Skip to main content
SpringerLink
Log in

Systemic antimicrobial therapy of nosocomial pneumonia: Monotherapy versus combination therapy

  • Current Topic: Review
  • Published:
European Journal of Clinical Microbiology and Infectious Diseases Aims and scope Submit manuscript

Abstract

The treatment of nosocomial pneumonia is difficult because of the absence of a precise microbial etiology in a sizable fraction of cases and the severity of predisposing conditions in patients who develop these infections.Staphylococcus aureus and aerobic gram-negative rods continue to be the most common isolates in these infections. Therapy of nosocomial pneumonia is often empiric, with initial antimicrobial therapy based upon local experience and sensitivity patterns, immune competence of the patient and disease severity. Combination therapy with an aminoglycoside and a beta-lactam has long been the cornerstone of therapy, and clinical success has been correlated with peak serum bactericidal levels of 1:8 in non-granulocytopenic patients and peak gentamicin and tobramycin levels > 8 µg/ml. The introduction of new broad-spectrum antibiotics, such as monobactams, third-generation cephalosporins and imipenem, has introduced the possibility of monotherapy for the treatment of nosocomial pneumonia. In general, monotherapy has proven to be a useful alternative to combination therapy, with success rates ranging from 77 to 96%. Development of resistance during therapy, particularly byPseudomonas, Enterobacter andSerratia spp., remains an unresolved problem.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Toews, G. B. Southwestern Internal Medicine Conference: nosocomial pneumonia. American Journal of Medical Sciences 1986, 291: 355–367.

    Google Scholar 

  2. Levison, M. E., Kaye, F. Pneumonia caused by gram-negative bacilli: an overview. Reviews of Infectious Diseases 1985, 7: 656–665.

    PubMed  Google Scholar 

  3. Klastersky, J., Meunier-Carpentier, F., Prevost, J. Significance of antimicrobial synergism for the outcome of gram-negative sepsis. American Journal of Medical Sciences 1977, 273: 157–167.

    Google Scholar 

  4. Young, L. S. Reviews of clinical significance of synergy in gram-negative infections at the University of California Los Angeles Hospital. Infection 1978, 6, Supplement: 47–52.

    Article  Google Scholar 

  5. Young, L. S. Combination or single drug therapy for gram-negative sepsis. In: Remington, J. S., Swarz, M. N. (ed.): Current clinical topics in infectious diseases. McGraw Hill, New York, 1982, p. 177–205.

    Google Scholar 

  6. Sculier, J. P., Klastersky, J. Significance of serum bactericidal activity in gram-negative bacillary bacteremia in patients with and without granulocytopenia. In: Brown, A. E., Armstrong, D. (ed.): Infectious complications of neoplastic disease. Yorke, New York, 1985, p. 35–48.

    Google Scholar 

  7. Reller, L. B., Stratton, C. W. Serum dilution test for bactericidal activity. II: Standardization and correlation with antimicrobial assays and susceptibility tests. Journal of Infectious Diseases 1977, 136: 196–204.

    PubMed  Google Scholar 

  8. Winstein, M. P., Stratton, C. W., Ackley, A. Multicenter collaborative evaluation of a standardized bactericidal test as a prognostic indicator in infective endocarditis. American Journal of Medicine 1985, 87: 262–269.

    Article  Google Scholar 

  9. Bergogne-Berezin, E. Pharmacokinetics of antibiotics in respiratory secretions. In: Pennington, J. E. (ed.): Respiratory infections: diagnosis and management. Raven Press, New York, 1983, p. 461–479.

    Google Scholar 

  10. Pennington, J. E. Penetration of antibiotics into respiratory secretions. Reviews of Infectious Diseases 1981, 3: 67–73.

    PubMed  Google Scholar 

  11. Klastersky, J., Thys, J. P., Mombelli, G. Comparative studies of intermittent and continuous administration of aminoglycosides in the treatment of bronchopulmonary infections due to gram-negative bacteria. Reviews of Infectious Diseases 1981, 3: 74–83.

    PubMed  Google Scholar 

  12. Moore, R., Smith, C. R., Lietman, P. S. Association of aminoglycoside plasma levels with therapeutic outcome in gram-negative pneumonia. American Journal of Medicine 1984, 77: 657–662.

    Article  PubMed  Google Scholar 

  13. Cipolle, R. J., Seifert, R. D., Zaske, D. E., Strate, R. G. Hospital-acquired gram-negative pneumonias: response rate and dosage requirements with individualized tobramycin therapy. Therapeutic Drug Monitoring 1980, 2: 359–363.

    PubMed  Google Scholar 

  14. Young, L. S., Hewitt, W. L. Activity of five aminoglycoside antibiotics in vitro against gram-negative bacilli andStaphylococcus aureus. Antimicrobial Agents and Chemotherapy 1973, 4: 617–625.

