Treatment Of Community-acquired Bacterial Pneumonia Research Articles

Ceftaroline: A New Cephalosporin with Activity Against Resistant Gram‐Positive Pathogens

Ceftaroline is a novel, broad-spectrum, advanced-generation cephalosporin whose action is mediated by binding to penicillin-binding proteins in bacteria, consistent with other beta-lactam antibiotics. Ceftaroline is distinct in that it has antimicrobial activity against multidrug-resistant Staphylococcus aureus (including methicillin-resistant S. aureus, vancomycin-intermediate S. aureus [VISA], heteroresistant VISA, and vancomycin-resistant S. aureus), Streptococcus pneumonia (including drug-resistant strains), and respiratory gram-negative pathogens such as Moraxella catarrhalis and Haemophilus influenzae (including beta-lactamase-positive strains). Development of resistance to ceftaroline occurs rarely in gram-positive bacteria and at a similar rate to that of other oxyimino-cephalosporins in gram-negative bacteria. The inactive prodrug, ceftaroline fosamil, is administered by intravenous infusion and rapidly undergoes biotransformation to ceftaroline. Ceftaroline then follows a two-compartment pharmacokinetic model and is eliminated primarily by renal excretion, with a half-life of approximately 3 hours. Similar to other cephalosporins, time above the minimum inhibitory concentration is the pharmacodynamic parameter that best predicts efficacy for ceftaroline. Ceftaroline 600 mg intravenously every 12 hours has been shown to have similar efficacy to vancomycin plus aztreonam for the treatment of complicated skin and skin structure infections and to ceftriaxone for the treatment of community-acquired bacterial pneumonia in phase III clinical trials. Ceftaroline displayed a safety profile similar to that of other cephalosporins in clinical trials. Dosage adjustment is required for moderate renal impairment and for patients receiving hemodialysis. Ceftaroline breakpoints have been proposed but not confirmed. Ceftaroline is a renally excreted broad-spectrum cephalosporin that is clinically effective for the treatment of complicated skin and skin structure infections and community-acquired bacterial pneumonia, and it has distinctive activity against some difficult-to-treat multidrug-resistant gram-positive organisms.

Clinical experience in Germany of treating community-acquired respiratory infections with the new 8-methoxyfluoroquinolone, moxifloxacin.

Moxifloxacin, a new 8-methoxyfluoroquinolone, was evaluated in a large community-based study involving 16,007 patients over a 9-month period. This study was designed as a large post-marketing observational study of the speed, efficacy and tolerability of moxifloxacin when used in clinical practice for the treatment of community-acquired bacterial pneumonia, or acute exacerbations of chronic bronchitis. Physicians and patients were specifically questioned about overall efficacy and safety as well as symptom relief. According to physicians' assessments 96.3% of patients were cured or improved after moxifloxacin treatment. Symptom relief ('feeling better') occurred in almost 70% of patients by day 3 and only 2.3% reported an adverse drug reaction. No individual adverse drug reaction was reported at a frequency above 1%. Among the 209 events considered as serious, only 34 were regarded as possibly or probably related to therapy. There were no moxifloxacin-related clinically relevant cases of phototoxicity, hepatotoxicity or cardiotoxicity. Overall, 92.1% of patients considered moxifloxacin to have been beneficial.

Trovafloxacin vs High Dose Amoxicillin in the Treatment of Community-Acquired Bacterial Pneumonia

Trovafloxacin vs High Dose Amoxicillin in the Treatment of Community-Acquired Bacterial Pneumonia

Trovafloxacin versus High-Dose Amoxicillin (1 g Three Times Daily) in the Treatment of Community-Acquired Bacterial Pneumonia

Trovafloxacin versus High-Dose Amoxicillin (1 g Three Times Daily) in the Treatment of Community-Acquired Bacterial Pneumonia

A comparative study of dirithromycin and erythromycin in bacterial pneumonia

Dirithromycin, a new once-daily macrolide, was studied in a multicentre, randomised, double-blind trial in community-acquired bacterial pneumonia. A total of 591 patients received either a single daily dose of dirithromycin, 500 mg, or erythromycin, 250 mg, four times daily. Clinical response rates were similar in both treatment groups (127 dirithromycin-treated and 118 erythromycin-treated patients): at the time of the final consultation, the clinical and bacteriological response rates for dirithromycin-treated patients were 94.5% and 93.0%, while for erythromycin-treated patients, they were 92.1% and 90.3%, respectively. The nature and frequency of treatment-emergent events were comparable. We conclude that dirithromycin, 500 mg, once daily, is safe and effective in the treatment of community-acquired bacterial pneumonia. The once daily dose is likely to improve compliance, making it preferable to erythromycin.

Ceforanide (BL-S 786) in the treatment of community-acquired bacterial pneumonia

Ceforanide (BL-S 786) is a new long-acting parenteral cephalosporin which has the major pharmacologic advantage of requiring only twice a day dosage. We treated 28 adult patients with community-acquired bacterial pneumonia using doses of 500 or 1000 mg every 12 hours. Twenty-four of 28 infections were due toStreptococcus pneumoniae and/orHemophilus influenzae, and all pathogens were susceptible in vitro to both cephalothin and ceforanide. Patients were treated for a mean of 7.5 days, and all showed a good clinical and radiographic response with no mortality. Of the 13 patients withH. influenzae, the organism could still be recovered during therapy in 9/12 and post therapy in 3/8. One clinical superinfection (sepsis due toPseudomonas aeruginosa) occurred during therapy. Side effects with therapy included thrombocytosis (15), asymptomatic eosinophilia (5), and mild elevation of the serum transaminases (3). These studies suggest that ceforanide is a safe and effective agent for the treatment of adult patients with bacterial pneumonia due toS. pneumoniae; further experience in therapy ofH. influenzae is needed because of frequent failure of ceforanide to eradicate this organism from the sputum.