hr-810 and Pneumonia--Bacterial

Vancomycin is always the drug of choice for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in spite of his bactericidal kinetic.. The aim of this study was to evaluate in vivo the improvement of bactericidal kinetic of vancomycin associated with cefpirome against MRSA infection in critically ill patients.. The prospective cross-over study was carried out in 20 patients with severe pneumonia or bacteremia. There were randomized to receive vancomycin 2 g per day (Group 1, n = 10) or vancomycin with cefpirome 2 g x 2 (Group 2, n = 10). Clinical recovery, bacteriologic parameters (bactericidal kinetic and bactericidal power in vivo at the peak and the valley), duration of ventilation and stay in ICU were comparatively explored in both groups.. Clinical outcome did not significantly differ between Group 1 and 2. Bactericidal kinetics were better in the Group 2 (40% vs 60% after 6 hours to the dilution for 1/8e) but the difference was not significant. However, bactericidal power in sera was also better in the Group 2 with more bactericidal dilution at 1/16e (68% vs 88.8%: NS) and overall at 1/32e (10.5% vs 50%: p < 0.05) and CRP, an inflammatory marker, was significantly lower in the Group 2 than in the Group 1 (119.5 +/- 24 mg/l vs 198.6 +/- 78 mg/l: p < 0.05) on the third day.

Topics: Adult; Aged; Bacteremia; Cefpirome; Cephalosporins; Critical Care; Drug Therapy, Combination; Female; Humans; Male; Methicillin Resistance; Middle Aged; Pneumonia, Bacterial; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vancomycin

In an international, multicenter, open-label, randomized comparative study, adult patients in intensive care units were enrolled to receive cefpirome intravenously at 2 g twice daily or ceftazidime intravenously at 2 g three times daily for the empiric treatment of pneumonia. Randomization was performed after a double stratification according to the investigator's initial choice of monotherapy or combination therapy and then on the basis of the severity of disease. The primary endpoint was the clinical response at the end of treatment in the intent-to-treat population. Data for all patients were reviewed by a blinded observer. Of the 400 enrolled patients, 201 received cefpirome (monotherapy, 56%) and 199 received ceftazidime (monotherapy, 51%). Pneumonia was hospital acquired for 75% of the patients. Clinical failures rates were 34 versus 36% (odds ratio = 0.922; upper bound of 90% confidence interval = 1.301) in the intent-to-treat analysis for cefpirome and ceftazidime, respectively. For the cefpirome and ceftazidime groups, there were 35 versus 30% clinical failures among monotherapy-stratified patients, respectively, and 34 versus 42% clinical failures among combination therapy-stratified patients, respectively. The rates of clinical failures in the per-protocol analysis were 38 and 42%, respectively. In the population of patients evaluable for bacteriologic efficacy, eradication or presumed eradication was obtained for 71% (172 of 241) and 70% (162 of 230) of the pathogens isolated from the patients receiving cefpirome and ceftazidime, respectively. The mortality rates within 2 weeks after the end of treatment were similar (cefpirome group, 31%; ceftazidime group, 26%), as were the percentages of patients with at least one treatment-related adverse event (17 and 19%, respectively). An empiric treatment strategy with cefpirome at 2 g twice daily is equivalent in terms of efficacy and tolerance to ceftazidime at 2 g three times daily for the treatment of pneumonia in patients in intensive care units.

