Ceftobiprol vs combination of vancomycin and ceftazidime in the treatment of patients with complicated skin and soft tissue infections
Ceftobiprol is no less effective than the combination of vancomycin and ceftazidime in the treatment of patients with complicated skin and soft tissue infections of both gram-positive and gram-negative etiology.
The objective of a multicenter, randomized, double-blind study by G.J. Noel et al. (United States), this was a comparative evaluation of the efficacy of ceftobiprol and the combination of vancomycin and ceftazidime in the treatment of patients with complicated skin and soft tissue infections ( ICMT) caused by Gram positive and Gram negative pathogens.
The data included 828 patients with the indicated pathology, randomized in a 2: 1 ratio to receive treatment with ceftobiprol at a dose of 500 mg intravenously for 120 minutes every 8 hours and with a combination of vancomycin at a dose of 1 g intravenously for 1 hour every 12 hours and ceftazidime at a dose of 1 g intravenously for 120 minutes every 8 hours The results were determined 7-14 days after the end of treatment for the whole population of patients and subgroups, taking into account the main types and severity of the infection.
According to the results, there was no significant difference in the clinical efficacy of ceftobiprol and the comparison drugs (90.5% [439 out of 485 patients] vs 90.2% [220 patients out of 244] in the population to be evaluated. and 81.9% [448 patients out of 547] vs 80.8% [227 patients out of 281] for all patients included in the study). In general, the efficacy of ceftobiprol treatment ranged from 86.2% (125 of 145 patients) in the group of patients with diabetes mellitus complicated by foot infection, to 93% (80 of 86 patients) in patients with cellulite.
It should be noted that the drug is very active regardless of the etiology of the infectious process (87.9% [109 of 124 patients] for infections caused by Gram-negative pathogens and 91.8% [292 of 318 patients] for infections caused by Gram-positive flora), similar to that of the comparison mode (89.7% [61 of 68 patients] and 90.3% [149 of 165 patients], respectively). At the same time, approximately 1/3 of the strains of Staphylococcus aureus that caused the infection were resistant to methicillin. The clinical efficacy in this group of patients was slightly lower for the two treatment regimens, but remained comparable, which allows us to consider ceftobiprol as the first cephalosporin active against MRSA and to recommend it for use in infections caused by this pathogen. The incidence of adverse events, including serious events, did not differ significantly in the two study groups.
Thus ceftobiprol is no less effective than the combination of vancomycin and ceftazidime in the treatment of patients with complicated skin and soft tissue infections of both Gram positive and Gram negative etiology , with a comparable safety profile, which allows us to recommend the use of this drug as monotherapy for these infections..