Usefulness of Betalactam Therapy for Community-Acquired Pneumonia in the Era of Drug-ResistantStreptococcus pneumoniae:A Randomized Study of Amoxicillin-Clavulanate and Ceftriaxone
Open Access
- 1 March 2001
- journal article
- clinical trial
- Published by Mary Ann Liebert Inc in Microbial Drug Resistance
- Vol. 7 (1) , 85-96
- https://doi.org/10.1089/107662901750152864
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.Keywords
This publication has 36 references indexed in Scilit:
- Fluoroquinolone Resistance inStreptococcus pneumoniaeNew England Journal of Medicine, 1999
- Risk Factors and Course of Illness Among Children With Invasive Penicillin-resistant Streptococcus pneumoniaePediatrics, 1999
- Impact of Antibiotic Resistance on Chemotherapy for Pneumococcal InfectionsMicrobial Drug Resistance, 1998
- Surveillance of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the United States in 1996–1997 respiratory seasonDiagnostic Microbiology and Infectious Disease, 1997
- Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992-1996. A detailed analysis of 108 casesArchives of internal medicine (1960), 1997
- Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysisJAMA, 1996
- Community-Acquired PneumoniaNew England Journal of Medicine, 1995
- New and Emerging Etiologies for Community-Acquired Pneumonia with Implications for TherapyMedicine, 1990
- Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae Isolates Causing Systematic Infections in Spain, 1979-1989Clinical Infectious Diseases, 1990
- Risk Factors and Response to Antibiotic Therapy in Adults with Bacteremic Pneumonia Caused by Penicillin-Resistant PneumococciNew England Journal of Medicine, 1987