A comparison of ampicillin/sulbactam versus cefotaxime in the therapy of lower respiratory tract infections in hospitalized patients.

Fifty-three hospitalized patients suffering from lower respiratory tract infections were evaluated in a randomized, comparative trial studying the safety and efficacy of ampicillin/sulbactam (2 g ampicillin plus 1 g sulbactam intravenously every 6 h) versus cefotaxime (2 g intravenously every 6 h). Thirty-four of the 36 and 16 of the 17 patients treated with ampicillin/sulbactam and cefotaxime, respectively, were evaluable. Clinical and bacteriologic efficacy did not differ significantly between the two treatment groups (p = 0.828 and p = 0.648, respectively). Twenty-one (61.8%) of the ampicillin/sulbactam-treated patients were cured, eight (23.5%) improved and four (11.8%) were treatment failures. Nine (56.3%) of the cefotaxime treated patients were cured, four (25.0%) improved and two (12.5%) failed therapy. All primary pathogens were eradicated in 19 (55.9%) of the ampicillin/sulbactam group and were partially eradicated in seven (20.6%) patients. In the cefotaxime treatment group bacteriologic eradication occurred in 10 (62.5%) and partial eradication in two (12.5%) patients. Both study drugs were well tolerated, as the number of adverse reactions in each treatment group was small and similar between the two groups. Ampicillin/sulbactam appears to be as safe and effective as cefotaxime in the therapy of hospitalized patients with lower respiratory tract infections caused by beta-lactamase positive and beta-lactamase negative pathogens.

Ampicillin/sulbactam compared with cefotaxime in the treatment of lower respiratory tract infections of bacterial etiology.

This was a randomized, prospective, parallel study of the efficacy and safety of ampicillin/sulbactam (2 g/1 g) and cefotaxime (2 g), administered intravenously every 6 hours, in 53 hospitalized patients with lower respiratory tract infections. Thirty-four of the 36 patients treated with ampicillin/sulbactam and 16 of the 17 patients treated with cefotaxime were evaluable. Clinical and bacteriologic effectiveness did not differ significantly between the two groups (P = .828, P = .648, respectively). Of the ampicillin/sulbactam-treated patients, 21 (61.8%) were cured, 8 (23.5%) were improved, and 4 (11.8%) were treatment failures. In the cefotaxime group, 9 patients (56.3%) were cured, 4 (25%) were improved, and 2 (12.5%) were treatment failures. All primary pathogens were eradicated in 19 (55.9%) ampicillin/sulbactam-treated patients and partially eradicated in 7 (20.6%); in cefotaxime-treated patients, all primary pathogens were eradicated in 10 (62.5%) patients and partially eradicated in 2 (12.5%). Both study drugs were well tolerated, with the overall incidence of adverse events similarly low in the two groups.

Cefepime as treatment for osteomyelitis and other severe bacterial infections.

Cefepime, a novel, injectable alpha-methoxyimino aminothiazolyl cephalosporin, is active in vitro against many of the Gram-positive and Gram-negative bacteria which cause severe infections, including Pseudomonas aeruginosa. It is more active than existing third-generation cephalosporins against multiply-resistant strains of Enterobacteriaceae because of its low affinity for beta-lactamases and its resistance to hydrolysis by these enzymes. Cefepime retains its high potency of activity against methicillin-susceptible Staphylococcus aureus, coagulase-negative staphylococci and streptococci other than enterococci. Seventy-four patients (46 male and 28 female) were treated with cefepime 2 g i.v. every 12 h; 61 patients were evaluable for efficacy (39 male and 22 female). The infections included pneumonia caused by Gram-negative bacilli (21 patients, six with bacteraemia), septicaemia (seven), pyelonephritis (two), osteomyelitis (23, mainly caused by S. aureus), septic arthritis (four) and soft tissue infections (four, one with bacteraemia). Responses were as follows: 52 (85.3%) patients cured; three (4.9%) improved and six (9.8%) failed. The failures included three patients with osteomyelitis, one with pyelonephritis and two with pneumonia. The pathogens and eradication rates were: S. aureus 23/24 (96%), Staphylococcus epidermidis 4/4, Streptococcus spp. 10/10 (100%), P. aeruginosa 11/14 (79%), Enterobacteriaceae 28/28 (100%), Haemophilus spp. 3/3 and others 7/7. Clinical adverse effects included diarrhoea in 11 patients (14.9%) nausea in five (6.8%) and pruritus in three (4.1%). Laboratory abnormalities included leucopenia in three patients (4.1%) and direct Coombs' conversion in 32 (43.2%). Patients were treated for an average of 31.8 days for osteomyelitis and 11.9 days for other infections.(ABSTRACT TRUNCATED AT 250 WORDS)