Skip to main content

Advertisement

SpringerLink
Log in

Role of beta-lactam agents in the treatment of community-acquired pneumonia

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

Abstract

Community-acquired pneumonia (CAP) is a common illness associated with high rates of morbidity and mortality worldwide. The β-lactam antibacterial agents have been the mainstay of therapy for CAP for over four decades and remain as first-line therapy. However, the impact of the substantial prevalence of resistance seen among the common respiratory pathogens, particularly penicillin and macrolide resistance among Streptococcus pneumoniae, is now an area for concern. CAP treatment guidelines often recommend the use of a macrolide or fluoroquinolone in conjunction with, or as an alternative to, β-lactam agents, but whether this is necessary is uncertain. This review outlines the historical use of β-lactam antibacterial agents in the treatment of CAP along with their ongoing therapeutic utility.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. World Health Organization (1999) WHO infectious disease report. http://www.who.int/infectious-diseases-report/index.htm. Cited 1 March 2004

  2. Meyer RD, Finch RG (1992) Community-acquired pneumonia. J Hosp Infect 22(Suppl A):51–59

    Google Scholar 

  3. Bartlett JG, Mundy LM (1995) Community-acquired pneumonia. N Engl J Med 333:1618–1624

    Article  Google Scholar 

  4. Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, Dean N, File T, Fine MJ, Gross PA, Martinez F, Marrie TJ, Plouffe JF, Ramirez J, Sarosi GA, Torres A, Wilson R, Yu VL (2001) American Thoracic Society guidelines for the management of adults with community-acquired pneumonia. Am J Respir Crit Care Med 163:1730–1754

    CAS  PubMed  Google Scholar 

  5. Medicare and Medicaid statistical supplement (1997) Health Care Fin Rev 18(Suppl):73

    Google Scholar 

  6. Gil A, San-Martín M, Carrasco P, Gónzalez A (2002) Epidemiology of pneumonia hospitalizations in Spain, 1995–1998. J Infect 44:84–87

    Article  Google Scholar 

  7. Fang G-D, Fine MJ, Orloff J, Arisumi D, Yu VL, Kapoor W, Grayston JT, Wang SP, Kohler R, Muder RR, Yee YC, Rihs JD, Vickers RM (1990) New and emerging etiologies for community-acquired pneumonia with implications for therapy. Medicine (Baltimore) 69:307–316

    Google Scholar 

  8. Fass RJ (1993) Aetiology and treatment of community-acquired pneumonia in adults: an historical perspective. J Antimicrob Chemother 32(Suppl A):17–27

    Google Scholar 

  9. File TMJ (2003) Community-acquired pneumonia. Lancet 362:1991–2001

    Article  PubMed  Google Scholar 

  10. Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, Kapoor WN (1996) Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA 275:134–141

    Google Scholar 

  11. Garau J (2002) Treatment of drug-resistant pneumococcal pneumonia. Lancet Infect Dis 2:404–415

    Article  Google Scholar 

  12. Garau J (2001) Clinical failures: the tip of the iceberg? Respir Med 95(Suppl A):S5–S11

    Article  Google Scholar 

  13. File TM Jr, Segreti J, Dunbar L, Player R, Kohler R, Williams RR, Kojak C, Rubin A (1997) A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia. Antimicrob Agents Chemother 41:1965–1972

    CAS  PubMed  Google Scholar 

  14. Forgarty C, Grossman C, Williams J, Haverstock D, Church D (1999) Efficacy and safety of moxifloxacin vs clarithromycin for community-acquired pneumonia. Infect Med 16:748–763

    Google Scholar 

  15. Ramirez J, Nguyen TH, Tellier G, Coppola G, Bettis R, Dolmann A, St Pierre C, Mayer H (1999) Once-daily 400 mg oral gatifloxacin (GAT) vs twice-daily 500 mg oral clarithromycin (CLA) in the treatment of community-acquired pneumonia. In: Program and abstracts of the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy. Abstract no. 2242

  16. File TM Jr, Schlemmer B, Garau J, Cupo M, Young C, and the 049 Clinical Study Group (2001) Efficacy and safety of gemifloxacin in the treatment of community-acquired pneumonia: a randomized, double-blind comparison with trovafloxacin. J Antimicrob Chemother 48:67–74

    Article  Google Scholar 

  17. Jacobs MR, Felmingham D, Appelbaum PC, Grüneberg RN (2003) The Alexander Project 1998–2000: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. J Antimicrob Chemother 52:229–246

