This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow An erratum has been published
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Jaccard, C.
Right arrow Articles by Cometta, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Jaccard, C.
Right arrow Articles by Cometta, A.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, November 1998, p. 2966-2972, Vol. 42, No. 11
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Prospective Randomized Comparison of Imipenem-Cilastatin and Piperacillin-Tazobactam in Nosocomial Pneumonia or Peritonitis

C. Jaccard,1,* N. Troillet,2 S. Harbarth,3 G. Zanetti,1 D. Aymon,1 R. Schneider,1 R. Chiolero,1 B. Ricou,3 J. Romand,3 O. Huber,3 P. Ambrosetti,3 G. Praz,2 D. Lew,3 J. Bille,1 M. P. Glauser,1 and A. Cometta1

Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne,1 Institut Central des Hôpitaux valaisans, 1951 Sion,2 and Division of Infectious Diseases, Hôpital Cantonal Universitaire, 1211 Geneva,3 Switzerland

Received 23 October 1997/Returned for modification 8 April 1998/Accepted 14 August 1998

Nosocomial pneumonia and acute peritonitis may be caused by a wide array of pathogens, and combination therapy is often recommended. We have previously shown that imipenem-cilastatin monotherapy was as efficacious as the combination of imipenem-cilastatin plus netilmicin in these two settings. The efficacy of imipenem-cilastatin is now compared to that of piperacillin-tazobactam as monotherapy in patients with nosocomial pneumonia or acute peritonitis. Three hundred seventy one patients with nosocomial pneumonia or peritonitis were randomly assigned to receive either imipenem-cilastatin (0.5 g four times a day) or piperacillin-tazobactam (4.5 g three times a day). Three hundred thirteen were assessable (154 with nosocomial pneumonia and 159 with peritonitis). For nosocomial pneumonia, clinical-failure rates in the piperacillin-tazobactam group (13 of 75 [17%]) and in the imipenem-cilastatin group (23 of 79 [29%]) were similar (P = 0.09), as were the numbers of deaths due to infection (6 in the imipenem-cilastatin group [8%], 7 in the piperacillin-tazobactam group [9%]) (P = 0.78). For acute peritonitis, clinical success rates were comparable (piperacillin-tazobactam, 72 of 76 [95%]; imipenem-cilastatin, 77 of 83 [93%]). For infections due to Pseudomonas aeruginosa, 45 patients had nosocomial pneumonia (21 in the piperacillin-tazobactam group and 24 in the imipenem-cilastatin group) and 10 had peritonitis (5 in each group). In the patients with nosocomial pneumonia, clinical failure was less frequent in the piperacillin-tazobactam group (2 of 21 [10%]) than in the piperacillin-cilastatin group (12 of 24 [50%]) (P = 0.004). Bacterial resistance to allocated regimen was the main cause of clinical failure (1 in the piperacillin-tazobactam group and 12 in the imipenem-cilastatin group). For the patients with peritonitis, no difference in clinical outcome was observed (five of five cured in each group). The overall frequencies of adverse events related to treatment in the two groups were similar (24 in the piperacillin-tazobactam group, 22 in the imipenem-cilastatin group). Diarrhea was significantly more frequent in the piperacillin-tazobactam group (10 of 24) than in the imipenem-cilastatin group (2 of 22). This study suggests that piperacillin-tazobactam monotherapy is at least as effective and safe as imipenem-cilastatin monotherapy in the treatment of nosocomial pneumonia or peritonitis. In P. aeruginosa pneumonia, piperacillin-tazobactam achieved a better clinical efficacy than imipenem-cilastatin, due to reduced development of microbiological resistance. Tolerance was comparable, with the exception of diarrhea, which was more frequent with piperacillin-tazobactam.

* Corresponding author. Mailing address: Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. Phone: 41 21 314 10 10. Fax: 41 21 314 10 07.

Antimicrobial Agents and Chemotherapy, November 1998, p. 2966-2972, Vol. 42, No. 11
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


This article has been cited by other articles:

