Ampicillin-Sulbactam for the Treatment of Aspiration Pneumonia in Patients with Opioid Overdose: A Randomized Controlled Clinical Trial
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 11 No. 4 (2021),
17 November 2021
,
Page 34657
https://doi.org/10.32598/ijmtfm.v11i4.34657
Abstract
Background: Aspiration pneumonia is among overdose complications, requiring timely appropriate treatment. The present study aimed to evaluate the effects of ampicillin-sulbactam, compared to our usual regimen ceftriaxone + clindamycin on aspiration pneumonia in opioid-poisoned patients.
Methods: In a randomized-controlled clinical trial, opioid-poisoned patients with aspiration pneumonia were randomly divided into the experimental and control groups to receive ampicillin-sulbactam 3 g Intravenously (IV) every 6 hours (experimental group) and ceftriaxone 1 g IV every 12 hours + clindamycin 600 mg IV every 8 hours (control group) followed by co-amoxiclav 625 mg orally every 8 hours and cefixime 400 mg once daily + clindamycin 600 mg orally every 8 hours in experimental and control groups, respectively, to complete a 7-day course of therapy. White blood cell count and temperature (axillary) at baseline and the third day of the intervention and the treatment outcome on the third day of the intervention, defined as either complete response, partial response, or failure, were evaluated and recorded for all patients.
Results: Except for the number of cases of leukocytosis on the third day of the intervention, i.e., lower in the control group (5 patients, 26.30%) than the experimental group (13 patients, 68.40%) (P=0.020), no significant difference was observed between the study groups regarding other outcome variables. Clinical response was similar between the study groups; so that, 10.50% and 63.20% of patients in the experimental group and 21.10% and 47.4% of patients in the control group presented complete and partial responses, respectively (P=0.550).
Conclusion: The obtained data suggested that ampicillin-sulbactam is an effective antibiotic for the treatment of aspiration pneumonia in patients with opioid overdose, in which case, it has the same efficacy as the two-drug regimen of ceftriaxone + clindamycin.
- Aspiration pneumonia
- Opioid overdose
- Ampicillin-Sulbactam
- Clinical trial
How to Cite
References
Taylor JK, Fleming GB, Singanayagam A, Hill AT, Chalmers JD. Risk factors for aspiration in community-acquired pneumonia: Analysis of a hospitalized UK cohort. Am J Med. 2013; 126(11):995-1001. [DOI:10.1016/j.amjmed.2013.07.012] [PMID]
Gleeson K, Eggli DF, Maxwell SL. Quantitative aspiration during sleep in normal subjects. Chest. 1997; 111(5):1266-72. [DOI:10.1378/chest.111.5.1266] [PMID]
Mandell LA, Niederman MS. Aspiration pneumonia. N Engl J Med. 2019; 380(7):651-63. [DOI:10.1056/NEJMra1714562] [PMID]
Dublin S, Walker RL, Jackson ML, Nelson JC, Weiss NS, Von Korff M, et al. Use of opioids or benzodiazepines and risk of pneumonia in older adults: A population-based case-control study. J Am Geriatr Soc. 2011; 59(10):1899-907. [DOI:10.1111/j.1532-5415.2011.03586.x] [PMID] [PMCID]
Sacerdote P, Manfredi B, Mantegazza P, Panerai AE. Antinociceptive and immunosuppressive effects of opiate drugs: A structure-related activity study. Br J Pharmacol. 1997; 121(4):834-40. [DOI:10.1038/sj.bjp.0701138] [PMID] [PMCID]
Finegold SM. Aspiration pneumonia. Rev Infect Dis. 1991; 13 (Suppl 9):S737-42. [DOI:10.1093/clinids/13.Supplement_9.S737] [PMID]
Bartlett JG. Anaerobic bacterial pneumonitis. Am Rev Respir Dis. 1979; 119(1):19-23. [PMID]
Lorber B, Swenson RM. Bacteriology of aspiration pneumonia. A prospective study of community- and hospital-acquired cases. Ann Intern Med. 1974; 81(3):329-31. [DOI:10.7326/0003-4819-81-3-329] [PMID]
El-Solh AA, Pietrantoni C, Bhat A, Aquilina AT, Okada M, Grover V, et al. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med. 2003; 167(12):1650-4. [DOI:10.1164/rccm.200212-1543OC] [PMID]
Klompas M. Aspiration pneumonia in Adult [Internet]. 2019 [Updated 2019 July 21]. Available from: https://www.uptodate.com/contents/aspiration-pneumonia-in-adults?search=aspiration-pneumonia-in%20adults&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
Kazachkov M, Palma JA, Norcliffe-Kaufmann L, Bar-Aluma BE, Spalink CL, Barnes EP, et al. Respiratory care in familial dysautonomia: Systematic review and expert consensus recommendations. Respir Med. 2018; 141:37-46. [DOI:10.1016/j.rmed.2018.06.017] [PMID] [PMCID]
Son YG, Shin J, Ryu HG. Pneumonitis and pneumonia after aspiration. J Dent Anesth Pain Med. 2017; 17(1):1-12. [DOI:10.17245/jdapm.2017.17.1.1] [PMID] [PMCID]
Bowerman TJ, Zhang J, Waite LM. Antibacterial treatment of aspiration pneumonia in older people: A systematic review. Clin Interv Aging. 2018; 13:2201-13. [DOI:10.2147/CIA.S183344] [PMID] [PMCID]
Hoffman JR, Schriger DL, Luo JS. The empiric use of naloxone in patients with altered mental status: A reappraisal. Ann Emerg Med. 1991; 20(3):246-52. [DOI:10.1016/S0196-0644(05)80933-3]
Lomotan JR, George SS, Brandstetter RD. Aspiration pneumonia. Strategies for early recognition and prevention. Postgrad Med. 1997; 102(2):225-6, 229-31. [PMID]
Allewelt M, Schüler P, Bölcskei PL, Mauch H, Lode H; Study Group on Aspiration Pneumonia. Ampicillin + sulbactam vs clindamycin +/- cephalosporin for the treatment of aspiration pneumonia and primary lung abscess. Clin Microbiol Infect. 2004; 10(2):163-70. [DOI:10.1111/j.1469-0691.2004.00774.x] [PMID]
Hasegawa S, Shiraishi A, Yaegashi M, Hosokawa N, Morimoto K, Mori T. Ceftriaxone versus ampicillin/sulbactam for the treatment of aspiration-associated pneumonia in adults. J Comp Eff Res. 2019; 8(15):1275-84. [DOI:10.2217/cer-2019-0041] [PMID]
Kadowaki M, Demura Y, Mizuno S, Uesaka D, Ameshima S, Miyamori I, et al. Reappraisal of clindamycin IV monotherapy for treatment of mild-to-moderate aspiration pneumonia in elderly patients. Chest. 2005; 127(4):1276-82. [DOI:10.1016/S0012-3692(15)34477-9] [PMID]
Ott SR, Allewelt M, Lorenz J, Reimnitz P, Lode H; German Lung Abscess Study Group. Moxifloxacin vs ampicillin/sulbactam in aspiration pneumonia and primary lung abscess. Infection. 2008; 36(1):23-30. [DOI:10.1007/s15010-007-7043-6] [PMID]
Herbeck DM, Fitek DJ, Svikis DS, Montoya ID, Marcus SC, West JC. Treatment compliance in patients with comorbid psychiatric and substance use disorders. Am J Addict. 2005; 14(3):195-207. [DOI:10.1080/10550490590949488] [PMID] [PMCID]
- Abstract Viewed: 675 times
- PDF Downloaded: 605 times