    Article  Google Scholar 

  18. Yu VL, Vergis EN (1998) New macrolides or new quinolones as monotherapy for patients with community-acquired pneumonia. Our cup runneth over? Chest 113:1158–1159

    Google Scholar 

  19. Zhanel GG, Ennis K, Vercaigne L, Walkty A, Gin AS, Embil J, Smith H, Hoban DJ (2002) A critical review of the fluoroquinolones. Drugs 62:13–59

    Google Scholar 

  20. Periti P, Mazzei T, Mini E, Novelli A (1993) Adverse effects of macrolide antibacterials. Drug Saf 9:346–364

    Google Scholar 

  21. Harrison BD, Farr BM, Connolly CK, MacFarlane J, Selkon JB, Bartlett CL (1987) The hospital management of community-acquired pneumonia. Recommendations of the British Thoracic Society. J R Coll Physicians Lond 21:267–269

    Google Scholar 

  22. Niederman MS, Bass JBJ, Campbell GD, Fein AM, Grossman RF, Mandell LA, Marrie TJ, Sorosi GA, Torres A, Yu VL (1993) Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity and initial antimicrobial therapy. American Thoracic Society. Medical section of the American Lung Association. Am Rev Respir Dis 148:1418–1426

    CAS  PubMed  Google Scholar 

  23. Huchon G, Woodhead M, and the European Study on Community-Acquired Pneumonia Committee (1998) Guidelines for management of adult community-acquired lower respiratory tract pneumonia. Eur Respir J 11:986–991

    Article  Google Scholar 

  24. Mandell LA, Marrie TJ, Grossman RF, Chow AT, Hyland RH, and the Canadian Community-Acquired Pneumonia Working Group (2000) Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. Clin Infect Dis 31:383–421

    Article  Google Scholar 

  25. MacFarlane J, Boswell T, Douglas G, Finch R, Holmes W, Honeybourne D, Lim WS, Marriott R, Nathwani D, Saul P, Woodhead M, Wyatt J (2001) BTS guidelines for the management of community-acquired pneumonia in adults. Thorax 56:iv1–iv64

    Article  Google Scholar 

  26. Mandell LA, Bartlett JG, Dowell SF, File T, Musher DM, Whitney C (2003) Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 37:1405–1433

    Article  PubMed  Google Scholar 

  27. Garau J (2001) Have guidelines had an impact on antimicrobial resistance? Semin Respir Infect 16:210–214

    Article  Google Scholar 

  28. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336:243–250

    Article  CAS  PubMed  Google Scholar 

  29. Mundy LM, Oldach D, Auwaerter PG, Gaydos CA, Moore RD, Bartlett JG, Quinn TC, Hopkins, and the CAP Team (1998) Implications for macrolide treatment in community-acquired pneumonia. Chest 113:1201–1206

    Google Scholar 

  30. Frei CR, Koeller JM, Burgess DS, Talbert RL, Johnsrud MT (2003) Impact of atypical coverage for patients with community-acquired pneumonia managed on the medical ward: results from the United States Community-Acquired Pneumonia Project. Pharmacotherapy 23:1167–1174

    Article  Google Scholar 

  31. File TM Jr, Tan JS (2003) International guidelines for the treatment of community-acquired pneumonia in adults. The role of macrolides. Drugs 63:181–205

    Google Scholar 

  32. File TM, Tan JS, Plouffe JF (1998) The role of atypical pathogens: Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in respiratory infection. Infect Dis Clin North Am 12:569–592

    PubMed  Google Scholar 

  33. Waterer GW, Baselski VS, Wunderink RG (2001) Legionella and community-acquired pneumonia: a review of current diagnostic tests from a clinician’s viewpoint. Am J Med 110:41–48

    Article  Google Scholar 

  34. Ball P, Baquero F, Cars O, File T, Garau J, Klugman K, Low DE, Rubenstein E, Wise R (2002) Antibiotic therapy of community respiratory tract infections: strategies for optimal outcomes and minimized resistance emergence. J Antimicrob Chemother 49:31–40

    Article  Google Scholar 

  35. Baquero F (1999) Evolving resistance patterns of Streptococcus pneumoniae: a link with long-acting macrolide consumption? J Chemother 11:35–43

    Google Scholar 

  36. Lonks JR, Garau J, Gomez L, Xercavins M, Ochoa de Eschaquen A, Gareen IF, Reiss PT, Maderios AA (2002) Failure of macrolide antibiotic treatment in patients with bacteremia due to erythromycin-resistant Streptococcus pneumoniae. Clin Infect Dis 35:556–564

