Tazobactam/piperacillin for moderate-to-severe pneumonia in patients with risk for aspiration: Comparison with imipenem/cilastatin

Background: Treatment of aspiration pneumonia is becoming an important issue due to aging of populations worldwide. Effectiveness of tazobactam/piperacillin (TAZ/PIPC) in aspiration pneumonia is not clear. Purpose: To compare clinical efficacy between TAZ/PIPC (1:4 compound) and imipenem/cilastatin (IPM/CS) in patients with moderate-to-severe aspiration pneumonia. Patients and methods: In this open-label, randomized study either TAZ/PIPC 5 g or IPM/CS 1 g was intravenously administered every 12 h to patients with moderate-to-severe community-acquired aspiration pneumonia or nursing home-acquired pneumonia with risk for aspiration pneumonia for average 11 days. The primary outcome was clinical response rate at the end of treatment (EOT) in validated perprotocol (VPP) population. Secondary outcomes were clinical response during treatment (days 4 and 7) and at the end of study (EDS) in VPP population, and survival at day 30 in modified intention-to-treat (MITI) population. Results: There was no difference between the groups in primary or secondary outcome. However, significantly faster improvement as measured by axillary temperature (p < 0.05) and WBC count (p = 0.01) was observed under TAZ/PIPC treatment. In patients with gram-positive bacterial infection, TAZ/PIPC was more effective at EOT in VPP population (p = 0.03). Conclusion: TAZ/PIPC is as effective and safe as IPM/CS in the treatment of moderate-to-severe aspiration pneumonia. (C) 2010 Elsevier Ltd. All rights reserved.