Document Detail


Efficacy and safety of high-dose ampicillin/sulbactam vs. colistin as monotherapy for the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia.
MedLine Citation:
PMID:  18501431     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare the safety and efficacy of ampicillin/sulbactam (Amp/Sulb) and colistin (COL) in the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP). METHODS: A prospective cohort study in adult critically ill patients with VAP. Patients were randomly assigned to receive Amp/Sulb (9 g every 8h) or COL (3 MIU every 8h) intravenously. Dosage was adjusted according to creatinine clearance. RESULTS: A total of 28 patients were enrolled (15 COL, 13 Amp/Sulb). Resolution of symptoms and signs occurred in 60% (9/15) of the COL group and 61.5% (9/13) of the Amp/Sulb group, improvement in 13.3% (2/15) vs. 15.3% (1/13) and failure in 26.6% (4/15) vs. 23% (3/13), respectively. The difference was not statistically significant. Bacteriologic success was achieved in 66.6% (10/15) vs. 61.5% (8/13) in the COL and Amp/Sulb groups, respectively (p<0.2). Mortality rates (14 days and 28 days) were 15.3% and 30% for the Amp/Sulb and 20% and 33% for the COL group, respectively. Adverse events were 39.6% (including 33% nephrotoxicity) for the COL group and 30.7% (15.3% nephrotoxicity) for the Amp/Sulb group (p=NS). CONCLUSION: Colistin and high-dose ampicillin/sulbactam were comparably safe and effective treatments for critically ill patients with MDR A. baumannii VAP.
Authors:
Alex P Betrosian; Frantzeska Frantzeskaki; Anna Xanthaki; Emmanuel E Douzinas
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2008-05-23
Journal Detail:
Title:  The Journal of infection     Volume:  56     ISSN:  1532-2742     ISO Abbreviation:  J. Infect.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-09     Completed Date:  2008-07-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7908424     Medline TA:  J Infect     Country:  England    
Other Details:
Languages:  eng     Pagination:  432-6     Citation Subset:  IM    
Affiliation:
3rd Department of Critical Care, Athens University, Evgenidion Hospital, Papadiamantopoulou 20, Athens, Greece. abetrosian@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Acinetobacter Infections / drug therapy*,  microbiology
Acinetobacter baumannii / drug effects*
Aged
Ampicillin / pharmacology,  therapeutic use
Anti-Bacterial Agents / pharmacology,  therapeutic use*
Colistin / pharmacology,  therapeutic use
Drug Resistance, Multiple, Bacterial
Female
Humans
Male
Middle Aged
Pneumonia, Bacterial / drug therapy*,  microbiology
Pneumonia, Ventilator-Associated / drug therapy*
Sulbactam / pharmacology,  therapeutic use
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 1066-17-7/Colistin; 68373-14-8/Sulbactam; 69-53-4/Ampicillin; 76497-13-7/sultamicillin

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