Topics: Adult; Cefpirome; Ceftazidime; Cephalosporins; Critical Care; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Drug Tolerance; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Pneumonia, Bacterial; Prospective Studies; Treatment Outcome

Twenty two patients with inflammatory respiratory tract infection were treated with cefpirome. Among the patients 14 were with severe pneumonia, 4 with exacerbated obstructive chronic purulent bronchitis and 4 with mucoviscidosis. All the patients were subjected to clinical, laboratory and x-ray examinations, electrocardiography, estimation of the external respiration and sputum bacteriological tests. The cefpirome susceptibility was determined by the agar diffusion assay with standard disks from Roussel Uclaf. Cefpirome was administered by slow intravenous infusion in a daily dose of 2 to 4 g every 12 hours depending on the disease severity. After 2 or 3 days of the patient afebrile temperature and normal differential blood count the therapy was discontinued. The favourable time course of the disease was recorded in 12 out of the 14 patients with pneumonia. Recovery and clinical improvement were stated in 64.3 and 21.4 per cent of the cases respectively. In 2 patients the treatment failed. In all the patients with exacerbated severe chronic purulent bronchitis the cefpirome therapy resulted in the disease remission. The clinical effect of the mucoviscidosis treatment was observed in 3 out of the 4 patients. The drug tolerance in the doses used was good.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bronchitis; Cefpirome; Cephalosporins; Chronic Disease; Cystic Fibrosis; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Pseudomonas aeruginosa; Staphylococcus; Treatment Outcome

Twenty patients with lower respiratory tract infection were treated with cefpirome: 16 patients with pneumonia and 4 patients with chronic bronchitis which developed at the background of other diseases such as chronic somatic diseases, lung cancer, exudative pleurisy and others. The drug was administered intravenously in a dose of 1 g twice a day for 7 to 10 days. The clinical efficacy was stated in 80 per cent of the cases. In 95 per cent of the cases the drug tolerance was good. The isolates from the patients were susceptible to cefpirome in 83 per cent of the cases.

Topics: Adult; Bacterial Infections; Bronchitis; Cefpirome; Cephalosporins; Chronic Disease; Female; Humans; Male; Microbial Sensitivity Tests; Pneumonia, Bacterial; Treatment Outcome

The clinical efficacy and tolerance of cefpirome were estimated in the treatment of patients with bacterial infection of the respiratory tract. The estimate included 15 patients with acute and chronic bronchopulmonary diseases: 6 patients with acute pneumonia, 5 with exacerbated chronic purulent obstructive bronchitis and 4 with primary immune deficiency (agammaglobulinemia and acute pneumonia). Excellent and good total efficacy of the drug was stated in 6 and 8 patients respectively. In 1 patient the treatment was discontinued because of acute urticaria. Therefore, cefpirome is to be recommended as a highly efficient agent for the treatment of bronchopulmonary infection.

Topics: Acute Disease; Adolescent; Adult; Agammaglobulinemia; Bacterial Infections; Bronchitis; Cefpirome; Cephalosporins; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Treatment Outcome

The pharmacokinetic profile of antibiotics at the site of antiinfective action is one of the most important determinants of drug response, since it correlates the antimicrobial effect. Up to now, only limited information on the lung tissue pharmacokinetics of antibiotic agents has been available. The aim of in-vivo microdialysis is to measure antibiotic penetration into the extracellular space fluid of normal or pneumonic human lung parenchyma. The lung penetration of cefpirom in elective thoracic surgery and piperacillin in septic thoracic surgery, substances with low protein binding, was measured. Intra-, or postoperatively, respectively, microdialysis probes were inserted into normal or pneumonic lung tissue and into healthy skeletal muscle to obtain reference values. Serum and microdialysis samples were collected at 20-minute intervals for at last 8 hours. The intrapulmonary concentrations of the antibiotics exceeded the minimum inhibitory concentrations (MIC) for most relevant bacteria for 4-6 hours. The procedure was well tolerated by all patients and no adverse events or microdialysis-associated side effects were observed. This microdialysis technique enabled continuous tissue pharmacokinetic measurement of free, unbound anti-infective agents in the lung tissue, even in pneumonia.

Topics: Anti-Bacterial Agents; Cefpirome; Cephalosporins; Empyema, Pleural; Extracellular Space; Humans; Lung; Microbial Sensitivity Tests; Microdialysis; Penicillanic Acid; Piperacillin; Pneumonia, Bacterial; Tazobactam; Thoracotomy