    Article  CAS  PubMed  Google Scholar 

  37. File T (2002) Appropriate use of antimicrobials for drug-resistant pneumonia: focus on the significance of beta-lactam-resistant Streptococcus pneumoniae. Clin Infect Dis 34(Suppl 1):S17–S26

    Article  Google Scholar 

  38. Miravitlles M, Murio C, Guerrero T, Gisbert R, and the DAFNE Study Group (2002) Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD. Chest 121:1449–1455

    Article  Google Scholar 

  39. Fine MJ, Pratt HM, Obrosky S, Lave JR, McIntosh LJ, Singer DE, Coley CM, Kapoor WN (2000) Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. Am J Med 109:378–385

    Article  Google Scholar 

  40. Yagupsky P, Porat N, Fraser D, Prajgrod F, Merires M, McGee L, Klugman K, Dagan R (1998) Acquisition, carriage, and transmission of pneumococci with decreased antibiotic susceptibility in young children attending a day care facility in southern Israel. J Infect Dis 177:1003–1012

    Google Scholar 

  41. Iannini PB, Tillotson GS (2000) Combating RTI: designing an antimicrobial to meet key criteria for success. Consultant 40(Suppl):S21–S28

    Google Scholar 

  42. World Health Organization (2001) WHO global strategy for containment of antimicrobial resistance. Document no. WHO/CDS/CSR/DRS/2001.2. WHO, Geneva

  43. White AR, Kaye C, Poupard JA, Pypstra R, Woodnutt G, Wynne B (2004) Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review of the continuing development of an innovative antimicrobial agent. J Antimicrob Chemother 53(Suppl S1):i3–i20

    Article  Google Scholar 

  44. Rolinson GN (1979) 6-APA and the development of the β-lactam antibiotics. J Antimicrob Chemother 5:7–14

    Google Scholar 

  45. Sykes RB (2000) From moulds to drugs. Clin Microbiol Infect 6(Suppl 3):10–12

    Google Scholar 

  46. Bryskier A (2000) Perfecting the ring and extending the antibacterial spectrum: “the multiple generations”. Clin Microbiol Infect 6(Suppl 3):13–21

    Article  Google Scholar 

  47. Jacobs MR (2004) Building in efficacy: developing solutions to combat drug-resistant Streptococcus pneumoniae. Clin Microbiol Infect 10(Suppl 2):18–27

    Article  Google Scholar 

  48. Craig WA (1998) Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis 26:1–12

    Google Scholar 

  49. Andes D, Craig WA (2002) Animal model pharmacokinetics and pharmacodynamics: a critical review. Int J Antimicrob Agents 19:261–268

    Article  CAS  PubMed  Google Scholar 

  50. Woodnutt G, Berry V (1999) Two pharmacodynamic models for assessing the efficacy of amoxicillin-clavulanate against experimental respiratory infections caused by strains of Streptococcus pneumoniae. Antimicrob Agents Chemother 43:29–34

    Google Scholar 

  51. Drusano GL, Craig WA (1997) Relevance of pharmacokinetics and pharmacodynamics in the selection of antibiotics for respiratory tract infections. J Chemother 9(Suppl 3):38–44

    Google Scholar 

  52. Craig WA (2001) Re-evaluating current antibiotic therapy. Respir Med 95(Suppl A):S12–S19

    Article  Google Scholar 

  53. Dagan R (2003) Achieving bacterial eradication using pharmacokinetic/pharmacodynamic principles. Int J Infect Dis 7(Suppl 1):S21–S26

    Article  Google Scholar 

  54. Schentag JJ (1990) Correlation of pharmacokinetic parameters of efficacy of antibiotics: relationship between serum concentrations, MIC values, and bacterial eradication in patients with gram-negative pneumonia. Scan J Infect Dis 74(Suppl):218–234

    Google Scholar 

  55. Todd PA, Benfield P (1990) Amoxicillin/clavulanate. An update of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 39:264–307

    Google Scholar 

  56. Chulavatnatol S, Charles BG (1994) Determination of dose-dependent absorption of amoxycillin from urinary excretion data in healthy subjects. Br J Clin Pharmacol 38:274–277

    Google Scholar 

  57. Pallares R, Fenoll A, Liñares J, and the Spanish Pneumococcal Infection Study Network (G03/103) (2003) The epidemiology of antibiotic resistance in Streptococcus pneumoniae and the clinical relevance of resistance to cephalosporins, macrolides and quinolones. Int J Antimicrob Agents 22:S15–S24

