Efficacy and safety of piperacillin/tazobactam versus biapenem in late elderly patients with nursing- and healthcare-associated pneumonia

Karino, Fumi; Miura, Kiyonori; Fuchita, Hiroshi; Koba, Naoya; Nishikawa, Emiko; Hotta, Tomomitsu; Okimoto, Tamio; Iwamoto, Shinichi; Tsubata, Yukari; Tada, Mitsuhiro; Hamaguchi, Shunichi; Honda, Takeshi; Ohe, Miki; Sutani, Akihisa; Kuraki, Takashige; Takeyama, Hiroyasu; Isobe, Takeshi

doi:10.1007/s10156-013-0605-x

Cited by 16 publications

(12 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Regarding HCAP, Yamamoto et al investigated the efficacy of MEPM and TAZ/PIPC and reported that both antimicrobials achieved a high cure rate (TAZ/PIPC: 88% and MEPM: 74%) and that the use of these drugs as initial empiric therapy for HCAP was appropriate [22]. Karino et al also analyzed the efficacy of another carbapenem (BIPM) compared with TAZ/PIPC in the treatment of nursing and healthcare-associated pneumonia (NHCAP) and concluded that TAZ/PIPC and BIPM were associated with high cure rates for NHCAP (96% vs. 87% p ¼ 0.09) [23]. These previous studies compared other carbapenems or TAZ/ PIPC, for which the spectrum is almost equivalent to that of carbapenems.…”

Section: Discussionmentioning

confidence: 97%

Clinical evaluation of the need for carbapenems to treat community-acquired and healthcare-associated pneumonia

Kamata

Suzuki

Kanemoto

et al. 2015

Journal of Infection and Chemotherapy

View full text Add to dashboard Cite

Carbapenems have an overall broad antibacterial spectrum and should be protected against from the acquisition of drug resistance. The clinical advantages of carbapenem in cases of pneumonia have not been certified and the need for antipseudomonal antimicrobial agents to treat healthcare-associated pneumonia (HCAP) remains controversial. We introduced an antimicrobial stewardship program for carbapenem and tazobactam/piperacillin use and investigated the effects of this program on the clinical outcomes of 591 pneumonia cases that did not require intensive care unit management, mechanical ventilation or treatment with vasopressor agents [221 patients with community-acquired pneumonia (CAP) and 370 patients with HCAP]. Compared with the pre-intervention period, age, comorbidities and the severity and etiology of pneumonia did not differ during the intervention period. Carbapenems were rarely used during the intervention period in cases of pneumonia (CAP: 12% vs. 1%, HCAP: 13% vs. 1%), while antipseudomonal beta-lactam use was reduced from 33% to 8% among cases with HCAP. This reduction in the rate of carbapenem administration did not have an impact on the prognosis in the cases of CAP, and the in-hospital mortality was lower among the patients with HCAP during the intervention period (15% vs. 5%, p = 0.013). The causes of death in the cases of HCAP were not directly related to pneumonia during the intervention period. The current study shows that carbapenem use can be avoided in cases of CAP or HCAP that are not in a critical condition. The frequent use of antipseudomonal beta-lactams does not improve the clinical outcomes of HCAP.

show abstract

Section: Discussionmentioning

confidence: 97%

Clinical evaluation of the need for carbapenems to treat community-acquired and healthcare-associated pneumonia

Kamata

Suzuki

Kanemoto

et al. 2015

Journal of Infection and Chemotherapy

View full text Add to dashboard Cite

show abstract

“…A narrow spectrum of antibiotics, including sulbactam/ampicillin, which are effective against major lower respiratory infection pathogens and anaerobes, may be selected as a first-line therapy [30][31][32][33]. Antibiotics that are effective against indigenous oral and anaerobic bacteria are administered as a priority when treating elderly patients with an aspiration risk.…”

