A RANDOMIZED COMPARATIVE TRIAL OF AZTREONAM PLUS CEFAZOLIN VERSUS CEFTAZIDIME FOR THE TREATMENT OF NOSOCOMIAL PNEUMONIA

A multicentre prospective randomised open-label controlled trial was c onducted to compare the efficacy and safety of aztreonam (1 to 2 g eve ry 8 hours) plus cefazolin (1 g every 8 hours) with that of ceftazidim e (1 to 2 g every 8 hours) in patients with nosocomial pneumonia. 66 a dults were enrolled who had a presumptive diagnosis of pneumonia made at least 48 hours after hospitalisation. Patients exhibited the classi c clinical picture of pneumonia and/or fever and/or leucocytosis and a newly developed or expanding infiltrate on chest x-ray.Among 48 evalu able patients treated, clinical cum or improvement was reported in 18 of 20 (90%) aztreonam patients as compared with 24 of 28 (85.7%) patie nts treated with ceftazidime. Bacteriological eradication or presumpti ve eradication was reported in 11 of 13 (84.6%) aztreonam patients and 15 of 19 (78.9%) ceftazidime recipients. Five patients with positive blood cultures prior to therapy (2 aztreonam, 3 ceftazidime) had negat ive blood cultures at study completion. Superinfection was reported in 2 patients randomised to aztreonam (both Staphylococcus aureus) and i n 3 ceftazidime patients (2 with Pseudomonas aeruginosa and 1 with bet a-haemolytic Streptococcus). Colonisation was observed following cefta zidime (n = 4) and aztreonam (n = 2) therapy. Six aztreonam and 3 ceft azidime recipients experienced adverse events, which were possibly rel ated to study therapy. Aztreonam plus cefazolin appears to be as effec tive as ceftazidime for the treatment of adults with nosocomial pneumo nia.