Interim Study: Comparison Of Safety And Efficacy of Levofloxacin Plus Colistin Regimen With Levofloxacin Plus High Dose Ampicillin/Sulbactam Infusion In Treatment of Ventilator-Associated Pneumonia Due To Multi Drug Resistant Acinetobacter
Open Access
- 1 September 2018
- journal article
- research article
- Vol. 17 (Suppl2), 206-213
Abstract
Due to the emerging antibiotic resistance of Acinetobacter, which is the leading cause of ventilator-associated pneumonia (VAP) in critically ill patients, there is an urgent need for studies comparing various antibiotic regimens for its treatment. In this single blinded randomized clinical trial, adult patients with VAP due to multi dnig resistant Acinctobacter (MDRA), were randomly assigned to receive 9x10(9) unit loading dose of colistin followed by 4.5x10(9) unit intravenously twice daily plus 750 mg intravenous levofloxacin daily or continuous infusion of ampicillin/sulbactam, 24g daily plus 750mg IV levofloxacin daily. Dose and dosing interval were adjusted according to serum creatinine levels during the study. Clinical and microbiological cure, inflammatory biomarkers, and possible adverse effects were recorded in participants. Twenty-nine patients were recruited (14 in colistin and 15 in ampicillin/sulbactam groups). Three patients were excluded in each group. Clinical response occurred in 3 (27%) and 10 (83%) in colistin and ampicillin-sulbactam arms, respectively (P = 0.007). Nephrotoxicity happened in 6 (54%) and 1 (8%) of cases in colistin and ampicillin-sulbactam groups, (P = 0.016). 14-day and 28-day survival rate were significantly higher in ampicillin-sulbactam group compared to colistin ann with P values of 0.002 and 0.049, respectively. This study revealed that levofloxacin plus high dose ampicillin/sulbactam as continuous infusion is more effective than levofloxacin plus colistin in patients with MDR Acinetobacter VAP with significantly lower risk of nephrotoxicity.Keywords
This publication has 20 references indexed in Scilit:
- Ventilator associated pneumonia caused by extensive-drug resistant Acinetobacter species: Colistin is the remaining choiceEgyptian Journal of Anaesthesia, 2016
- Synergistic effects of sulbactam in multi-drug-resistant Acinetobacter baumanniiBrazilian Journal of Microbiology, 2015
- Colistin-associated Acute Kidney Injury in Severely Ill Patients: A Step Toward a Better Renal Care? A Prospective Cohort StudyClinical Infectious Diseases, 2015
- Acute Phase Reactants in Infections: Evidence-Based Review and a Guide for CliniciansOpen Forum Infectious Diseases, 2015
- Acinetobacter baumannii ventilator-associated pneumonia: epidemiology, clinical characteristics, and prognosis factorsInternational Journal of Infectious Diseases, 2013
- Clinical Outcomes With Extended or Continuous Versus Short-term Intravenous Infusion of Carbapenems and Piperacillin/Tazobactam: A Systematic Review and Meta-analysisClinical Infectious Diseases, 2012
- Continuous Infusion of Beta-Lactam Antibiotics in Severe Sepsis: A Multicenter Double-Blind, Randomized Controlled TrialClinical Infectious Diseases, 2012
- High Prevalence of Multidrug-Resistant Nonfermenters in Hospital-acquired Pneumonia in AsiaAmerican Journal of Respiratory and Critical Care Medicine, 2011
- Multi-drug resistant Acinetobacter ventilator-associated pneumoniaLung India, 2010
- Efficacy and safety of high-dose ampicillin/sulbactam vs. colistin as monotherapy for the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumoniaJournal of Infection, 2008