    PubMed  Google Scholar 

  15. Bodem, C. R., Lampton, L. M., Miller, D. P., Tarka, E. F., Everett, E. D. Endobronchial pH: relevance to aminoglycoside activity in gram-negative bacillary pneumonia. American Review of Respiratory Disease 1983, 127: 39–41.

    PubMed  Google Scholar 

  16. Young, L. S. Treatment of respiratory infections in the patient at risk. American Journal of Medicine 1984, 76, Supplement 5A: 61–68.

    Article  Google Scholar 

  17. Fass, F. J. Efficacy and safety of oral ciprofloxacin in the treatment of serious respiratory infections. American Journal of Medicine 1987, 82, Supplement 6A: 202–207.

    Article  Google Scholar 

  18. Goldfarb, J., Stern, R. C., Reed, M. D., Yamashita, T. S., Myers, C. M., Blumer, J. L. Ciprofloxacin monotherapy for acute pulmonary exacerbations of cyctic fibrosis. American Journal of Medicine 1987, 82, Supplement 4A: 174–179.

    PubMed  Google Scholar 

  19. Goldfarb, J., Stern, R. C., Reed, M. D., Yamashita, T. S., Myers, C. M., Blumer, J. M. Ciprofloxacin monotherapy for acute pulmonary exacerbations of cyctic fibrosis. American Journal of Medicine 1987, 82, Supplement 4A: 174–179.

    PubMed  Google Scholar 

  20. Scully, B. E., Nakatomi, M., Ores, C., Davidson, S., Neu, H. C. Ciprofloxacin therapy in cystic fibrosis. American Journal of Medicine 1987, 82, Supplement 4A: 196–201.

    PubMed  Google Scholar 

  21. Salata, R. A., Gebhart, R. L., Palmer, D. L., Wade, B. H., Scheld, W. M., Groschel, D. H. M., Wenzel, R. P., Mandell, G. L., Duma, R. J. Pneumonia treated with imipenem/cilastin. American Journal of Medicine 1985, 78, Supplement 6A: 104–109.

    Article  PubMed  Google Scholar 

  22. Scentag, J. J., Vari, A. J., Winslade, N. E., Swanson, D. J., Smith, I. L., Simons, G. W., Vigano, A. Treatment with aztreonam or tobramycin in critical care patients with nosocomial gram-negative rod pneumonia. American Journal of Medicine 1985, 78: 3441.

    Google Scholar 

  23. Mangi, R. J., Greco, T., Ryan, J., Thornton, G., Andriole, V. T. Cefoperazone versus combination antibiotic therapy of hospital-acquired pneumonia. American Journal of Medicine 1988, 84: 68–74.

    Article  PubMed  Google Scholar 

  24. Mangi, R. J., Ryan, J., Berenson, C., Greco, C., Simms, M., Thornton, G., Andriole, V. T. Cefoperazone versus ceftazidime monotherapy of nosocomial pneumonia. American Journal of Medicine 1988, 85, Supplement 1A: 44–48.

    Article  Google Scholar 

  25. Rapp, R. P., Young, B., Foster, T. S., Tibbs, P. A., O'Neal, W. Ceftazidime versus tobramycin/ticarcillin in treating hospital acquired pneumonia and bacteremia. Pharmacotherapy 1984, 4: 211–215.

    PubMed  Google Scholar 

  26. Mandel, L. A., Nicolle, L. E., Ronald, A. R. A multicenter prospective randomized trial comparing ceftazidime with cefazolin/tobramycin in the treatment of hospitalized patients with non-pneumococcal pneumonia. Journal of Antimicrobial Chemotherapy 1983, 12, Supplement A: 9–20.

    Google Scholar 

  27. Francioli, P., Clement, M., Geroulanos, S. Ceftazidime in severe infections: a Swiss multicentre study. Journal of Antimicrobial Chemotherapy 1983, 12, Supplement A: 139–146.

    PubMed  Google Scholar 

  28. Schwigon, C. D., Hulla, F. W., Schulze, B., Maslak, A. Timentin in the treatment of nosocomial bronchopulmonary infections in intensive care units. Journal of Antimicrobial Chemotherapy 1986, 17: 115–122.

    Google Scholar 

  29. Schentag, J. J., Reitberg, D. P., Cumbo, T. J. Cefmenoxime efficacy, safety, and pharmacokinetics in critical care patients with nosocomial pneumonia. American Journal of Medicine 1984, 77: 34–42.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Genesee Hospital, 224 Alexander Street

    F. M. LaForce

  2. University of Rochester School of Medicine and Dentistry, 14607, Rochester, New York, USA

    F. M. LaForce

Authors
  1. F. M. LaForce
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

LaForce, F.M. Systemic antimicrobial therapy of nosocomial pneumonia: Monotherapy versus combination therapy. Eur. J. Clin. Microbiol. Infect. Dis. 8, 61–68 (1989). https://doi.org/10.1007/BF01964122

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01964122

Keywords

Search

Navigation