Skip to main content
Erschienen in: Critical Care 1/2006

01.02.2006 | Commentary

Choosing the right combination therapy in severe community-acquired pneumonia

verfasst von: Grant W Waterer, Jordi Rello

Erschienen in: Critical Care | Ausgabe 1/2006

Einloggen, um Zugang zu erhalten

Abstract

Recent studies have suggested that combination antibiotic therapy is preferable to monotherapy for severe community-acquired pneumonia (CAP). In this issue Mortensen and colleagues present retrospective data suggesting that combination therapy with a cephalosporin and a fluoroquinolone is inferior to combination therapy with a cephalosporin and a macrolide. Several mechanisms exist by which quinolones could be inferior to macrolides in combination therapy, so if these findings are confirmed by other groups they have significant implications for physicians treating patients with severe CAP.
Literatur
1.
Zurück zum Zitat Mufson MA, Stanek RJ: Bacteremic pneumococcal pneumonia in one American City: a 20-year longitudinal study, 1978–1997. Am J Med 1999, 107: 34S-43S. 10.1016/S0002-9343(99)00098-4CrossRefPubMed Mufson MA, Stanek RJ: Bacteremic pneumococcal pneumonia in one American City: a 20-year longitudinal study, 1978–1997. Am J Med 1999, 107: 34S-43S. 10.1016/S0002-9343(99)00098-4CrossRefPubMed
2.
Zurück zum Zitat Waterer GW, Somes GW, Wunderink RG: Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med 2001, 161: 1837-1842. 10.1001/archinte.161.15.1837CrossRefPubMed Waterer GW, Somes GW, Wunderink RG: Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med 2001, 161: 1837-1842. 10.1001/archinte.161.15.1837CrossRefPubMed
3.
Zurück zum Zitat Martinez JA, Horcajada JP, Almela M, Marco F, Soriano A, Garcia E, Marco MA, Torres A, Mensa J: Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2003, 36: 389-395. 10.1086/367541CrossRefPubMed Martinez JA, Horcajada JP, Almela M, Marco F, Soriano A, Garcia E, Marco MA, Torres A, Mensa J: Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2003, 36: 389-395. 10.1086/367541CrossRefPubMed
4.
Zurück zum Zitat Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, Morris AJ, Luna CM, Snydman DR, Ko WC, et al.: Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 2004, 170: 440-444. 10.1164/rccm.200311-1578OCCrossRefPubMed Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, Morris AJ, Luna CM, Snydman DR, Ko WC, et al.: Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 2004, 170: 440-444. 10.1164/rccm.200311-1578OCCrossRefPubMed
5.
Zurück zum Zitat Weiss K, Low DE, Cortes L, Beaupre A, Gauthier R, Gregoire P, Legare M, Nepveu F, Thibert D, Tremblay C, et al.: Clinical characteristics at initial presentation and impact of dual therapy on the outcome of bacteremic Streptococcus pneumoniae pneumonia in adults. Can Respir J 2004, 11: 589-593.PubMed Weiss K, Low DE, Cortes L, Beaupre A, Gauthier R, Gregoire P, Legare M, Nepveu F, Thibert D, Tremblay C, et al.: Clinical characteristics at initial presentation and impact of dual therapy on the outcome of bacteremic Streptococcus pneumoniae pneumonia in adults. Can Respir J 2004, 11: 589-593.PubMed
6.
Zurück zum Zitat Dudas V, Hopefl A, Jacobs R, Guglielmo BJ: Antimicrobial selection for hospitalized patients with presumed community-acquired pneumonia: a survey of nonteaching US community hospitals. Ann Pharmacother 2000, 34: 446-452. 10.1345/aph.19174CrossRefPubMed Dudas V, Hopefl A, Jacobs R, Guglielmo BJ: Antimicrobial selection for hospitalized patients with presumed community-acquired pneumonia: a survey of nonteaching US community hospitals. Ann Pharmacother 2000, 34: 446-452. 10.1345/aph.19174CrossRefPubMed
7.
Zurück zum Zitat Brown RB, Iannini P, Gross P, Kunkel M: Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest 2003, 123: 1503-1511. 10.1378/chest.123.5.1503CrossRefPubMed Brown RB, Iannini P, Gross P, Kunkel M: Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest 2003, 123: 1503-1511. 10.1378/chest.123.5.1503CrossRefPubMed