  • El Solh, A. A., Alhajhusain, A. (2009). Update on the treatment of Pseudomonas aeruginosa pneumonia. J Antimicrob Chemother 64: 229-238 [Abstract] [Full Text]  
  • Niederman, M. S. (2009). Severe Pneumonia. ACCP Crit Care Med Brd Rev 20: 485-506 [Full Text]  
  • Masterton, R. G., Galloway, A., French, G., Street, M., Armstrong, J., Brown, E., Cleverley, J., Dilworth, P., Fry, C., Gascoigne, A. D., Knox, A., Nathwani, D., Spencer, R., Wilcox, M. (2008). Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 62: 5-34 [Abstract] [Full Text]  
  • Siempos, I. I., Vardakas, K. Z., Manta, K. G., Falagas, M. E. (2007). Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia. Eur Respir J 29: 548-560 [Abstract] [Full Text]  
  • Rodloff, A. C., Goldstein, E. J. C., Torres, A. (2006). Two decades of imipenem therapy. J Antimicrob Chemother 58: 916-929 [Abstract] [Full Text]  
  • Cirioni, O., Giacometti, A., Ghiselli, R., Bergnach, C., Orlando, F., Silvestri, C., Mocchegiani, F., Licci, A., Skerlavaj, B., Rocchi, M., Saba, V., Zanetti, M., Scalise, G. (2006). LL-37 Protects Rats against Lethal Sepsis Caused by Gram-Negative Bacteria. Antimicrob. Agents Chemother. 50: 1672-1679 [Abstract] [Full Text]  
  • (2005). Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia. Am. J. Respir. Crit. Care Med. 171: 388-416 [Full Text]  
  • Giacometti, A., Ghiselli, R., Cirioni, O., Mocchegiani, F., D'Amato, G., Orlando, F., Sisti, V., Kamysz, W., Silvestri, C., Naldoski, P., Lukasiak, J., Saba, V., Scalise, G. (2004). Therapeutic efficacy of the magainin analogue MSI-78 in different intra-abdominal sepsis rat models. J Antimicrob Chemother 54: 654-660 [Abstract] [Full Text]  
  • Giacometti, A., Cirioni, O., Ghiselli, R., Mocchegiani, F., D'Amato, G., Circo, R., Orlando, F., Skerlavaj, B., Silvestri, C., Saba, V., Zanetti, M., Scalise, G. (2004). Cathelicidin Peptide Sheep Myeloid Antimicrobial Peptide-29 Prevents Endotoxin-induced Mortality in Rat Models of Septic Shock. Am. J. Respir. Crit. Care Med. 169: 187-194 [Abstract] [Full Text]  
  • Zanetti, G., Bally, F., Greub, G., Garbino, J., Kinge, T., Lew, D., Romand, J.-A., Bille, J., Aymon, D., Stratchounski, L., Krawczyk, L., Rubinstein, E., Schaller, M.-D., Chiolero, R., Glauser, M.-P., Cometta, A., the Cefepime Study Group,, (2003). Cefepime versus Imipenem-Cilastatin for Treatment of Nosocomial Pneumonia in Intensive Care Unit Patients: a Multicenter, Evaluator-Blind, Prospective, Randomized Study. Antimicrob. Agents Chemother. 47: 3442-3447 [Abstract] [Full Text]  
  • Fowler, R. A., Flavin, K. E., Barr, J., Weinacker, A. B., Parsonnet, J., Gould, M. K. (2003). Variability in Antibiotic Prescribing Patterns and Outcomes in Patients With Clinically Suspected Ventilator-Associated Pneumonia. Chest 123: 835-844 [Abstract] [Full Text]  
  • Lepper, P. M., Grusa, E., Reichl, H., Hogel, J., Trautmann, M. (2002). Consumption of Imipenem Correlates with {beta}-Lactam Resistance in Pseudomonas aeruginosa. Antimicrob. Agents Chemother. 46: 2920-2925 [Abstract] [Full Text]  
  • Chastre, J., Fagon, J.-Y. (2002). Ventilator-associated Pneumonia. Am. J. Respir. Crit. Care Med. 165: 867-903 [Abstract] [Full Text]  
  • Giamarellou, H. (2002). Prescribing guidelines for severe Pseudomonas infections. J Antimicrob Chemother 49: 229-233 [Full Text]  
  • Lynch, J. P. III (2001). Hospital-Acquired Pneumonia : Risk Factors, Microbiology, and Treatment. Chest 119 : 373S-384S [Abstract] [Full Text]  
  • Lee, N. L. S., Yuen, K. Y., Kumana, C. R. (2001). {beta}-Lactam Antibiotic and {beta}-Lactamase Inhibitor Combinations. JAMA 285: 386-388 [Full Text]  
  • Morehead, R. S., Pinto, S. J. (2000). Ventilator-Associated Pneumonia. Arch Intern Med 160: 1926-1936 [Abstract] [Full Text]  
  • Carmeli, Y., Troillet, N., Eliopoulos, G. M., Samore, M. H. (1999). Emergence of Antibiotic-Resistant Pseudomonas aeruginosa: Comparison of Risks Associated with Different Antipseudomonal Agents. Antimicrob. Agents Chemother. 43: 1379-1382 [Abstract] [Full Text]  


Copyright © 2010 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»