sultamicillin and Pneumonia--Aspiration

Aspiration pneumonia (AP) and primary lung abscess (PLA), are diseases following aspiration of infectious material from the oropharynx or stomach. An antibiotic therapy, also covering anaerobic pathogens, is the treatment of choice. In this study we compared moxifloxacin (MXF) and ampicillin/sulbactam (AMP/SUL) concerning efficacy and safety in the treatment of AP and PLA.. Patients with pulmonary infections following aspiration were included in a prospective, open-label, randomized, multicenter trial. Sequential antibiotic therapy with MXF or AMP/SUL was administered until complete radiologic and clinical resolution.. A total of 139 patients with AP and PLA were included, 96 were evaluable for efficacy (EE, 48 patients in each treatment group). The overall clinical response rates in both groups were numerically identical (66.7%). MXF and AMP/SUL were both well tolerated, even after long-term administration [median duration of treatment (range) in days MXF versus AMP/SUL: AP 11 (4-45) vs 9 (3-25), PLA 30.5 (7-158) vs 35 (6-90)].. In the treatment of aspiration-associated pulmonary infections moxifloxacin appears to be clinically as effective and as safe as ampicillin/sulbactam; but, however, having the additional benefit of a more convenient (400 mg qd) treatment.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Aza Compounds; Female; Fluoroquinolones; Gram-Negative Bacterial Infections; Gram-Negative Facultatively Anaerobic Rods; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Lung Abscess; Male; Moxifloxacin; Pneumonia, Aspiration; Quinolines; Radiography; Sulbactam

As the number of elderly people has increased in Japan, the occurrence of aspiration pneumonia has also increased. Guidelines for the treatment of pneumonia have been proposed, in which the use of antibiotics, such as beta-lactam plus beta-lactamase inhibitor, clindamycin, and carbapenem, has been recommended as effective against anaerobic bacteria in the treatment of aspiration pneumonia. However, to our knowledge, a prospective comparison of these antibiotics regarding their clinical efficacy in aspiration pneumonia has not been performed.. We compared the effects of IV administration of a half dose of ampicillin/sulbactam (SBT/ABPC), normal dose of SBT/ABPC, IV clindamycin, and IV panipenem/betamiprom (PAPM/BP) for treatment of mild-to-moderate aspiration pneumonia in elderly patients.. Randomized prospective study.. One hundred adult patients with compatible signs and symptoms of aspiration pneumonia.. Patients were assessed before, during, and after treatment regarding symptoms, as well as results of laboratory values, chest radiograph examinations, and sputum bacterial cultures.. We found few differences between the groups regarding cure rate, duration of IV medication, and occurrence of adverse effects with the tested therapies. However, clindamycin therapy was less expensive and was associated with a lower rate of posttreatment occurrence of methicillin-resistant Staphylococcus aureus.. Clindamycin therapy for mild-to-moderate aspiration pneumonia is clinically effective, and provides economic advantages as compared to SBT/ABPC or PAPM/BP therapy.

Topics: Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; beta-Alanine; Clindamycin; Female; Humans; Injections, Intravenous; Male; Pneumonia, Aspiration; Prospective Studies; Severity of Illness Index; Sulbactam; Thienamycins

Aspiration pneumonia is an urgent health concern with high mortality and long hospitalization in industrialized and aging countries. However, there is no information about the effectiveness of azithromycin (AZM) for the treatment of aspiration pneumonia. This study investigated if AZM is effective for the treatment of aspiration pneumonia.. Patients with aspiration pneumonia with no risk of multidrug-resistant pathogens were included in this prospective study at Kishiwada City Hospital from December 2011 to June 2013. Patients were divided into the ampicillin/sulbactam (ABPC/SBT) and AZM (intravenous injection) groups. The success rates of 1(st)-line antibiotic therapy, mortality, length of hospital stay, and total antibiotic costs were compared.. There were 81 and 36 patients in the ABPC/SBT and AZM groups, respectively. There was no significant difference in the success rate of 1(st)-line antibiotics between the groups (74.1% vs. 75.0%, respectively, P = 1.000). Mortality and hospitalization periods did not differ between the 2 groups (11.1% vs. 8.3%, P = 0.753, and 22.3 ± 7.3 days vs. 20.5 ± 8.1 days, P = 0.654, respectively). However, the total antibiotic costs were significantly lower in the AZM group than the ABPC/SBT group (2.19 ± 1.65 × 10,000 yen vs. 2.94 ± 1.67 × 10,000 yen, respectively, P = 0.034). The febrile period of the ABPC/SBT group was significantly shorter than that of the AZM group (P = 0.025).. In this small prospective non-randomized observational study, we found no statistically significant differences in mortality or antibiotic failure in patients receiving AZM compared to ABPC/SBT for the treatment of patients with aspiration pneumonia who require hospital admission and have no risk of drug-resistant pathogens. Therefore, AZM may be another first choice of antibiotic treatment for patients with aspiration pneumonia when they have no risk of multidrug-resistant pathogens.

Topics: Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Azithromycin; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia, Aspiration; Prospective Studies; Sulbactam; Treatment Outcome

Klebsiella pneumoniae is an important causative bacterium of aspiration pneumonia in many elderly patients. We retrospectively investigated the clinical effects of the early treatment of aspiration pneumonia and background factors in 24 patients from whom Klebsiella pneumoniae was isolated. Sulbactam/ampicillin (SBT/ABPC) was selected for early treatment in 12 of the 24 patients diagnosed with aspiration pneumonia, and tazobactam/piperacillin (TAZ/PIPC) was selected for the other patients. The effective rates and success rates of early treatment were significantly higher in the TAZ/PIPC group than in the SBT/ABPC group (p = 0.003 and 0.027, respectively). Although no significant difference was noted because of the limited number of cases, the survival rates after 30 days were 91.7 and 58.3 % in the TAZ/PIPC and SBT/ABPC groups, respectively. Several bacteria isolated with Klebsiella pneumoniae were resistant bacteria, such as methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa, and no anaerobe or extended-spectrum β-lactamase-producing Klebsiella pneumoniae was isolated. Thirteen and 11 of the 24 cases were classified as healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP), respectively, with no case classified as community-acquired pneumonia (CAP). As population aging progresses, the frequency of aspiration pneumonia classified as HCAP will increase. To cover anaerobes, it is necessary to select antibacterial drugs, such as TAZ/PIPC, for early treatment in consideration of resistant gram-negative bacteria to improve the outcome, and not drugs with weak activity against these bacteria.

Topics: Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Bacteria; C-Reactive Protein; Drug Therapy, Combination; Humans; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia, Aspiration; Retrospective Studies; Sulbactam; Treatment Outcome