8.
Zurück zum Zitat Houck PM, MacLehose RF, Niederman MS, Lowery JK: Empiric antibiotic therapy and mortality among medicare pneumonia inpatients in 10 western states: 1995, and 1997. Chest 2001, 119: 1420-1426. 10.1378/chest.119.5.1420CrossRefPubMed Houck PM, MacLehose RF, Niederman MS, Lowery JK: Empiric antibiotic therapy and mortality among medicare pneumonia inpatients in 10 western states: 1995, and 1997. Chest 2001, 119: 1420-1426. 10.1378/chest.119.5.1420CrossRefPubMed
9.
Zurück zum Zitat Garcia Vazquez E, Mensa J, Martinez JA, Marcos MA, Puig J, Ortega M, Torres A: Lower mortality among patients with community-acquired pneumonia treated with a macrolide plus a beta-lactam agent versus a beta-lactam agent alone. Eur J Clin Microbiol Infect Dis 2005, 24: 190-195. 10.1007/s10096-005-1295-9CrossRefPubMed Garcia Vazquez E, Mensa J, Martinez JA, Marcos MA, Puig J, Ortega M, Torres A: Lower mortality among patients with community-acquired pneumonia treated with a macrolide plus a beta-lactam agent versus a beta-lactam agent alone. Eur J Clin Microbiol Infect Dis 2005, 24: 190-195. 10.1007/s10096-005-1295-9CrossRefPubMed
10.
Zurück zum Zitat Mortensen EM, Restrepo MI, Anzueto A, Pugh J: The impact of empiric antimicrobial therapy with a β-lactam and fluoroquinolone on mortality for patients hospitalized with severe pneumonia. Crit Care 2006, 10: R8. 10.1186/cc3934PubMedCentralCrossRef Mortensen EM, Restrepo MI, Anzueto A, Pugh J: The impact of empiric antimicrobial therapy with a β-lactam and fluoroquinolone on mortality for patients hospitalized with severe pneumonia. Crit Care 2006, 10: R8. 10.1186/cc3934PubMedCentralCrossRef
11.
Zurück zum Zitat Lagrou K, Peetermans WE, Jorissen M, Verhaegen J, Van Damme J, Van Eldere J: Subinhibitory concentrations of erythromycin reduce pneumococcal adherence to respiratory epithelial cells in vitro. J Antimicrob Chemother 2000, 46: 717-723. 10.1093/jac/46.5.717CrossRefPubMed Lagrou K, Peetermans WE, Jorissen M, Verhaegen J, Van Damme J, Van Eldere J: Subinhibitory concentrations of erythromycin reduce pneumococcal adherence to respiratory epithelial cells in vitro. J Antimicrob Chemother 2000, 46: 717-723. 10.1093/jac/46.5.717CrossRefPubMed
12.
Zurück zum Zitat Parnham MJ: Immunomodulatory effects of antimicrobials in the therapy of respiratory tract infections. Curr Opin Infect Dis 2005, 18: 125-131. 10.1097/01.qco.0000160901.71813.feCrossRefPubMed Parnham MJ: Immunomodulatory effects of antimicrobials in the therapy of respiratory tract infections. Curr Opin Infect Dis 2005, 18: 125-131. 10.1097/01.qco.0000160901.71813.feCrossRefPubMed
13.
Zurück zum Zitat Sabria M, Pedro-Botet ML, Gomez J, Roig J, Vilaseca B, Sopena N, Banos V: Fluoroquinolones vs macrolides in the treatment of Legionnaires disease. Chest 2005, 128: 1401-1405. 10.1378/chest.128.3.1401CrossRefPubMed Sabria M, Pedro-Botet ML, Gomez J, Roig J, Vilaseca B, Sopena N, Banos V: Fluoroquinolones vs macrolides in the treatment of Legionnaires disease. Chest 2005, 128: 1401-1405. 10.1378/chest.128.3.1401CrossRefPubMed
14.
Zurück zum Zitat Williams AC, Galley HF, Watt AM, Webster NR: Differential effects of three antibiotics on T helper cell cytokine expression. J Antimicrob Chemother 2005, 56: 502-506. 10.1093/jac/dki251CrossRefPubMed Williams AC, Galley HF, Watt AM, Webster NR: Differential effects of three antibiotics on T helper cell cytokine expression. J Antimicrob Chemother 2005, 56: 502-506. 10.1093/jac/dki251CrossRefPubMed
15.
