Tazobactam/piperacillin for moderate-to-severe pneumonia in patients with risk for aspiration: Comparison with imipenem/cilastatin

• Published in: Pulmonary pharmacology & therapeutics Vol. 23; no. 5; pp. 403 - 410
• Main Authors: Ito, Isao, Kadowaki, Seizo, Tanabe, Naoya, Haruna, Akane, Kase, Masahito, Yasutomo, Yoshiro, Tsukino, Mitsuhiro, Nakai, Asako, Matsumoto, Hisako, Niimi, Akio, Chin, Kazuo, Ichiyama, Satoshi, Mishima, Michiaki
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2010
• Subjects: Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Aspiration; Cilastatin - therapeutic use; Community-Acquired Infections - drug therapy; Community-Acquired Infections - microbiology; Community-acquired pneumonia (CAP); Drug Combinations; Female; Humans; Imipenem - therapeutic use; Imipenem/cilastain (IPM/CS); Injections, Intravenous; Male; Medical Education; Nursing home-acquired pneumonia (NHAP); Nursing Homes; Open-label randomized study; Penicillanic Acid - analogs & derivatives; Penicillanic Acid - therapeutic use; Piperacillin - therapeutic use; Pneumonia, Aspiration - drug therapy; Pneumonia, Aspiration - microbiology; Prospective Studies; Protease Inhibitors - therapeutic use; Pulmonary/Respiratory; Tazobactam/piperacillin (TAZ/PIPC); Treatment Outcome; Nursing home-acquired pneumonia (NHAP); Tazobactam/piperacillin (TAZ/PIPC); Community-acquired pneumonia (CAP); Open-label randomized study; Aspiration; Imipenem/cilastain (IPM/CS)
• ISSN: 1094-5539; 1522-9629
• DOI: 10.1016/j.pupt.2010.05.007

Abstract Background Treatment of aspiration pneumonia is becoming an important issue due to aging of populations worldwide. Effectiveness of tazobactam/piperacillin (TAZ/PIPC) in aspiration pneumonia is not clear. Purpose To compare clinical efficacy between TAZ/PIPC (1:4 compound) and imipenem/cilastatin (IPM/CS) in patients with moderate-to-severe aspiration pneumonia. Patients and methods In this open-label, randomized study either TAZ/PIPC 5 g or IPM/CS 1 g was intravenously administered every 12 h to patients with moderate-to-severe community-acquired aspiration pneumonia or nursing home-acquired pneumonia with risk for aspiration pneumonia for average 11 days. The primary outcome was clinical response rate at the end of treatment (EOT) in validated per-protocol (VPP) population. Secondary outcomes were clinical response during treatment (days 4 and 7) and at the end of study (EOS) in VPP population, and survival at day 30 in modified intention-to-treat (MITT) population. Results There was no difference between the groups in primary or secondary outcome. However, significantly faster improvement as measured by axillary temperature ( p  < 0.05) and WBC count ( p  = 0.01) was observed under TAZ/PIPC treatment. In patients with gram-positive bacterial infection, TAZ/PIPC was more effective at EOT in VPP population ( p  = 0.03). Conclusion TAZ/PIPC is as effective and safe as IPM/CS in the treatment of moderate- to-severe aspiration pneumonia.