Effects of Prior Effective Therapy on the Efficacy of Daptomycin and Ceftriaxone for the Treatment of Community-Acquired Pneumonia

Objective. We sought to compare daptomycin with ceftriaxone for the treatment of patients with community-acquired pneumonia (CAP). Methods. Two phase-3 randomized, double-blind trials that enrolled adult patients hospitalized with CAP were conducted. Patients received intravenous daptomycin (4 mg/kg...

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Veröffentlicht in:Clinical infectious diseases 2008-04, Vol.46 (8), p.1142-1151
Hauptverfasser: Pertel, Peter E., Bernardo, Patricia, Fogarty, Charles, Matthews, Peter, Northland, Rebeca, Benvenuto, Mark, Thorne, Grace M., Luperchio, Steven A., Arbeit, Robert D., Alder, Jeff
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container_end_page 1151
container_issue 8
container_start_page 1142
container_title Clinical infectious diseases
container_volume 46
creator Pertel, Peter E.
Bernardo, Patricia
Fogarty, Charles
Matthews, Peter
Northland, Rebeca
Benvenuto, Mark
Thorne, Grace M.
Luperchio, Steven A.
Arbeit, Robert D.
Alder, Jeff
description Objective. We sought to compare daptomycin with ceftriaxone for the treatment of patients with community-acquired pneumonia (CAP). Methods. Two phase-3 randomized, double-blind trials that enrolled adult patients hospitalized with CAP were conducted. Patients received intravenous daptomycin (4 mg/kg) or ceftriaxone (2 g) once daily for 5–14 days. Aztreonam could be added for patients with gram-negative infections. Clinical responses at the test-of-cure visit among patients in the intent-to-treat and clinically evaluable populations were the primary efficacy end points. Results. After combining data from the trials, the intent-to-treat population included 413 daptomycin-treated patients and 421 ceftriaxone-treated patients, and the clinically evaluable population included 369 daptomycin-treated patients and 371 ceftriaxone-treated patients. In the intent-to-treat population, the clinical cure rate among daptomycin-treated patients with CAP was 70.9%, compared with 77.4% among ceftriaxone-treated patients (95% confidence interval for the difference between cure rates, −12.4% to −0.6%). In the clinically evaluable population, the clinical cure rate was lower among daptomycin-treated patients (79.4%) than among ceftriaxone-treated patients (87.9%; 95% confidence interval for the difference between cure rates, −13.8% to −3.2%). A posthoc analysis revealed that, among those who had received up to 24 h of prior effective therapy, cure rates were similar among daptomycin-treated (90.7%) and ceftriaxone-treated patients (88.0%; 95% confidence interval for the difference between cure rates, −6.1% to 11.5%). Conclusions. Daptomycin is not effective for the treatment of CAP, including infections caused by Streptococcus pneumoniae and Staphylococcus aureus. The observation that as little as 24 h of prior effective therapy may impact clinical outcome suggests that trials to evaluate CAP treatment may need to exclude patients who have received any potentially effective therapy before enrollment.
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We sought to compare daptomycin with ceftriaxone for the treatment of patients with community-acquired pneumonia (CAP). Methods. Two phase-3 randomized, double-blind trials that enrolled adult patients hospitalized with CAP were conducted. Patients received intravenous daptomycin (4 mg/kg) or ceftriaxone (2 g) once daily for 5–14 days. Aztreonam could be added for patients with gram-negative infections. Clinical responses at the test-of-cure visit among patients in the intent-to-treat and clinically evaluable populations were the primary efficacy end points. Results. After combining data from the trials, the intent-to-treat population included 413 daptomycin-treated patients and 421 ceftriaxone-treated patients, and the clinically evaluable population included 369 daptomycin-treated patients and 371 ceftriaxone-treated patients. In the intent-to-treat population, the clinical cure rate among daptomycin-treated patients with CAP was 70.9%, compared with 77.4% among ceftriaxone-treated patients (95% confidence interval for the difference between cure rates, −12.4% to −0.6%). In the clinically evaluable population, the clinical cure rate was lower among daptomycin-treated patients (79.4%) than among ceftriaxone-treated patients (87.9%; 95% confidence interval for the difference between cure rates, −13.8% to −3.2%). A posthoc analysis revealed that, among those who had received up to 24 h of prior effective therapy, cure rates were similar among daptomycin-treated (90.7%) and ceftriaxone-treated patients (88.0%; 95% confidence interval for the difference between cure rates, −6.1% to 11.5%). Conclusions. Daptomycin is not effective for the treatment of CAP, including infections caused by Streptococcus pneumoniae and Staphylococcus aureus. The observation that as little as 24 h of prior effective therapy may impact clinical outcome suggests that trials to evaluate CAP treatment may need to exclude patients who have received any potentially effective therapy before enrollment.