    Article  Google Scholar 

  58. Ramgoolam A, Steele R (2002) Formulations of antibiotics for children in primary care. Pediatric Drugs 4:323–333

    Google Scholar 

  59. Korppi M (2003) Community-acquired pneumonia in children. Issues in optimizing antibacterial treatment. Drugs 5:821–832

    Google Scholar 

  60. Harris JA, Kolokathis A, Campbell M, Cassell GH, Hammerschlag MR (1998) Safety and efficacy of azithromycin in the treatment of community-acquired pneumonia in children. Pediatr Infect Dis J 17:865–871

    Article  Google Scholar 

  61. Wubbel L, Muniz L, Ahmed A, Trujillo M, Carubelli C, McCoig C, Abramo T, Leinonen M, McCracken GH Jr (1999) Etiology and treatment of community-acquired pneumonia in ambulatory children. Pediatr Infect Dis J 18:98–104

    Article  Google Scholar 

  62. Bergan T (1984) Pharmacokinetics of the beta-lactam antibiotics. Scand J Infect Dis 42(Suppl):83–98

    Google Scholar 

  63. File TM Jr, Garau J, Blasi F, Chidiac C, Klguman K, Lode H, Lonks JR, Mandell L, Ramirez J, Yu V (2004) Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia. Chest 124:1888–1901

    Article  Google Scholar 

  64. Garau J, Lonks JR, Gomez L, Xercavins M, Medeiros AA (2000) Failure of macrolide therapy in patients with bacteremia due to macrolide-resistant Streptococcus pneumoniae. In: Abstracts of the 5th International Conference on Macrolides, Azalides and Streptogramins. Abstract no. N709

  65. Kelley MA, Weber DJ, Gilligan P, Cohen MS (2000) Breakthrough pneumococcal bacteremia in patients being treated with azithromycin and clarithromycin. Clin Infect Dis 31:1008–1011

    Article  Google Scholar 

  66. Fogarty C, Goldschmidt R, Bush K (2000) Bacteremic pneumonia due to multidrug-resistant pneumococci in 3 patients treated unsuccessfully with azithromycin and successfully with levofloxacin. Clin Infect Dis 31:613–615

    Article  Google Scholar 

  67. Waterer GW, Wunderink RG, Jones CB (2000) Fatal pneumococcal pneumonia attributed to macrolide resistance and azithromycin monotherapy. Chest 118:1839–1840

    Article  Google Scholar 

  68. Delgine B, Turgeon PL, Fleury C, Lamothe F, Gaudreau C, Bourgault A, Vincelette J, Lette L (2001) Are macrolides still appropriate for empiric therapy of community-acquired pneumococcal pneumonia? In: Program and abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy. Abstract no. L-1849

  69. Musher DM, Dowell ME, Shortridge VD, Flamm RK, Jorgensen JH, Le Magueres P, Krause KL (2002) Emergence of macrolide resistance during treatment of pneumococcal pneumonia. N Engl J Med 346:630–631

    Article  Google Scholar 

  70. Butler JC, Lennox JL, McDougal LK, Sutcliffe JA, Tait-Kamradt A, Tenover FC (2003) Macrolide-resistant pneumococcal endocarditis and epidural abscess that developed during erythromycin therapy. Clin Infect Dis 36:e19–e25

    Article  Google Scholar 

  71. van Kerkhoven D, Peetermans WE, Verbist L, Verhaegen J (2003) Breakthrough pneumococcal bacteremia in patients treated with clarithromycin or oral beta-lactams. J Antimicrob Chemother 51:691–696

    Article  Google Scholar 

  72. Perez-Trallero E, Marimon JM, Iglasias L, Larruskain J (2003) Fluoroquinolone and macrolide treatment failure in pneumococcal pneumonia and selection of multidrug-resistant isolates. Emerg Infect Dis 9:1159–1162

    Google Scholar 

  73. Peric M, Bozdogan B, Jacobs MR, Appelbaum PC (2003) Effects of an efflux mechanism and ribosomal mutations on macrolide susceptibility of Haemophilus influenzae clinical isolates. Antimicrob Agents Chemother 47:1017–1022

    Article  Google Scholar 

  74. Kuehnert MJ, Nolte FS, Perlino CA (1999) Fluoroquinolone resistance in Streptococcus pneumoniae. Ann Intern Med 131:312–313

    Google Scholar 

  75. Urban C, Rahman N, Zhao X, Mariano N, Segal-Maurer S, Drlica K, Rahal JJ (2001) Fluoroquinolone-resistant Streptococcus pneumoniae associated with levofloxacin therapy. J Infect Dis 184:794–798

