Combination therapy versus monotherapy: a randomised pilot study on the evolution of inflammatory parameters after ventilator associated pneumonia

摘要

Introduction Combination antibiotic therapy for ventilatorassociated pneumonia (VAP) is often used to broaden thespectrum of activity of empirical treatment. The relevance ofsuch synergy is commonly supposed but poorly supported. Theaim of the present study was to compare the clinical outcomeand the course of biological variables in patients treated for aVAP, using a monotherapy with a beta-lactam versus acombination therapy.Methods Patients with VAP were prospectively randomised toreceive either cefepime alone or cefepime in association withamikacin or levofloxacin. Clinical and inflammatory parameterswere measured on the day of inclusion and thereafter.Results Seventy-four mechanically ventilated patients meetingclinical criteria for VAP were enrolled in the study. VAP wasmicrobiologically confirmed in 59 patients (84%). Patients wererandomised to receive cefepime (C group, 20 patients),cefepime with amikacin (C-A group, 19 patients) or cefepimewith levofloxacin (C-L group, 20 patients). No significantdifference was observed regarding the time course oftemperature, leukocytosis or C-reactive protein level. Therewere no differences between length of stay in the intensive careunit after infection, nor in ventilator free days within 28 days afterinfection. No difference in mortality was observed.Conclusion Antibiotic combination using a fourth generationcephalosporin with either an aminoside or a fluoroquinolone isnot associated with a clinical or biological benefit whencompared to cephalosporin monotherapy against commonsusceptible pathogens causing VAP.