Zurück zum Zitat Culic O, Erakovic V, Cepelak I, Barisic K, Brajsa K, Ferencic Z, Galovic R, Glojnaric I, Manojlovic Z, Munic V, et al.: Azithromycin modulates neutrophil function and circulating inflammatory mediators in healthy human subjects. Eur J Pharmacol 2002, 450: 277-289. 10.1016/S0014-2999(02)02042-3CrossRefPubMed Culic O, Erakovic V, Cepelak I, Barisic K, Brajsa K, Ferencic Z, Galovic R, Glojnaric I, Manojlovic Z, Munic V, et al.: Azithromycin modulates neutrophil function and circulating inflammatory mediators in healthy human subjects. Eur J Pharmacol 2002, 450: 277-289. 10.1016/S0014-2999(02)02042-3CrossRefPubMed
16.
Zurück zum Zitat Shinkay M, Park CS, Rubin BK: Immunomodulatory effects of macrolide antibiotics. Clin Pulm Med 2005, 12: 341-348. 10.1097/01.cpm.0000187294.53696.c0CrossRef Shinkay M, Park CS, Rubin BK: Immunomodulatory effects of macrolide antibiotics. Clin Pulm Med 2005, 12: 341-348. 10.1097/01.cpm.0000187294.53696.c0CrossRef
17.
Zurück zum Zitat Dalhoff A, Shalit I: Immunomodulatory effects of quinolones. Lancet Infect Dis 2003, 3: 359-371. 10.1016/S1473-3099(03)00658-3CrossRefPubMed Dalhoff A, Shalit I: Immunomodulatory effects of quinolones. Lancet Infect Dis 2003, 3: 359-371. 10.1016/S1473-3099(03)00658-3CrossRefPubMed
18.
Zurück zum Zitat Rello J, Diaz E, Bodi M, Catalan M, Alvarez B: Associations between empirical antimicrobial therapy at the hospital and mortality in patients with severe community-acquired pneumonia. Intensive Care Med 2003, 28: 1030-1035.CrossRef Rello J, Diaz E, Bodi M, Catalan M, Alvarez B: Associations between empirical antimicrobial therapy at the hospital and mortality in patients with severe community-acquired pneumonia. Intensive Care Med 2003, 28: 1030-1035.CrossRef
19.
Zurück zum Zitat Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ: Associations between initial antimicrobial therapy and medical outcomes for hospitalized patients with pneumonia. Arch Intern Med 1999, 159: 2562-2572. 10.1001/archinte.159.21.2562CrossRefPubMed Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ: Associations between initial antimicrobial therapy and medical outcomes for hospitalized patients with pneumonia. Arch Intern Med 1999, 159: 2562-2572. 10.1001/archinte.159.21.2562CrossRefPubMed
20.
Zurück zum Zitat Bodi M, Rodriguez A, Sole-Violan J, Gilavert MC, Garnacho J, Blanquer J, Jimenez J, de la Torre MV, Sirvent JM, Almirall J, et al.: Antibiotic prescribing for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America Guidelines on survival. Clin Infect Dis 2005, 41: 1709-1716. 10.1086/498119CrossRefPubMed Bodi M, Rodriguez A, Sole-Violan J, Gilavert MC, Garnacho J, Blanquer J, Jimenez J, de la Torre MV, Sirvent JM, Almirall J, et al.: Antibiotic prescribing for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America Guidelines on survival. Clin Infect Dis 2005, 41: 1709-1716. 10.1086/498119CrossRefPubMed
Metadaten
Titel
Choosing the right combination therapy in severe community-acquired pneumonia
verfasst von
Grant W Waterer
Jordi Rello
Publikationsdatum
01.02.2006
Verlag
BioMed Central
Erschienen in
Critical Care / Ausgabe 1/2006
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3976

Weitere Artikel der Ausgabe 1/2006

Critical Care 1/2006 Zur Ausgabe

Eingreifen von Umstehenden rettet vor Erstickungstod!

15.05.2024 Fremdkörperaspiration Nachrichten

Wer sich an einem Essensrest verschluckt und um Luft ringt, benötigt vor allem rasche Hilfe. Dass Umstehende nur in jedem zweiten Erstickungsnotfall bereit waren, diese zu leisten, ist das ernüchternde Ergebnis einer Beobachtungsstudie aus Japan. Doch es gibt auch eine gute Nachricht.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Häufigste Gründe für Brustschmerzen bei Kindern

06.05.2024 Pädiatrische Diagnostik Nachrichten

Akute Brustschmerzen sind ein Alarmsymptom par exellence, schließlich sind manche Auslöser lebensbedrohlich. Auch Kinder klagen oft über Schmerzen in der Brust. Ein Studienteam ist den Ursachen nachgegangen.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.