[Efficacy of monotherapy by meropenem in ventilator-associated pneumonia].

Abstract

We performed a prospective, open label, randomized study in intensive care unit patients with ventilator-associated pneumonia (VAP) to determine the efficacy and safety of empiric intravenous (i.v.) meropenem monotherapy compared with the combination of ceftazidime plus amikacin. A total of 140 patients receiving mechanical ventilation and diagnosed with pneumonia were included in the study. Patients were randomized to receive either 1 g meropenem i.v. every 8 hours or 2 g ceftazidime i.v. every 8 hours plus 15 mg/kg amikacin daily, administered to patients with normal renal function as two daily doses. Satisfactory clinical responses (cure or improvement) were achieved at the end of treatment in 68.1% of meropenem-treated patients and 54.9% in the ceftazidime/amikacin treated group (relative risk 1.25; 95% confidence interval > 1.00, 1.55). When non-evaluable patients were excluded from the analysis, the satisfactory clinical response was 82.5% and 66.1% for the meropenem and ceftazidime/amikacin patients, respectively (p = 0.044). Logistic regression demonstrated that treatment with meropenem and both the basic traumatic and medical pathologies were significantly associated with a satisfactory response. Adverse events judged to be possible or probably related to treatment were reported by seven (10.1%) patients in the meropenem group and by eight patients (11.3%) in the ceftazidime/amikacin group. The results of this study confirm that monotherapy with meropenem is well tolerated and provides superior efficacy to the conventional combination of ceftazidime and amikacin in combating VAP.

• Authors: F Alvarez Lerma, Serious Infections Study Group
• Journal: Antibiotiki i khimioterapiia = Antibiotics and chemoterapy [sic] (Antibiot Khimioter) Vol. 46 Issue 12 Pg. 42-52 ( 2001) ISSN: 0235-2990 [Print] Russia (Federation)
• Vernacular Title: Effektivnost' monoterapii meropenemom pri ventiliator-assotsiirovannoĭ pnevmonii.
• PMID: 12108093 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Thienamycins
• Amikacin
• Ceftazidime
• Meropenem

Topics

• Amikacin (administration & dosage, adverse effects, therapeutic use)
• Ceftazidime (administration & dosage, adverse effects, therapeutic use)
• Cross Infection (drug therapy, microbiology, mortality)
• Drug Therapy, Combination (administration & dosage, adverse effects, therapeutic use)
• Female
• Humans
• Male
• Meropenem
• Middle Aged
• Pneumonia, Bacterial (drug therapy, microbiology, mortality)
• Prospective Studies
• Respiration, Artificial (adverse effects, instrumentation)
• Superinfection (drug therapy, etiology, mortality)
• Thienamycins (adverse effects, therapeutic use)