a significant contributor to increased morbidity and mortality of patients with hematologic malignancies. The aim of this study was to determine the efficacy and safety of colistin (colistimethate sodium) in the treatment of serious infections caused by MDR-PA in these patients. Patients and Methods A matched pair analysis of renal function, toxicities, and outcome of 26 patients receiving colistin and control subjects was done. All patients had clinical signs of sepsis; P. aeruginosa was isolated from blood in 69% of patients in colistin group and 84% in control group. Patients treated with colistin received 3 million units every 8 hours for a median duration of 13 days. Additionally, patients received at least two additional antimicrobial or antifungal drugs. Results Resolution of infection was achieved in twenty patients (76.9%) receiving colistin and in 17 (65.4%) control subjects. Mortality rate was 11% in both groups. There was no statistically significant difference in the level of serum creatinine, creatinine clearance, or potassium levels before and after treatment between groups. Only one patient receiving colistin developed de novo renal failure and one displayed transient neurologic toxicity. Conclusion Our results suggest that in patients with hematologic malignancies, colistin is effective in treating severe infections caused by MDR-PA while maintaining an acceptable toxicity profile. Prospective randomized studies comparing efficacy and safety of colistin with those of other antipseudomonal drugs are needed.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Colistin in the Treatment of Infections Caused by Multidrug-resistant Pseudomonas aeruginosa in Patients with Hematologic Malignancy: A Matched Pair Analysis

et al. 2011

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“…Ampicillin-sulbactam is one of these early drugs proving in vitro activity [12] and two recent comparative, one retrospective [14] and one prospective [19], studies suggest that it may be effective against infections caused by this organism. In the retrospective study, more than 80 patients were either treated with colistin or ampicillin-sulbactam and colistin, but not ampicillin-sulbactam, proved independently associated with higher mortality rate [14].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, some case series had previously been reported [20][21][22][23]. In most studies an ampicillin-sulbactam combination containing 1-g of sulbactam, given every 8h, was used; but 2g [20] and 3g [19] of sulbactam were also employed. This dose variability may be attributable to the lack of pharmacodynamic studies for supporting any dosing schedule.…”

Section: Discussionmentioning

confidence: 99%

“…We believe that determining the optimal dose is a crucial issue to reach the maximum antimicrobial efficacy with the minimal rate of certain adverse events observed in some small clinical trial testing high sulbactam dosage (i.e. 3g), such as diarrhea, skin rush or nephrotoxicity [19]. Our data show that both 0.5g and 1g of sulbactam, infused as AMX-SUL over 30 min, were able to reach bactericidal serum levels at 2h after dose, but a net regrowth and trend to regrowth occurred at 4h after dose with the 0.5-g and 1-g sulbactam dose, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Pharmacodynamic assessment of Amoxicillin-Sulbactam against Acinetobacter baumannii: searching the optimal dose and infusion time through a human ex-vivo model

Bantar¹,

Canigia²,

Berger³

et al. 2009

Braz J Infect Dis

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Amoxicillin-sulbactam (AMX-SUL) is an aminopenicillin/ß-lactamase inhibitor combination currently available in 29 countries and may be a suitable option for treating infections caused by Acinetobacter spp. Thus, we sought to search the optimal dosing strategy for this formulation through an ex vivo pharmacodynamic human model against Acinetobacter baumanniii. Four volunteers were randomized to receive alternatively a single dose AMX-SUL infused both either over 30 min or 3h at the following ratios (g/g): 1/0.5; 1/1, and 0/2. Time-kill studies were performed with the 0-, 0.5-, 2-, 4-, 6-and 8-h sera after dose against a clinical isolate of A. baumannii (sulbactam MIC, 4µg/mL). Bactericidal activity (i.e. a mean decrease ≥3 log 10 CFU/mL in the viable cell counts from the initial inoculum) was displayed by the 0.5-and the 2-h sera after dose for all formulations. The 4-h sera proved inhibitory with the AMX-SUL 1g/1g formulation, albeit a trend to regrowth was observed after 24-h incubation. With the AMX-SUL 0g/2g dose, the 4-h sera proved almost bactericidal activity (i.e. a mean decrease of 2.4 log 10 CFU/mL in the viable cell counts from the initial inoculum), whereas the 6-h sera was inhibitory, with a trend to regrowth after 24-h incubation. When infused over 3h, AMX-SUL 1g/0.5g and 1g/1g, bactericidal activity was displayed by the 0.5-, 2-and the 4-h sera after dose and the 6-h sera proved inhibitory with the AMX-SUL 1g/1g formulation. The present study, albeit preliminary, might give a rationale for the dosing strategy to treat infections caused by A. baumannii with sulbactam, either alone or combined with amoxicillin. A 2-g sulbactam dose seems to be optimal to be infused over 30 min with a 6-h dosing interval. When infused over 3h, AMX-SUL 1g/1g given every 6h or 8h seems a suitable dosing schedule.

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Current awareness: Pharmacoepidemiology and drug safety

2008

Pharmacoepidemiology and Drug

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 23 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Antidiabetic Agents; 21 Contrast Agents; 22 Bone Conservation Agents; 23 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

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Efficacy and safety of high-dose ampicillin/sulbactam vs. colistin as monotherapy for the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia

Cited by 188 publications

References 25 publications

Efficacy and Safety of Colistin in the Treatment of Infections Caused by Multidrug-resistant Pseudomonas aeruginosa in Patients with Hematologic Malignancy: A Matched Pair Analysis

Efficacy and Safety of Colistin in the Treatment of Infections Caused by Multidrug-resistant Pseudomonas aeruginosa in Patients with Hematologic Malignancy: A Matched Pair Analysis

Pharmacodynamic assessment of Amoxicillin-Sulbactam against Acinetobacter baumannii: searching the optimal dose and infusion time through a human ex-vivo model

Current awareness: Pharmacoepidemiology and drug safety

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