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/533441</identifier><identifier>PMID: 18444848</identifier><language>eng</language><publisher>United States: The University of Chicago Press</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - adverse effects ; Anti-Bacterial Agents - therapeutic use ; Antibacterials ; Articles and Commentaries ; Ceftriaxone - adverse effects ; Ceftriaxone - therapeutic use ; Community-Acquired Infections - drug therapy ; Community-Acquired Infections - microbiology ; Community-Acquired Infections - pathology ; Cubism ; Daptomycin - adverse effects ; Daptomycin - therapeutic use ; Diarrhea - chemically induced ; Double-Blind Method ; Drug therapy ; Effectiveness studies ; Female ; Headache - chemically induced ; Health outcomes ; Humans ; Infections ; Logistic Models ; Male ; Medical cures ; Middle Aged ; Nausea - chemically induced ; Pathogens ; Pharmaceutical preparations ; Pneumonia ; Pneumonia - drug therapy ; Pneumonia - pathology ; Pneumonia, Ventilator-Associated - drug therapy ; Pneumonia, Ventilator-Associated - pathology ; Sepsis - drug therapy ; Sepsis - pathology ; Side effects ; Sputum ; Staphylococcus aureus ; Staphylococcus infections ; State hospitals ; Streptococcus infections ; Streptococcus pneumoniae ; Treatment Outcome</subject><ispartof>Clinical infectious diseases, 2008-04, Vol.46 (8), p.1142-1151</ispartof><rights>Copyright 2008 Infectious Diseases Society of America</rights><rights>2008 by the Infectious Diseases Society of America 2008</rights><rights>Copyright University of Chicago, acting through its Press Apr 15, 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c487t-b49fde93470dc548ee1b35ca3098b999a34102483de7a9030dfde92093b34ecd3</citedby><cites>FETCH-LOGICAL-c487t-b49fde93470dc548ee1b35ca3098b999a34102483de7a9030dfde92093b34ecd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/40307182$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/40307182$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18444848$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pertel, Peter E.</creatorcontrib><creatorcontrib>Bernardo, Patricia</creatorcontrib><creatorcontrib>Fogarty, Charles</creatorcontrib><creatorcontrib>Matthews, Peter</creatorcontrib><creatorcontrib>Northland, Rebeca</creatorcontrib><creatorcontrib>Benvenuto, Mark</creatorcontrib><creatorcontrib>Thorne, Grace M.</creatorcontrib><creatorcontrib>Luperchio, Steven A.</creatorcontrib><creatorcontrib>Arbeit, Robert D.</creatorcontrib><creatorcontrib>Alder, Jeff</creatorcontrib><title>Effects of Prior Effective Therapy on the Efficacy of Daptomycin and Ceftriaxone for the Treatment of Community-Acquired Pneumonia</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>Objective. We sought to compare daptomycin with ceftriaxone for the treatment of patients with community-acquired pneumonia (CAP). Methods. Two phase-3 randomized, double-blind trials that enrolled adult patients hospitalized with CAP were conducted. Patients received intravenous daptomycin (4 mg/kg) or ceftriaxone (2 g) once daily for 5–14 days. Aztreonam could be added for patients with gram-negative infections. Clinical responses at the test-of-cure visit among patients in the intent-to-treat and clinically evaluable populations were the primary efficacy end points. Results. After combining data from the trials, the intent-to-treat population included 413 daptomycin-treated patients and 421 ceftriaxone-treated patients, and the clinically evaluable population included 369 daptomycin-treated patients and 371 ceftriaxone-treated patients. In the intent-to-treat population, the clinical cure rate among daptomycin-treated patients with CAP was 70.9%, compared with 77.4% among ceftriaxone-treated patients (95% confidence interval for the difference between cure rates, −12.4% to −0.6%). In the clinically evaluable population, the clinical cure rate was lower among daptomycin-treated patients (79.4%) than among ceftriaxone-treated patients (87.9%; 95% confidence interval for the difference between cure rates, −13.8% to −3.2%). A posthoc analysis revealed that, among those who had received up to 24 h of prior effective therapy, cure rates were similar among daptomycin-treated (90.7%) and ceftriaxone-treated patients (88.0%; 95% confidence interval for the difference between cure rates, −6.1% to 11.5%). Conclusions. Daptomycin is not effective for the treatment of CAP, including infections caused by Streptococcus pneumoniae and Staphylococcus aureus. 