Randomized comparative trial with ampicillin/sulbactam versus cefamandole in the therapy of community acquired pneumonia

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Abstract
In a randomized prospective study ampicillin/sulbactam and cefamandole were compared in the therapy of patients hospitalized with community acquired pneumonia. Patients receiving ampicillin/sulbactam (n=37) and cefamandole (n=38) were similar with respect to age (mean age 70 vs. 76 years respectively), clinical characteristics, severity of illness and underlying disease. Pathogens isolated from patients in the cefamandole and ampicillin/sulbactam group, respectively, wereStreptococcus pneumoniae (7 vs. 7 patients),Haemophilus parainfluenzae (7 vs. 6 patients),Haemophilus influenzae (5 vs. 5 patients),Staphylococcus aureus (5 vs. 4 patients),Escherichia coli (4 vs. 4 patients),Klebsiella pneumoniae (3 vs. 3 patients),Enterobacter spp. (2 vs. 3 patients),Moraxella catarrhalis (1 vs. 2 patients), and organisms of the oral flora (4 vs. 3 patients). The rate of resistance to penicillin was 80 %, to clindamycin 76 %, to erythromycin 45 %, to ampicillin 43 %, and to cefazolin 18 %. Overall successful treatment rates of 81 % for cefamandole and 97 % for ampicillin/sulbactam (p=0.05) were observed. Both cefamandole and ampicillin/sulbactam were shown to be effective agents for therapy of community acquired pneumonia; however ampicillin/sulbactam demonstrated superior overall clinical efficacy.