    Article  Google Scholar 

  76. Empey PE, Jennings HR, Thornton AC, Rapp RP, Evans ME (2001) Levofloxacin failure in a patient with pneumococcal pneumonia. Ann Pharmacother 35:687–690

    Article  Google Scholar 

  77. Piper J, Couch K, Tuttle D, Steele-Moore L (2001) Epidemiology and clinical outcomes of patients with levofloxacin-resistant pneumococcus. In: Program and abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy. Abstract no. L-902

  78. Kays MB, Smith DW, Wack ME, Denys GA (2002) Levofloxacin treatment failure in a patient with fluoroquinolone-resistant Streptococcus pneumoniae pneumonia. Pharmacotherapy 22:395–359

    Article  PubMed  Google Scholar 

  79. Davidson R, Cavalcanti R, Brunton JL, Bast DJ, de Azavedo JC, Kibsey P, Fleming C, Low DE (2002) Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia. N Engl J Med 346:747–750

    Article  PubMed  Google Scholar 

  80. Anderson KB, Tan JS, File TMJ, DiPersio JR, Willey BM, Low DE (2003) Emergence of levofloxacin-resistant pneumococci in immunocompromised adults after therapy for community-acquired pneumonia. Clin Infect Dis 37:376–381

    Article  PubMed  Google Scholar 

  81. Chen DK, McGeer A, de Azavedo JC, Low DE (1999) Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. N Engl J Med 341:233–239

    Article  Google Scholar 

  82. Liñares J, de la Campa AG, Pallares R (1999) Fluoroquinolone resistance in Streptococcus pneumoniae. N Engl J Med 341:1546–1547

    Article  Google Scholar 

  83. Thornsberry C, Ogilvie PT, Holley HPJ, Sahm DF (1999) Survey of susceptibilities of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis isolates to 26 antimicrobial agents: a prospective U.S. study. Antimicrob Agents Chemother 43:2612–2623

    Google Scholar 

  84. Sahm D, Jones M, Hickey ML, Diakun D, Mani S, Thornsberry C (2000) Resistance surveillance of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated in Asia and Europe 1997–1998. J Antimicrob Chemother 45:457–466

    Article  Google Scholar 

  85. World Health Organization (1999) Essential drugs and medicines policy. Alert no. 86. Trovafloxacin and alatrofloxacin: suspension & warnings: hepatotoxicity. http://www.who.int/medicines/library/qsm/drugalert/alert86.htm. Cited 1 July 2004

  86. Buckingham SC, Brown SP, Joaquin VH (1998) Breakthrough bacteremia and meningitis during treatment with cephalosporins parenterally for pneumococcal pneumonia. J Pediatr 132:174–176

    Google Scholar 

  87. Simmons WP (1999) Moraxella catarrhalis pneumonia and bacteremia in an otherwise healthy child. Clin Pediatr (Phila) 38:560–561

    Google Scholar 

  88. Dowell SF, Smith T, Leversedge K, Snitzer J (1999) Failure of treatment of pneumonia associated with highly resistant pneumococci in a child. Clin Infect Dis 29:462–463

    Google Scholar 

  89. Sacho H, Klugman KP, Koornhof HJ, Ruff P (1987) Community-acquired pneumonia in an adult due to a multiply-resistant pneumococcus. J Infect 14:188–189

    Google Scholar 

  90. Feldman C, Kallenbach JM, Miller SD, Thorburn JR, Koornhof HJ (1985) Community-acquired pneumonia due to penicillin-resistant pneumococci. N Engl J Med 313:615–617

    Google Scholar 

  91. Yu VL, Chiou CCC, Feldman C, Ortqvist A, Rello J, Morris AJ, Baddour LM, Luna CM, Snydman DR, Ip M, Ko WC, Chedid BF, Andremont A, Klugman K (2003) An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis 37:230–237

    Article  Google Scholar 

  92. Andes D (2001) Pharmacokinetic and pharmacodynamic properties of antimicrobials in the therapy of respiratory tract infections. Curr Opin Infect Dis 14:165–172

    Article  Google Scholar 

  93. Craig WA (1995) Interrelationship between pharmacokinetics and pharmacodynamics in determining dose regimens for broad-spectrum cephalosporins. Diagn Microbiol Infect Dis 22:89–96

