Ertapenem versus cefepime for initial empirical treatment of pneumonia acquired in skilled-care facilities or in hospitals outside the intensive care unit

被引:40
作者
Yakovlev, S. V.
Stratchounski, L. S.
Woods, G. L.
Adeyi, B.
McCarroll, K. A.
Ginanni, J. A.
Friedland, I. R.
Wood, C. A.
DiNubile, M. J.
机构
[1] Merck Res Labs, N Wales, PA 19454 USA
[2] Municipal Hosp 7, Moscow, Russia
[3] Smolensk State Med Acad, Smolensk, Russia
[4] Merck Res Labs, West Point, PA 19486 USA
关键词
D O I
10.1007/s10096-006-0193-0
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
The study presented here compared the efficacy and safety of ertapenem and cefepime as initial treatment for adults with pneumonia acquired in skilled-care facilities or in hospital environments outside the intensive care unit (ICU). Non-ventilated patients developing pneumonia in hospital environments outside the ICU, in nursing homes, or in other skilled-care facilities were enrolled in this double-blind non-inferiority study, stratified by APACHE II score (<= 15 vs > 15) and randomized (1:1) to receive cefepime (2 g every 12 h with optional metronidazole 500 mg every 12 h) or ertapenem (1 g daily). After 3 days of parenteral therapy, participants demonstrating clinical improvement could be switched to oral ciprofloxacin or another appropriate oral agent. Probable pathogens were identified in 162 (53.5%) of the 303 randomized participants. The most common pathogens were Enterobacteriaceae, Streptococcus pneumoniae, and Staphylococcus aureus, isolated from 59 (19.5%), 39 (12.9%), and 35 (11.6%) participants, respectively. At the test-of-cure assessment 7-14 days after completion of all study therapy, pneumonia had resolved or substantially improved in 89 (87.3%) of 102 clinically evaluable ertapenem recipients and 80 (86%) of 93 clinically evaluable cefepime recipients (95% confidence interval for the difference, -9.4 to 11.8%), fulfilling pre-specified criteria for statistical non-inferiority. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. In this study population, ertapenem was as well-tolerated and efficacious as cefepime for the initial treatment of pneumonia acquired in skilled-care facilities or in hospital environments outside the ICU.
引用
收藏
页码:633 / 641
页数:9
相关论文
共 47 条
[2]   Community-acquired bacteria frequently detected by means of quantitative polymerase chain reaction in nosocomial early-onset ventilator-associated pneumonia [J].
Apfalter, P ;
Stoiser, B ;
Barousch, W ;
Nehr, M ;
Kramer, L ;
Burgmann, H .
CRITICAL CARE MEDICINE, 2005, 33 (07) :1492-1498
[3]  
Bartlett John G., 2000, Clinical Infectious Diseases, V31, P347, DOI 10.1086/313954
[4]  
BEAM TR, 1992, CLIN INFECT DIS S1, V15, P5
[5]   NOSOCOMIAL PNEUMONIA IN MEDICARE PATIENTS - HOSPITAL COSTS AND REIMBURSEMENT PATTERNS UNDER THE PROSPECTIVE PAYMENT SYSTEM [J].
BOYCE, JM ;
POTTERBYNOE, G ;
DZIOBEK, L ;
SOLOMON, SL .
ARCHIVES OF INTERNAL MEDICINE, 1991, 151 (06) :1109-1114
[6]  
CARRATALA J, 2004, 44 INT C ANT AG CHEM
[7]   Antibiotic resistance in nosocomial pulmonary pathogens [J].
Chalfine, A ;
Timsit, JF ;
Acar, A .
SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, 2000, 21 (01) :45-51
[8]   Risk factors for ICU-acquired pneumonia [J].
Cook, DJ ;
Kollef, MH .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 279 (20) :1605-1606
[9]   EFFECT OF INTENSIVE-CARE UNIT NOSOCOMIAL PNEUMONIA ON DURATION OF STAY AND MORTALITY [J].
CRAIG, CP ;
CONNELLY, S .
AMERICAN JOURNAL OF INFECTION CONTROL, 1984, 12 (04) :233-238
[10]   PREVENTING NOSOCOMIAL PNEUMONIA - STATE-OF-THE-ART AND PERSPECTIVES FOR THE 1990S [J].
CRAVEN, DE ;
STEGER, KA ;
BARBER, TW .
AMERICAN JOURNAL OF MEDICINE, 1991, 91 :S44-S53