meropenem and Pneumonia--Aspiration

Treatment of aspiration pneumonia is an important problem due to aging of populations worldwide. However, the effectiveness of cefepime in aspiration pneumonia has not yet been evaluated.. To compare the clinical efficacy and safety of cefepime and meropenem in patients with moderate-to-severe aspiration pneumonia.. In this open-label, randomized study, either cefepime 1 g or meropenem 0.5 g was administered intravenously every 8 h to patients with moderate-to-severe community-acquired or nursing-home acquired pneumonia at risk for aspiration for an average of 10.5 days. The primary outcome was the clinical response rate at the end of treatment (EOT) in the validated per-protocol (VPP)-population. Secondary outcomes were clinical response during treatment (days 4 and 7) and at the end of study (EOS) in the VPP-population, and survival at day 30 in the modified intention-to-treat (MITT)-population.. There was no difference between the groups in the primary or secondary outcomes or safety. Significant improvement was observed in each group on day 4.. Cefepime is as effective and safe as meropenem in the treatment of moderate-to-severe aspiration pneumonia.. UMIN000001349.

Topics: Administration, Intravenous; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefepime; Community-Acquired Infections; Cross Infection; Female; Humans; Male; Meropenem; Pneumonia, Aspiration; Prospective Studies; Severity of Illness Index; Treatment Outcome

In Japan, an increase in the elderly population is associated with an increased incidence of aspiration pneumonia. Treatment guidelines for aspiration pneumonia recommend the use of antibiotics effective against anaerobic bacteria, such as carbapenems. However, the role of anaerobic bacteria in aspiration pneumonia and the clinical efficacy of meropenem in elderly aspiration pneumonia patients have only begun to be investigated.. A prospective study of 62 elderly hospitalized patients with aspiration pneumonia (34 males, 28 females; mean age 86.6 years) was conducted. The causative organisms of aspiration pneumonia, including anaerobic bacteria, were investigated using fiberoptic bronchoscopy. In addition, the efficacy and safety of intravenous meropenem for this treatment of this condition were evaluated.. When disease severity was classified according to the Japanese Respiratory Society (JRS) guidelines, 80.7% of the cases in this study were graded as "most severe". The overall detection rate of bacteria was 87.1% (monomicrobial, 32.3%; polymicrobial, 54.8%). Of the 111 pathogens detected (14 anaerobic pathogens remained unidentified), anaerobic bacteria accounted for 19.8% and gram-negative enteric bacilli made up 19.8%. The overall clinical efficacy rate of meropenem therapy (1.0 g/day) was 61.3%. The mortality rate was 9.7%, and anaerobic bacteria coexisted with aerobic bacteria in 66.7% of the patients who died.. The use of antibiotics effective against anaerobic bacteria may be necessary for patients with potentially fatal aspiration pneumonia. Meropenem therapy for aspiration pneumonia is clinically effective and tolerable in elderly patients.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria, Aerobic; Bacteria, Anaerobic; Female; Humans; Male; Meropenem; Pneumonia, Aspiration; Pneumonia, Bacterial; Prospective Studies; Sputum; Thienamycins

Topics: Anti-Bacterial Agents; C-Reactive Protein; Child; Child, Preschool; Glycine; Humans; Leukocyte Elastase; Leukocytes; Male; Meropenem; Middle Aged; Pneumonia, Aspiration; Radiography; Serine Proteinase Inhibitors; Sulfonamides; Thienamycins

Although there are ever increasing reports of extraintestinal human infections caused by Aeromonads, in both immunocompromised and immunocompetent patients, respiratory tract infections remain uncommon. We describe a case of aspiration pneumonia in an immunocompetent patient with multiple sclerosis, caused by a community acquired, multidrug resistant strain of Aeromonas hydrophila sensitive only to meropenem. The case highlights the clinical significance of Aeromonas hydrophila as a respiratory pathogen, as well as the community origin of multidrug resistance and the utility of newer carbapenems in such cases.

Topics: Adolescent; Aeromonas hydrophila; Drug Resistance, Microbial; Drug Resistance, Multiple; Female; Gram-Negative Bacterial Infections; Humans; Meropenem; Pneumonia, Aspiration; Thienamycins