    Article  Google Scholar 

  94. Hansman D, Bullen MM (1967) A resistant pneumococcus. Lancet ii:264–265

    Article  Google Scholar 

  95. McGee L, Goldsmith CE, Klugman K (2002) Fluoroquinolone resistance among clinical isolates of Streptococcus pneumoniae belonging to international multiresistant clones. J Antimicrob Chemother 49:173–176

    Article  Google Scholar 

  96. Matic V, Bozdogan B, Jacobs MR, Ubukata K, Appelbaum PC (2003) Contribution of β-lactamase and PBP amino acid substitutions to amoxicillin/clavulanate resistance in β-lactamase-positive, amoxicillin/clavulanate-resistant Haemophilus influenzae. J Antimicrob Chemother 52:1018–1021

    Article  Google Scholar 

  97. Friedland IR (1995) Comparison of the response to antimicrobial therapy of penicillin-resistant and penicillin-susceptible pneumococcal disease. Pediatr Infect Dis J 14:885–890

    CAS  PubMed  Google Scholar 

  98. Pallares R, Linares J, Vadillo M, Cabellos C, Manresa F, Viladrich PF, Martin R, Gudiol F (1995) Resistance to penicillin and cephalosporins and mortality from severe pneumococcal pneumonia in Barcelona, Spain. N Engl J Med 333:474–480

    Article  Google Scholar 

  99. Ewig S, Ruiz M, Torres A, Marco F, Martinez JA, Sanchez M, Mensa J (1999) Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae. Am J Respir Crit Care Med 159:1835–1842

    Google Scholar 

  100. Garau J, Aguilar L, Rodriguez-Creixems M, Dal-re R, Perez-Trallero E, Rodriguez M, Bouza E (1999) Influence of comorbidity and severity on the clinical outcome of bacteremic pneumococcal pneumonia treated with beta-lactam monotherapy. J Chemother 11:266–272

    Google Scholar 

  101. Turret G, Blum S, Fazal B, Justman J, Telzak E (1999) Penicillin resistance and other predictors of mortality in pneumococcal bacteremia in a population with high HIV seroprevalence. Clin Infect Dis 29:321–327

    Google Scholar 

  102. Feikin DR, Schuchat A, Kolczak M, Barrett NL, Harrison LH, Lefkowitz L, McGeer A, Farley MM, Vugia DJ, Lexau C, Stefonek KR, Patterson JE, Jorgensen JH (2000) Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995–1997. Am J Public Health 90:223–229

    CAS  PubMed  Google Scholar 

  103. Metlay JP, Hofmann J, Cetron MS, Fine MJ, Farley MM, Whitney C, Breiman RF (2000) Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 30:520–528

    Article  Google Scholar 

  104. Moroney JF, Fiore AE, Harrison LH, Patterson JE, Farley MM, Jorgensen JH, Phelan M, Facklam RR, Cetron MS, Breiman RF, Kolczak M, Schuchat A (2001) Clinical outcomes of bacteremic pneumoccal pneumonia in the era of antibiotic resistance. Clin Infect Dis 33:797–805

    Article  Google Scholar 

  105. Ailani RK, Alimchandani A, Hidalgo J, Ailani R, Buckley J, DiGiovine B (2002) Cephalosporin-resistant pneumococcal pneumonia: does it affect outcome? Respir Med 96:805–811

    Article  Google Scholar 

  106. Plaut ME, Perlino CA (1978) Cefamandole vs. procaine penicillin for treatment of pneumonia due to Streptococcus pneumoniae: a random trial. J Infect Dis 137(Suppl):S133–S138

    Google Scholar 

  107. Raff MJ, Rogers JH, Barnwell PA, Waterman NG (1978) Cefazolin in the treatment of pneumonia. Int J Clin Pharmacol Biopharm 16:78–82

    Google Scholar 

  108. Bax RP, Dawson AF, Mullinger BM, Dash CH (1979) Cefuroxime in the treatment of lower respiratory tract infection. Curr Med Res Opin 5:772–778

    Google Scholar 

  109. Nolen TM, Phillips HL, Hutchison J, Cocchetto DM (1988) Comparison of cefuroxime axetil and cefaclor for patients with lower respiratory tract infections presenting to a rural family practice clinic. Curr Ther Res 44:821–829

    Google Scholar 

  110. Schleupner CJ, Anthony WC, Tan J, File TM, Lifland P, Craig WA, Vogelman B (1988) Blinded comparison of cefuroxime to cefaclor for lower respiratory tract infections. Arch Intern Med 148:343–348

