A prospective randomized trial of ceftazidime versus cefazolin/tobramycin in the treatment of hospitalized patients with pneumonia

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Abstract
Ceftazidime and cefazolin/tobramycin were compared in the treatment of hospitalized patients with pneumonia. Iv doses 8-hourly were: ceftazidime—2 g, cefazolin—1.5 g, tobramycin—1.7 mg/kg. For patients with pseudomonas infection randomized to cefazolin/tobramycin, ticarcillin (3 g iv 4-hourly) was used instead of cefazolin. One hundred and ten of 129 patients were evaluable (ceftazidime = 52, cefazolin/tobramycin = 58). Seventy five cases (68%) had documented pathogens of which 81% were aerobic Gram-negative bacilli. Analysis of clinical response showed no difference in overall results (P =0.77), or separate outcomes: cured (P = 0.85), improved (P = 0.62), failed (P = 0.53), or relapsed (P = 0.50). No differences in bacteriological response were noted either: eradication (P > 0.10), elimination with recurrence (P > 0.l0), persistence (P > 0.l0). The incidence of enterococcal and fungal colonization and supermfection was the same for both regimens. There was a greater incidence of Coombs' test positivity with ceftazidime (P > 0.01) but greater nephrotoxicity with cefazolin/tobramycin (P > 0.02). Ceftazidime appears to be as eflicacious as cefazolin/tobramycin in the treatment of hospitalized patients with pneumonia, and is less nephrotoxic.