Single-blind controlled study of ceftizoxime and cefamandole in the treatment of community-acquired pneumonia

Ampicillin versus cefamandole as initial therapy for community-acquired pneumonia

“…This difference may reflect the fact that antibiotic trials, including ours, often exclude patients with immunosuppression or neutropenia or those who are severely ill and unable to give informed consent. Our overall response rate of 88% is similar to that reported in previous trials that used cefamandole alone for the treatment of lower respiratory tract infections (26,41,42,44,53) or in comparison with cefotiam (6), ceftizoxime (25,35,39,58), cefonicid (24,65), ceftazidime (16,31), or cefoperazone (20).…”

“…Several other antibiotic trials of patients hospitalized with communityacquired respiratory infections have reported mortality rates ranging from 4 to 11% and have noted that most deaths resulted from the patients' underlying disorders (10,20,22,25,26,31,53,58). The mortality rate for our patients is lower than the 8 to 24% reported for patients hospitalized with community-acquired pneumonia but not specifically entered in a therapeutic trial (14,15,21,40,46,61,66).…”

“…Previous antibiotic trials have demonstrated that cefamandole is as efficacious as penicillin for pneumococcal pneumonia (54,55) and as efficacious as ampicillin for lower respiratory infection due to H. influenzae (10). Further, broad-spectrum cephalosporins have not been shown to be more efficacious than cefamandole for communityacquired pneumonia (6,16,20,24,25,31,35,39,58,65). Thus, cost considerations appear to favor the empiric use of ampicillin over cefamandole for the majority of patients hospitalized with presumed bacterial pneumonia of uncertain etiology.…”

BTS guidelines for the management of community acquired pneumonia in adults: update 2009

“…The literature review for the period 1981–2008 provided only 19 acceptable articles relevant to the antibiotic management of CAP 277 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 . [Ib] [Ib] [Ib] [Ib] [II] [Ib] [Ib] [Ib] [Ib] [Ib] [Ib] [Ib] [Ib] [Ib] [Ib] [Ib] [Ib] [Ib] [Ib] The remainder were rejected for the following reasons: inadequately powered studies or a retrospective design,102 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 non-blinded/non-randomised studies,274 401 402 403 404 405 antibiotic not available in the UK or withdrawn,357 361 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 study population or management unrepresentative of normal clinical practice in the UK,377 442 …”