Assessing a strategy using amoxicillin-clavulanate IV then switching to per os, for the treatment of early nosocomial pneumoniae under mechanical ventilation.

Objective - The epidemiology of early nosocomial pneumonia (< day 5) appear s to be similar to that of inhalation pneumopathy. The aim of this open, pr ospective multicenter study was to confirm this epidemiological hypothesis and to evaluate a therapeutic strategy based on amoxicillin-clavulanate in early pneumonia occurring in intensive care patients. Material and methods - All patients presenting with clinical and radiologic al signs of early pneumonia and no exclusion criteria underwent respiratory tract sampling for bacteriological analysis before starting empiric therap y with an amoxicillin-clavulanate combination. Antibiotic therapy was admin istered initially IV and, after day 3, by per os. Treatment efficacy was as sessed on the basis of predefined clinical and bacteriological criteria. Results - 131 patients were enrolled, mean age 52 +/- 17.6 years and mean b aseline IGS II score of 41.1 +/- 13.5 Bacteriological documentation was obt ained in 62% of cases. Haemophilus influenzae, Streptococcus pneumonia, and Staphylococcus aureus represented 68% of the bacterial isolates, confirmin g the epidemiological hypothesis. The treatment success rate was 63.5% in t he intent-to-treat analysis and 77.5% in the per protocol analysis. The bac terial eradication rate was 97%. Comments - Initial intravenous treatment with amoxicillin-clavulanate, rapi dly replaced by oral administration, is thus feasible, effective, and well tolerated. It is an interesting alternative for the treatment of early pneu monia in intensive care patients. (C) 2001 Editions scientifiques et medica les Elsevier SAS.