Comparative efficacy of cefpirome & ceftazidime alone or in combination with isepamycin in empiric treatment of septicaemia in patients admitted to ICU

Abstract

An analysis was carried out to assess the efficacy, safety and cost effectiveness of Cefpirome (1-2g IV)/Ceftazidime (1-2g IV) alone or in combination with Isepamicin 8-15 mg/kg for empiric treatment of 120 patients of Nosocomial Septicaemia in Intensive Care Unit. Drug was given by random allocation according to the investigator's initial choice of monotherapy or combination therapy and then according to indication and severity of infection. The primary end point was the clinical response at the end of treatment. The result was viewed by blinded observer. 120 patients were divided into 4 groups of 30 cases each. Group I received Cefpirome alone, Group II received Ceftazidime alone, Group III received Cefpirome +Isepamicin and Group IV received Ceftazidime + Isepamicin. The main causative pathogen was gram - negative with Acinetobacter species predominating. Among gram-positive pathogens coagulase-negative staphylococcus predominated. Among clinically evaluable patients with confirmed septicaemia success rate was 50% for Group I and for other Groups it was 100%. In patients with clinically suspected septicaemia success rate obtained were 16.7% for Group I, 44.4% for Group II, 52.2% for Group III, and 48.0% for Group IV. Among monotherapy group adverse reactions were more in Group I than in Group II(16.7% versus 1.3%). Among combination therapy adverse reactions were more in Group III than in Group IV (19.9% versus 13.3%). Regarding cost effectiveness, ICU-stay with Group II was found to be less than that with Group I so Group II antibiotic was found to be more cost effective than Group I antibiotic (Rs. 3080.00 versus Rs. 6304.00). Among combination therapy group- Group IV was more cost effective than Group III (Rs. 8716.80 versus Rs.11151.00) irrespective of less ICU stay with Group III antibiotics. For empiric treatment of Nosocomial Septicaemia in ICU combination therapy may be the best choice. Among combination therapy because of better bacteriological and clinical efficacy, Group III is the better choice irrespective of its high cost, however Group IV antibiotics can also be advocated for empiric treatment of Nosocomial Septicaemia in ICU as it was found to have bacteriological efficacy similar to that of Group III antibiotics and also more cost effective. Among monotherapy Group II is the better choice.