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Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pertel, Peter E.</au><au>Bernardo, Patricia</au><au>Fogarty, Charles</au><au>Matthews, Peter</au><au>Northland, Rebeca</au><au>Benvenuto, Mark</au><au>Thorne, Grace M.</au><au>Luperchio, Steven A.</au><au>Arbeit, Robert D.</au><au>Alder, Jeff</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of Prior Effective Therapy on the Efficacy of Daptomycin and Ceftriaxone for the Treatment of Community-Acquired Pneumonia</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2008-04-15</date><risdate>2008</risdate><volume>46</volume><issue>8</issue><spage>1142</spage><epage>1151</epage><pages>1142-1151</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Objective. We sought to compare daptomycin with ceftriaxone for the treatment of patients with community-acquired pneumonia (CAP). Methods. Two phase-3 randomized, double-blind trials that enrolled adult patients hospitalized with CAP were conducted. Patients received intravenous daptomycin (4 mg/kg) or ceftriaxone (2 g) once daily for 5–14 days. Aztreonam could be added for patients with gram-negative infections. Clinical responses at the test-of-cure visit among patients in the intent-to-treat and clinically evaluable populations were the primary efficacy end points. Results. After combining data from the trials, the intent-to-treat population included 413 daptomycin-treated patients and 421 ceftriaxone-treated patients, and the clinically evaluable population included 369 daptomycin-treated patients and 371 ceftriaxone-treated patients. In the intent-to-treat population, the clinical cure rate among daptomycin-treated patients with CAP was 70.9%, compared with 77.4% among ceftriaxone-treated patients (95% confidence interval for the difference between cure rates, −12.4% to −0.6%). In the clinically evaluable population, the clinical cure rate was lower among daptomycin-treated patients (79.4%) than among ceftriaxone-treated patients (87.9%; 95% confidence interval for the difference between cure rates, −13.8% to −3.2%). A posthoc analysis revealed that, among those who had received up to 24 h of prior effective therapy, cure rates were similar among daptomycin-treated (90.7%) and ceftriaxone-treated patients (88.0%; 95% confidence interval for the difference between cure rates, −6.1% to 11.5%). Conclusions. Daptomycin is not effective for the treatment of CAP, including infections caused by Streptococcus pneumoniae and Staphylococcus aureus. The observation that as little as 24 h of prior effective therapy may impact clinical outcome suggests that trials to evaluate CAP treatment may need to exclude patients who have received any potentially effective therapy before enrollment.</abstract><cop>United States</cop><pub>The University of Chicago Press</pub><pmid>18444848</pmid><doi>10.1086/533441</doi><tpages>10</tpages></addata></record>
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subjects Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - therapeutic use
Antibacterials
Articles and Commentaries
Ceftriaxone - adverse effects
Ceftriaxone - therapeutic use
Community-Acquired Infections - drug therapy
Community-Acquired Infections - microbiology
Community-Acquired Infections - pathology
Cubism
Daptomycin - adverse effects
Daptomycin - therapeutic use
Diarrhea - chemically induced
Double-Blind Method
Drug therapy
Effectiveness studies
Female
Headache - chemically induced
Health outcomes
Humans
Infections
Logistic Models
Male
Medical cures
Middle Aged
Nausea - chemically induced
Pathogens
Pharmaceutical preparations
Pneumonia
Pneumonia - drug therapy
Pneumonia - pathology
Pneumonia, Ventilator-Associated - drug therapy
Pneumonia, Ventilator-Associated - pathology
Sepsis - drug therapy
Sepsis - pathology
Side effects
Sputum
Staphylococcus aureus
Staphylococcus infections
State hospitals
Streptococcus infections
Streptococcus pneumoniae
Treatment Outcome
title Effects of Prior Effective Therapy on the Efficacy of Daptomycin and Ceftriaxone for the Treatment of Community-Acquired Pneumonia
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