azlocillin and Pneumonia

In a still ongoing open, randomized prospective trial the preliminary data of 50 intensive care patients on artificial ventilation were analysed. The evaluation included clinical and bacteriological efficacy and tolerance of ceftazidime alone or in combination with tobramycin versus azlocillin plus tobramycin. Artificially ventilated patients who had been treated in an intensive care unit for at least five days were selected to enter the study because of a high probability of colonisation with gram-negative bacteria. 16 patients were treated for bronchopulmonary infection with ceftazidime alone, and 17 each were treated with ceftazidime plus tobramycin or with azlocillin plus tobramycin. In the ceftazidime group nine patients were cured and three were improved (75% clinical success). Of the patients treated with ceftazidime plus tobramycin, 11 were cured and one was improved (75% clinical success); one patient died from very severe multiple trauma. In the azlocillin-tobramycin group, six patients were cured and two were improved (57% clinical success). Two patients from this group died from their underlying disease and another died from multiple organ failure due to septicemia.

Topics: Adult; Azlocillin; Bacterial Infections; Ceftazidime; Clinical Trials as Topic; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Humans; Male; Middle Aged; Opportunistic Infections; Pneumonia; Random Allocation; Respiration, Artificial; Tobramycin

Topics: Azlocillin; Bronchi; Female; Humans; Male; Middle Aged; Pneumonia

Studies of therapy for experimental pneumonia due to Pseudomonas aeruginosa have failed to document beta-lactam-aminoglycoside synergy for most antibiotics examined, in contrast to results usually observed with pseudomonas infections at other sites. The neutropenic guinea-pig model of pseudomonas pneumonia was modified to resemble more closely therapy for clinical infections. Animals were treated 16 hr after infection with ticarcillin, azlocillin, ceftazidime, tobramycin, and netilmicin, alone and in combination. As predicted by in vitro synergy testing, in all cases combination drug therapy was more effective than the corresponding drugs given alone (P less than .05), as assessed by quantitative lung culture. Among single-drug regimens, those in which peak antibiotic levels did not exceed the minimal bactericidal concentration for the organism were significantly less effective. Resistance to aminoglycosides did not develop during therapy, and therefore, in this study does not explain the mechanism of synergy observed with beta-lactam antibiotics.

Topics: Agranulocytosis; Aminoglycosides; Animals; Anti-Bacterial Agents; Azlocillin; Ceftazidime; Cephalosporins; Drug Synergism; Drug Therapy, Combination; Guinea Pigs; Netilmicin; Neutropenia; Penicillin Resistance; Penicillins; Pneumonia; Pseudomonas aeruginosa; Pseudomonas Infections; Ticarcillin; Tobramycin

The therapeutic efficacies of the newer beta-lactam antibiotics piperacillin, azlocillin and aztreonam were compared with the efficacies of ticarcillin and tobramycin in a guinea pig model of experimental Pseudomonas aeruginosa pneumonia. For animals challenged with 2 X 10(8) CFU, tobramycin treatment resulted in survival rates and intrapulmonary killing of pseudomonads which were significantly greater than those found with any of the beta-lactam agents. There were no significant differences noted among the individual beta-lactam agents. When animals were challenged with 200-fold-fewer organisms (10(6) CFU), there was no significant difference between the efficacy of tobramycin and those of the various beta-lactams. These data suggest that tobramycin is particularly valuable in treating more severe P. aeruginosa pneumonia, whereas a number of different beta-lactam agents are of equivalent value in less severe lung infections.

Topics: Animals; Anti-Bacterial Agents; Azlocillin; Aztreonam; Guinea Pigs; Penicillins; Piperacillin; Pneumonia; Pseudomonas Infections; Ticarcillin; Tobramycin