Monotherapy versus combined therapy: pros and cons

Table of Contents

We conceed : 

Theoretical advantages of combination therapy

Treatment in neutropenic patients

Treatment of neutropenic patients

Antimicrobial activity of 15 drugs against the six most frequently isolated gram-negative (5,847 strains) from the 1997 SENTRY Antimicrobial Surveillance Program.

PPT Slide

Sera of volunteers receiving ceftazidime (2g) or amikacin (500mg), alone or in combination, or cefoperazone (2,4 or 6g) or cefoperazone (2g) with amikacin (500mg) were evaluated for bactericidal activity against Klebsiella pneumoniae and Pseudomonas aeruginosa. Serum bactericidal activities were similar for ceftazidime and ceftazidime plus amikacin, but were definitely lower for amikacin alone.

Median SBAs and percentage of sera with SBA ? 1:8

Treatment of neutropenic patients

Review of prospective studies in gram (-) bacteremia Combination > Monotherapy

Review of prospective studies in gram (-) bacteremia Combination = monotherapy

Review of prospective studies in gram (-) bacteremia Combination = monotherapy

PPT Slide

LEIBOVICI et Al., AAC, 1997 Mortality and antibiotic treatment : univariate analysis

Review of prospective studies in gram (-) bacteremia Combination = Monotherapy

Is combination therapy mandatory in P.aeruginosa septicemia ? 

Hospital acquired bronchopneumonia (HAP)

HAP - Human Trials (1)

HAP - Human Trials (2)

HAP - Human Trials (3)

Does combination therapy prevent the emergence of resistance ?

Combination therapy as a tool to prevent emergence of bacterial resistance

Number of animals with resistant subpopulations of P.aeruginosa after therapy in relation to the total number of animals treated during single drug therapy and combination therapy

Combination therapy and bacterial resistance

Combination therapy as a tool to prevent emergence of bacterial resistance

Possible indications for combination antibiotic therapy

Indications for monotherapy

Conclusion

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