Combined aztreonam and gentamicin therapy for pseudomonal lower respiratory tract infections.

Abstract

A multicenter, open-label study was performed to assess the efficacy and safety of aztreonam plus gentamicin in the treatment of lower respiratory tract infections due to Pseudomonas aeruginosa. Patients with documented P aeruginosa infections were given aztreonam 2 g every 8 hours (q8h) plus gentamicin 3 to 5 mg/kg per day in three equal doses. Clindamycin, 600 mg q8h, was added to the regimen for patients with infections also involving gram-positive and/or anaerobic bacteria. Therapy was continued for at least 5 days or until obvious failure to respond to treatment. Of 64 patients with suspected P aeruginosa infections, 57 were eligible for clinical evaluation and 51 for microbiologic evaluation. At entry, impaired host defense was present in 35% of patients, and chronic obstructive pulmonary disease in 28%, in addition to other predisposing conditions such as emphysema, history of tuberculosis, and pneumothorax. The clinical response rate for the combination regimen was 48/57 (84%), which included 27 (47%) cures and 21 (37%) partial responses. The microbiologic response rate was 35/51 (69%), of which 25 (49%) outcomes were classified as eradication and 10 (20%) as eradication with relapse. Superinfection was observed in 3 (6%) patients. The combination of aztreonam and gentamicin was synergistic in the initial isolates obtained from 33 (72%) patients. A total of 16 patients died of pulmonary or other underlying disease, for a mortality rate of 28%. The monobactam-aminoglycoside combination was generally well tolerated. Two other patients were withdrawn because rashes emerged on treatment. This study demonstrates that aztreonam can be administered as one component of a synergistic monobactam-aminoglycoside therapy in the treatment of nosocomial lower respiratory tract infections involving P aeruginosa.

• Authors: R Andrews, R Fasoli, W G Scoggins, G J Algozzine, R W Spann, K V Sundaresh, J A Mathers Jr, R Babb 3rd, M Kuppinger, B Cooper
• Journal: Clinical therapeutics (Clin Ther) 1994 Mar-Apr Vol. 16 Issue 2 Pg. 236-52 ISSN: 0149-2918 [Print] United States
• PMID: 8062319 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Gentamicins
• Clindamycin
• Aztreonam

Topics

• Adult
• Aged
• Aged, 80 and over
• Aztreonam (pharmacology, therapeutic use)
• Clindamycin (therapeutic use)
• Cross Infection (complications, drug therapy)
• Drug Administration Schedule
• Drug Synergism
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Gentamicins (pharmacology, therapeutic use)
• Gram-Negative Bacteria (drug effects)
• Humans
• Intensive Care Units
• Lung Diseases (complications)
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Pneumonia (complications, drug therapy)
• Pseudomonas Infections (complications, drug therapy)
• Pseudomonas aeruginosa (drug effects, isolation & purification)