Revilla RE, Molinar RF, Baltazar TJÁ, Vázquez HMI, Cruz ME

Idioma: Español
Referencias bibliográficas: 27
Paginas: 22-26
Archivo PDF: 71.27 Kb.

RESUMEN

Objetivo: Establecer una comparación entre cefepime y ceftazidima en el tratamiento de la neumonía nosocomial. Diseño: Reporte de serie de casos. Lugar: UCI de un hospital de tercer nivel de atención de la Ciudad de México. Pacientes: Treinta pacientes con neumonía nosocomial (17 hombres y 13 mujeres, edad media 50.3 ± 16.6 años) fueron estudiados. Intervenciones: Dos grupos de pacientes fueron randomizados para recibir cefepime 2 g i.v. cada 8 horas (grupo A, n = 15) y ceftazidima 1 g i.v. cada 8 horas (grupo B) durante diez días. Resultados: Se observó APACHE II de 11 ± 3.09 vs 11.53 ± 5.09 puntos (p = 0.733; mejoría clínica, 13 vs 6 pacientes (p = 0.023); y mejoría bacteriológica, 11 vs 3 pacientes (p = 0.01). Ningún paciente de ambos grupos murió o tuvo efectos adversos relacionados con el uso de los antibióticos. Conclusión: Cefepime es más efectivo que ceftazidima en el tratamiento de la neumonía nosocomial en nuestra UCI.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Lode H, Schaberg T, Raffenberg M, Mauch H. Nosocomial pneumonia in the critical care unit. Crit Care Clin 1998; 14: 119-33.

2. Young P, Ridley S. Ventilator-associated pneumonia: Diagnosis, pathogenesis and prevention. Anaesthesia 1999; 54: 1183-97.

3. Rello J, Diaz E, Roque M, Vallés J. Risk factors for developing pneumonia within 48 hours of intubation. Am J Respir Crit Care Med 1999; 159: 1742-46.

4. Cook DJ, Walther SD, Cook RJ et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Int Med 1998; 129: 433-40.

5. Kirtland S, Corley D, Winterbauer R et al. The diagnosis of ventilator-associated pneumonia: A comparison of histologic, microbiologic and clinical criteria. Chest 1997; 112: 445-57.

6. Pingleton SK, Fagon JY, Leeper KV Jr. Patient selection for clinical investigation for ventilator-associated pneumonia: Criteria for evaluating diagnostic techniques. Chest 1992; 102: 553S-56S.

7. Consensus statement. Hospital-acquired pneumonia in adults-diagnosis, assesment and preventive strategies. Am J Respir Crit Care Med 1995; 153: 1711-25.

8. Mandell, Douglas, Bennet. Principles and practice of infectious disease. 1990, chapter XX.

9. Pneumonia. Emergency Medicine Clinics of North America 1998; 7(2): 258-59.

10. Manual of medical therapeutics. 26 Ed. Department of Medicine at Washington University. Jul. 1990.

11. Investigators Brochure, Cefepime. Bristol Myers Squibb Company with appendices A, B,C,D and E.

12. Barbahaiya RE. Disposition of Cefepime in normal and renally impaired subjects. Bristol Myers Squibb internal report. 1989.

13. Knupp CA, Tenney J, Martin RE, Weidler DJ, Pittman KA. Safety, tolerance and pharmacokynetics of Cefepime administrated intramuscularly to healthy subjects. J Clin Pharmacol 1990; 30: 900-10.

14. Gubelmans EL, Matermen EC, Maesen FPT. Cefepime versus ceftriaxone: a tolerance study by intramuscular injection. Drug Ther Res 1990; 15: 124-26.

15. Jauregui K, Matzke D, Scott M, Minns P, Hagege T. Cefepime as treatment for osteomyelitis and other severe bacterial infections. J Antimicrob Chemoter 1993; 32 (suppl. B): 141-49.

16. Gouin F, Papaziani L, Martin C, Almanese J, Durbec O, Domart Y, Veyssier P, Leroy J, Gress JJ, Rolin C. A non-comparative study of the efficacy and tolerance of Cefepime in combination with amikacin in the treatment of severe infection in patients of intensive care. J Antimicrob Chemoter 1993; 32 (suppl. B): 205-14.

17. Barckow D, Schwigon CD. Cefepime versus cefotaxime in the treatment of lower respiratory tract infections. J Antimicrob Chemother 1993; 32 (suppl. B): 187-193.

18. Barradel LB, Bryson HM. Cefepime a review of its antibacterial activity, pharmacokinetic, properties and therapeutic use. Drugs 1994; 47(3): 472-05.

19. Schaeffer M, Bacher K, Lode H, Borner K, Priesnitz M. Prospective randomized clinical study: Cefepime (Cep) vs Mezclociclin (Mez) plus sulbactam (Sul) in severe LRTI. Abstract presented at the XXX International Congress on Antimicrobial Agents and Chemotherapy. 1990.

20. Okamoto MP, Nakahiro RK. Cefepime: A new fourth generation cephalosporin. Am J Hosp Pharm 1994; 51 (4): 463-77.

21. Mouton J, Hollander JD. Killing of Pseudomona aeruginosa during continuous and intermittent infusion of ceftazidime in an in vitro pharmacokinetic model. Antimicrob Agents Chemother 1994; 38: 931-936.

22. Van Dalen R, Vree TB, Baars AM et al. Dosage adjustment for ceftazidime in patients with impaired renal function. Eur J Clin Pharmacol 1986; 30: 597-605.

23. Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Gilbert C. Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay. Am J Med 1993; 94: 281-288.

24. Leu HS, Kaiser DL, Mori RF, Woolson RF. Hospital-Acquired pneumonia: attributable mortality and hospital stay. Am J Epidemiol 129: 1258-1267.

25. Young PJ, Ridley SA. Ventilator-associated pneumonia. Diagnosis, pathogenesis and prevention. Anaesthesia 1999; 54(12): 1183-1197.

26. Consensus statement: Hospital-acquired pneumonia in adults: Diagnosis, assesment of severity, initial antimicrobial therapy, and preventive strategies. Am J Resp Crit Care Med 1995; 153: 1711-1725.

27. Kirtland H, Corley E, Wintwrbauer R et al. The diagnosis of ventilator-associated pneumonia: a comparison of histologic, microbiologic and clinical criteria 1997; 112: 445-457.