Please use this identifier to cite or link to this item: http://hdl.handle.net/2445/55247
Title: Usefulness of betalactam therapy for community-acquired pneumonia in the era of drug-resistant Streptococcus pneumoniae: a randomized study of amoxicillin-clavulanate and ceftriaxone
Author: Rosón, Beatriz
Carratalà, Jordi
Tubau, Fe
Dorca i Sargatal, Jordi
Liñares Louzao, Josefina
Pallarés Giner, Roman
Manresa, Federico
Gudiol i Munté, Francesc
Keywords: Estreptococs
Resistència als medicaments
Amoxicil·lina
Medicaments antibacterians
Penicil·lina
Pneumònia
Pneumococs
Streptococcus
Drug resistance
Amoxicillin
Antibacterial agents
Penicillin
Pneumonia
Streptococcus pneumonia
Issue Date: Mar-2001
Publisher: Mary Ann Liebert, Inc.
Abstract: Empirical antibiotic therapy of community-acquired pneumonia (CAP) has been complicated by the worldwide emergence of penicillin resistance among Streptococcus pneumoniae. The impact of this resistance on the outcome of patients hospitalized for CAP, empirically treated with betalactams, has not been evaluated in a randomized study. We conducted a prospective, randomized trial to assess the efficacy of amoxicillin-clavulanate (2 g/200 mg/8 hr) and ceftriaxone (1 g/24 hr) in a cohort of patients hospitalized for moderate-to-severe CAP. Three-hundred seventy-eight patients were randomized to receive amoxicillin-clavulanate (184 patients) or ceftriaxone (194 patients). Efficacy was assessed on Day 2, after completion of therapy and at long term follow-up. There were no significant differences in outcomes between treatment groups, both in intention-to-treat and per-protocol analysis. Overall mortality was 10.3% for amoxicillin-clavulanate and 8.8% for ceftriaxone (NS). There were 116 evaluable patients with proven pneumococcal pneumonia. Rates of high-level penicillin resistance (MIC of penicillin ≥2 µg/mL) were similar in the two groups (8.2 and 10.2%). Clinical efficacy at the end of therapy was 90.6% for amoxicillin-clavulanate and 88.9% for ceftriaxone (95% C.I. of the difference: -9.3 to +12.7%). No differences in outcomes were attributable to differences in penicillin susceptibility of pneumococcal strains. Sequential i.v./oral amoxicillin-clavulanate and parenteral ceftriaxone were equally safe and effective for the empirical treatment of acute bacterial pneumonia, including penicillin and cephalosporin-resistant pneumococcal pneumonia. The use of appropriate betalactams in patients with penumococcal pneumonia and in the overall CAP population, is reliable at the current level of resistance
Note: Reproducció del document publicat a: http://dx.doi.org/10.1089/107662901750152864
It is part of: Microbial Drug Resistance, 2001, vol. 7, num. 1, p. 85-96
Related resource: http://dx.doi.org/10.1089/107662901750152864
URI: http://hdl.handle.net/2445/55247
ISSN: 1076-6294
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)
Articles publicats en revistes (Patologia i Terapèutica Experimental)

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