    Article  Google Scholar 

  111. Barradas P, Zamith M, Videira W, Cardosa T, Marques RA, Avila R (1989) Therapy of lower respiratory tract infections: a comparison of ceftriaxone and cefotaxime. Chemotherapy 35(Suppl 2):33–40

    Google Scholar 

  112. Yangco BG, Lowe J, Nolen TM, Schleupner C, Tan JS, Anthony W (1990) A multicenter trial comparing the efficacy and safety of cefuroxime axetil and cefaclor in pneumonia of adults. Clin Ther 12:440–446

    Google Scholar 

  113. Shalit I, Dagan R, Engelhard D, Ephros M, Cuningham K (1994) Cefuroxime efficacy in pneumonia; sequential short-course IV/oral suspension therapy. Isr J Med Sci 30:684–689

    Google Scholar 

  114. Williams D, Perri M, Zervos MJ (1994) Randomized comparative trial with ampicillin/sulbactam versus cefamandole in the therapy of community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 13:293–298

    Google Scholar 

  115. Fong IW, Laforge J, Dubois J, Small D, Grossman R, Zakhari R, and the Canadian Bronchitis Study Group (1995) Clarithromycin versus cefaclor in lower respiratory tract infections. Clin Invest Med 18:131–138

    Google Scholar 

  116. Bohte R, van’t Wout JW, Lobatto S, Blusse van Oud Alblas A, Boekhout M, Nauta EH, Hermans J, van den Broek PJ (1995) Efficacy and safety of azithromycin versus benzyl penicillin or erythromycin in community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 14:182–187

    Google Scholar 

  117. Lode H, Garau J, Grassi C, Hosie J, Huchon G, Legakis N, Segev S, Wijnands G (1995) Treatment of community-acquired pneumonia: a randomized comparison of sparfloxacin, amoxycillin-clavulanic acid and erythromycin. Eur Respir J 8:1999–2007

    Article  Google Scholar 

  118. Higuera F, Hidalgo H, Feris J, Giguere G, Collins JJ (1996) Comparison of oral cefuroxime axetil and oral amoxycillin/clavulanate in the treatment of community-acquired pneumonia. J Antimicrob Chemother 37:555–564

    Google Scholar 

  119. Oh HML, Ng AWK, Lee SK (1996) Cefuroxime compared to amoxicillin-clavulanic acid in the treatment of community-acquired pneumonia. Singapore Med J 37:255–257

    Google Scholar 

  120. Amir J, Harel L, Eiditz-Markus T, Varsano I (1996) Comparative evaluation of cefixime versus amoxicillin-clavulanate following ceftriaxone therapy of pneumonia. Clin Pediatr (Phila) 35:629–633

    Google Scholar 

  121. Camargos PA, Guimaraes MD, Ferreira CS (1997) Benzathine penicillin for unilateral lobar or segmental infiltrates presumptively caused by Streptococcus pneumoniae in children 2–12 years old. J Trop Pediatr 43:353–360

    Article  Google Scholar 

  122. Van den Brande P, Vondra V, Vogel F, Schlaeffer F, Staley H, Holmes C (1997) Sequential therapy with cefuroxime followed by cefuroxime axetil in community-acquired pneumonia. Chest 112:406–415

    Google Scholar 

  123. Calver AD, Walsh NS, Quinn PS, Barab C, Lonergan V, Singh KP, Orzolek WS (1997) Dosing of amoxicillin/clavulanate given every 12 h is as effective as dosing every 8 h for treatment of lower respiratory tract infection. Lower Respiratory Tract Infection Collaborative Study Group. Clin Infect Dis 24:570–574

    Google Scholar 

  124. File TM Jr, Segreti J, Dunbar L, Player R, Kohler R, Williams RR, Kojak C, Rubin A (1997) A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia. Antimicrob Agents Chemother 41:1955–1972

    Google Scholar 

  125. Nogeova A, Galova K, Krizan L, Sufliarska S, Cizmarova E, Raskova J, Hrachova J, Kukova Z, Durcanska K, Krcmery VJ (1997) Ceftibuten vs. cefuroxime-axetil in initial therapy for community-acquired bronchopneumonia: randomized multicentric study in 140 children. Infect Dis Clin Pract 6:133–134

    Google Scholar 

  126. Norrby SR, Petermann W, Willcox PA, Vetter N, Salewski E (1998) A comparative study of levofloxacin and ceftriaxone in the treatment of hospitalized patients with pneumonia. Scand J Infect Dis 30:397–404

