Use of β-Lactam/β-Lactamase Inhibitor Combinations to Treat Community-Acquired Respiratory Tract Infections

β-Lactamase production is an important cause of β-lactam antibiotic resistance among respiratory tract pathogens. One approach to overcoming this resistance is the coadministration of a β-lactam with a β-lactamase inhibitor. Such combinations are effective in vitro against a wide range of bacterial pathogens, including Gram-positive and Gram-negative aerobes and anaerobes. The combination of ampicillin plus sulbactam, administered orally as the mutual prodrug sultamicillin, has been shown to be clinically effective in the treatment of pediatric respiratory tract infections (RTIs), including acute otitis media, and upper and lower RTIs in adults. In addition, ampicillin/sulbactam administered intravenously and then orally has proved effective in the treatment of community-acquired pneumonia (CAP) in hospitalized patients, and offers cost savings because of reductions in the length of hospital stay and duration of intravenous therapy. β-Lactam/β-lactamase inhibitor combinations are generally well tolerated. Current treatment guidelines support the use of these combinations as empiric treatment options for patients with CAP and acute exacerbations of chronic bronchitis, particularly for patients with infections suspected to be caused by β-lactamase-producing strains.