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 |
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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. |
doi_str_mv | 10.1086/533441 |
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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. 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><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibacterials</subject><subject>Articles and Commentaries</subject><subject>Ceftriaxone - adverse effects</subject><subject>Ceftriaxone - therapeutic use</subject><subject>Community-Acquired Infections - drug therapy</subject><subject>Community-Acquired Infections - microbiology</subject><subject>Community-Acquired Infections - pathology</subject><subject>Cubism</subject><subject>Daptomycin - adverse effects</subject><subject>Daptomycin - therapeutic use</subject><subject>Diarrhea - chemically induced</subject><subject>Double-Blind Method</subject><subject>Drug therapy</subject><subject>Effectiveness studies</subject><subject>Female</subject><subject>Headache - chemically induced</subject><subject>Health outcomes</subject><subject>Humans</subject><subject>Infections</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical cures</subject><subject>Middle Aged</subject><subject>Nausea - chemically induced</subject><subject>Pathogens</subject><subject>Pharmaceutical preparations</subject><subject>Pneumonia</subject><subject>Pneumonia - drug therapy</subject><subject>Pneumonia - pathology</subject><subject>Pneumonia, Ventilator-Associated - drug therapy</subject><subject>Pneumonia, Ventilator-Associated - pathology</subject><subject>Sepsis - drug therapy</subject><subject>Sepsis - pathology</subject><subject>Side effects</subject><subject>Sputum</subject><subject>Staphylococcus aureus</subject><subject>Staphylococcus infections</subject><subject>State hospitals</subject><subject>Streptococcus infections</subject><subject>Streptococcus pneumoniae</subject><subject>Treatment Outcome</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10UGL1DAYBuAiiruu-g-U6MFbNWmSSXJcZ1ZHXHAOI4iXkKZf2YzTpJuksr36y23psAuCp4S8Dy_5-IriJcHvCZarD5xSxsij4pxwKsoVV-TxdMdclkxSeVY8S-mAMSES86fFGZGMMcnkefHnqm3B5oRCi3bRhYiWB_cb0P4GoulHFDzKNzAHzho7znRj-hy60TqPjG_QGtocnbkLHlA7dcx8H8HkDnye_Tp03eBdHstLezu4CA3aeRi64J15XjxpzTHBi9N5UXz_dLVfb8vrb5-_rC-vS8ukyGXNVNuAokzgxnImAUhNuTUUK1krpQxlBFfTtA0IozDFzcwrrGhNGdiGXhTvlt4-htsBUtadSxaOR-MhDElXeCU4lmyCb_-BhzBEP_1NV0QpgTkRD202hpQitLqPrjNx1ATreSV6WckEX5_ahrqD5oGddjCBNwsIQ___kleLOaQc4r1i05iCyGrKyyV3KcPdfW7iL70SVHC9_fFTb6modpuvH_WG_gXDzqjC</recordid><startdate>20080415</startdate><enddate>20080415</enddate><creator>Pertel, Peter E.</creator><creator>Bernardo, Patricia</creator><creator>Fogarty, Charles</creator><creator>Matthews, Peter</creator><creator>Northland, Rebeca</creator><creator>Benvenuto, Mark</creator><creator>Thorne, Grace M.</creator><creator>Luperchio, Steven A.</creator><creator>Arbeit, Robert D.</creator><creator>Alder, Jeff</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope></search><sort><creationdate>20080415</creationdate><title>Effects of Prior Effective Therapy on the Efficacy of Daptomycin and Ceftriaxone for the Treatment of Community-Acquired Pneumonia</title><author>Pertel, Peter E. ; Bernardo, Patricia ; Fogarty, Charles ; Matthews, Peter ; Northland, Rebeca ; Benvenuto, Mark ; Thorne, Grace M. ; Luperchio, Steven A. ; Arbeit, Robert D. ; Alder, Jeff</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c487t-b49fde93470dc548ee1b35ca3098b999a34102483de7a9030dfde92093b34ecd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - adverse effects</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibacterials</topic><topic>Articles and Commentaries</topic><topic>Ceftriaxone - adverse effects</topic><topic>Ceftriaxone - therapeutic use</topic><topic>Community-Acquired Infections - drug therapy</topic><topic>Community-Acquired Infections - microbiology</topic><topic>Community-Acquired Infections - pathology</topic><topic>Cubism</topic><topic>Daptomycin - adverse effects</topic><topic>Daptomycin - therapeutic use</topic><topic>Diarrhea - chemically induced</topic><topic>Double-Blind Method</topic><topic>Drug therapy</topic><topic>Effectiveness studies</topic><topic>Female</topic><topic>Headache - chemically induced</topic><topic>Health outcomes</topic><topic>Humans</topic><topic>Infections</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical cures</topic><topic>Middle Aged</topic><topic>Nausea - chemically induced</topic><topic>Pathogens</topic><topic>Pharmaceutical preparations</topic><topic>Pneumonia</topic><topic>Pneumonia - drug therapy</topic><topic>Pneumonia - pathology</topic><topic>Pneumonia, Ventilator-Associated - drug therapy</topic><topic>Pneumonia, Ventilator-Associated - pathology</topic><topic>Sepsis - drug therapy</topic><topic>Sepsis - pathology</topic><topic>Side effects</topic><topic>Sputum</topic><topic>Staphylococcus aureus</topic><topic>Staphylococcus infections</topic><topic>State hospitals</topic><topic>Streptococcus infections</topic><topic>Streptococcus pneumoniae</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><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><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & 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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