    Article  CAS  PubMed  Google Scholar 

  127. Tremolieres F, de Kock F, Pluck N, Daniel R (1998) Trovafloxacin versus high-dose amoxicillin (1 g three times daily) in the treatment of community-acquired bacterial pneumonia. Eur J Clin Microbiol Infect Dis 17:447–453

    Article  Google Scholar 

  128. Balgos AA, Rodriguez-Gomez G, Nasnas R, Mahasur AA, Margono BP, Tinoco-Favila JC, Sansores-Martinez RH, Hassan M, Beppo O, Wongsa A, Cukier A, Vargas F (1999) Efficacy of twice-daily amoxycillin/clavulanate in lower respiratory tract infections. Int J Clin Pract 53:325–330

    Google Scholar 

  129. Peterson J, and the Trovafloxacin Study Group (1999) Oral trovafloxacin vs oral cefuroxime ± erythromycin in community-acquired pneumonia. Drugs 58(Suppl 2):301–303

    Google Scholar 

  130. Vergis EN, Indorf A, File TMJ, Phillips J, Bates J, Tan J, Sarosi GA, Grayston JT, Summersgill J, Yu VL (2000) Azithromycin vs cefuroxime plus erythromycin for empiric treatment of community-acquired pneumonia in hospitalized patients. A prospective, randomized, multicenter trial. Arch Intern Med 160:1294–1300

    Google Scholar 

  131. Roson B, Carratala J, Tubau F, Dorca J, Linares J, Pallares R, Manresa F, Gudiol F (2001) Usefulness of beta-lactam therapy for community-acquired pneumonia in the era of drug-resistant Streptococcus pneumoniae: a randomized study of amoxicillin-clavulanate and ceftriaxone. Microbiol Drug Res 7:85–96

    Article  Google Scholar 

  132. Petitpretz P, Arvis P, Marel M, Moita J, Urueta J, and the CAP5 Moxifloxacin Study Group (2001) Oral moxifloxacin vs high-dosage amoxicillin in the treatment of mild-to-moderate, community-acquired, suspected pneumococcal pneumonia in adults. Chest 119:185–195

    Article  CAS  PubMed  Google Scholar 

  133. van Zyl L, le Roux JG, LaFata JA, Volk RS, Paolo WA, Flamm R, Hom RC (2002) Cefditoren pivoxil versus cefpodoxime proxetil for community-acquired pneumonia: results of a multicenter, prospective, randomized, double-blind study. Clin Ther 24:1840–1853

    Article  Google Scholar 

  134. Petitpretz P, Chidiac C, Soriano F, Garau J, Stevenson K, Rouffiac E, and the 556 Clinical Study Group (2002) The efficacy and safety of oral pharmacokinetically enhanced amoxycillin-clavulanate 2000/125 mg, twice daily, versus oral amoxycillin-clavulanate 1000/125 mg, three times daily, for the treatment of bacterial community-acquired pneumonia in adults. Int J Antimicrob Agents 20:119–129

    Article  Google Scholar 

  135. Garau J, Twynholm M, Garcia-Mendez E, Siquier B, Rivero A, and the 557 Clinical Study Group (2003) Oral pharmacokinetically enhanced co-amoxiclav 2000/125 mg, twice daily, compared with co-amoxiclav 875/125 mg, three times daily, in the treatment of community-acquired pneumonia in European adults. J Antimicrob Chemother 52:826–836

    Article  Google Scholar 

  136. File T, Lode H, Kurz H, Crann R (2003) Comparative efficacy and safety of pharmacokinetically enhanced amoxicillin/clavulanate 2000/125 mg vs amoxicillin/clavulanate 875/125 mg in community-acquired pneumonia (CAP). In: Abstracts of the 99th International Conference of the American Thoracic Society. Abstract no. B311

  137. Garau J (2004) Performance in practice: bacteriological efficacy in patients with drug-resistant Streptococcus pneumoniae. Clin Microbiol Infect 10(Suppl 2):28–35

    Article  Google Scholar 

Download references

Acknowledgements

The author is indebted to Jennifer Brown for her assistance in the preparation of the manuscript

Author information

Authors and Affiliations

  1. Department of Medicine, Hospital Mutua de Terrassa, Plaza Dr Robert, 5, 08221, Terrassa, Barcelona, Spain

    J. Garau

Authors
  1. J. Garau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Garau.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Garau, J. Role of beta-lactam agents in the treatment of community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 24, 83–99 (2005). https://doi.org/10.1007/s10096-005-1287-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-005-1287-9

Keywords

Search

Navigation