%0 Journal Article %1 Siempos2007 %A Siempos, I. I. %A Vardakas, K. Z. %A Manta, K. G. %A Falagas, M. E. %D 2007 %J Eur Respir J %K dosage/adverse dosing drug %N 3 %P 548--560 %R 10.1183/09031936.00080206 %T Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia. %U http://dx.doi.org/10.1183/09031936.00080206 %V 29 %X The comparative effectiveness and safety of carbapenems with other beta-lactams and fluoroquinolones for the empirical treatment of patients with hospital-acquired pneumonia remains controversial. In the present study, a meta-analysis of 12 relevant randomised controlled trials was performed. Overall, carbapenems were associated with lower mortality than fluoroquinolones or beta-lactams, alone or in combination with aminoglycosides (odds ratio 0.72, 95\% confidence interval 0.55-0.95). There was no difference between the compared antibiotics regarding treatment success (1.08, 0.91-1.29), microbiological success (1.04, 0.72-1.50) or development of adverse effects (0.81, 0.46-1.43). In the subset of patients with Pseudomonas aeruginosa pneumonia, carbapenems were associated with lower treatment success (0.42, 0.22-0.82) and lower eradication of P. strains (0.50, 0.24-0.89). Carbapenems are equivalent to fluoroquinolones or beta-lactams, alone or in combination with aminoglycosides, for the empirical treatment of immunocompetent adult patients with hospital-acquired pneumonia. However, there is limited evidence, based predominantly on unblinded randomised controlled trials, that carbapenems are associated with lower mortality than the comparators; this association was not observed in a subset analysis of randomised controlled trials with a high methodological quality score. In patients with Pseudomonas aeruginosa pneumonia, carbapenems are associated with worse outcomes than the comparators.

@article{Siempos2007, abstract = {The comparative effectiveness and safety of carbapenems with other beta-lactams and fluoroquinolones for the empirical treatment of patients with hospital-acquired pneumonia remains controversial. In the present study, a meta-analysis of 12 relevant randomised controlled trials was performed. Overall, carbapenems were associated with lower mortality than fluoroquinolones or beta-lactams, alone or in combination with aminoglycosides (odds ratio 0.72, 95\% confidence interval 0.55-0.95). There was no difference between the compared antibiotics regarding treatment success (1.08, 0.91-1.29), microbiological success (1.04, 0.72-1.50) or development of adverse effects (0.81, 0.46-1.43). In the subset of patients with Pseudomonas aeruginosa pneumonia, carbapenems were associated with lower treatment success (0.42, 0.22-0.82) and lower eradication of P. strains (0.50, 0.24-0.89). Carbapenems are equivalent to fluoroquinolones or beta-lactams, alone or in combination with aminoglycosides, for the empirical treatment of immunocompetent adult patients with hospital-acquired pneumonia. However, there is limited evidence, based predominantly on unblinded randomised controlled trials, that carbapenems are associated with lower mortality than the comparators; this association was not observed in a subset analysis of randomised controlled trials with a high methodological quality score. In patients with Pseudomonas aeruginosa pneumonia, carbapenems are associated with worse outcomes than the comparators.}, added-at = {2013-03-06T01:25:21.000+0100}, author = {Siempos, I. I. and Vardakas, K. Z. and Manta, K. G. and Falagas, M. E.}, biburl = {https://www.bibsonomy.org/bibtex/22835bb53a3e5c1c83a1b0ebd5fe71aa1/aorchid}, description = {see page 85 of notebook 00002.}, doi = {10.1183/09031936.00080206}, file = {:ID_General/EurRespirJ.29.548.pdf:PDF}, groups = {public}, institution = {Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.}, interhash = {7e6b1aa2d3daea3f80605b1fafefe349}, intrahash = {2835bb53a3e5c1c83a1b0ebd5fe71aa1}, journal = {Eur Respir J}, keywords = {dosage/adverse dosing drug}, language = {eng}, medline-pst = {ppublish}, month = Mar, number = 3, pages = {548--560}, pii = {29/3/548}, pmid = {17329491}, timestamp = {2013-03-06T01:25:21.000+0100}, title = {Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia.}, url = {http://dx.doi.org/10.1183/09031936.00080206}, username = {aorchid}, volume = 29, year = 2007 }