Section: Principles Of Selection and Administration Of Antibioticsmentioning

confidence: 99%

Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia

Teramoto

Yoshida

Hizawa

2015

Respiratory Investigation

View full text Add to dashboard Cite

“…The patients aged 65 years old or older, who were diagnosed with NHCAP in Shimane University Hospital, and satisfying the three items of: (1) body temperature of 37°C or more, (2) C-reactive protein (CRP) value of 1.0 mg/dL or more, and (3) clear pneumonia shadow observed upon chest X-ray or computed tomographic image within 2 d prior to commencing treatment. Furthermore, cases falling under any of the followings were excluded: (1) case with serious heart/ liver/renal function failure, (2) case in which atypical pneumonia is strongly suspected, (3) case requiring concomitant use of antibacterial drugs excluding macrolide antibiotics, (4) case with a history of allergies to beta lactam antibiotics, (5) case determined as being unsuitable as a subject of this study by the doctor in charge. The severity of pneumonia in each patient was evaluated in accordance with the classification of the disease severity of pneumonia (A-DROP).…”

Section: Subjects and Study Protocolmentioning

confidence: 99%

“…2) Although few epidemiological studies of this newly designated NHCAP in Japan have been reported so far, we previously reported that the frequency of nephrotoxicity caused by PIPC-TAZ therapy was significant higher than that by biapenem in patients with NHCAP. 4) However, there is no reports regarding to risk factors for nephrotoxicity induced by PIPC-TAZ therapy, so it is necessary to accumulate evidence on late elderly patients with NHCAP. In previous pharmacokinetic studies, it has been reported that the total body clearance, area under the drug concentration-time curve, and terminal elimination rate of PIPC-TAZ are correlated to renal function, 5) and moreover, simulation results of the optimal administration of PIPC-TAZ to renal impairment patients based on population pharmacokinetic analysis have been reported in Japan.…”

mentioning

confidence: 99%

Nephrotoxicity Induced by Piperacillin–Tazobactam in Late Elderly Japanese Patients with Nursing and Healthcare Associated Pneumonia

Karino

Nishimura

Ishihara

et al. 2014

Biological & Pharmaceutical Bulletin

Self Cite

View full text Add to dashboard Cite

This study aimed to clarify the efficacy, safety, and pharmacokinetics of piperacillin-tazobactam (PIPC-TAZ) in late elderly Japanese patients. This is the first antimicrobial pilot study in late elderly patients with nursing and healthcare associated pneumonia. After PIPC-TAZ administration, PIPC concentrations in plasma were measured chromatographically and the pharmacokinetic parameters were estimated. Efficacy, safety, and bacteriological evaluations were also carried out. The mean age was 85.0 years old and most of the patients were late elderly. Chest X-rays, body temperature, white blood cell count, and C reactive protein all improved significantly, and a high efficacy ratio of 90.9% was observed. Serious nephrotoxicity was observed in 4 cases (18.2%) after administration of PIPC-TAZ. Creatinine clearance (mean S.D.) measured before PIPC-TAZ therapy was significantly lower in the nephrotoxicity group (32.5 4.4 mL/min) than in the non-nephrotoxicity group (46.1 16.7 mL/min), although the ages were not different between the 2 groups. In the pharmacokinetic parameters for PIPC, total clearance was slightly lower in the nephrotoxicity group than in the non-nephrotoxicity group. However, no significant difference was observed in plasma PIPC levels between the 2 groups. In patients with renal impairment, especially with a creatinine clearance of <40 mL/ min, renal impairment was found to be an influencing factor for severe nephrotoxicity following PIPC-TAZ administration. In conclusion, the results suggest that physicians should pay close attention in order to avoid possible toxicity, and that deliberate administration planning and careful follow-up are required in late elderly patients with comprised organ dysfunction.

show abstract

Efficacy and safety of piperacillin/tazobactam versus biapenem in late elderly patients with nursing- and healthcare-associated pneumonia

Cited by 16 publications

References 18 publications

Clinical evaluation of the need for carbapenems to treat community-acquired and healthcare-associated pneumonia

Clinical evaluation of the need for carbapenems to treat community-acquired and healthcare-associated pneumonia

Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia

Nephrotoxicity Induced by Piperacillin–Tazobactam in Late Elderly Japanese Patients with Nursing and Healthcare Associated Pneumonia

Contact Info

Product

Resources

About