Treatment of Ventilator-Associated Gram-Negative Pneumonia with Imipenem-Cilastatin/Amikacin Versus Ticarcillin-Clavulanate/Amikacin

Ventilator-associated pneumonia (VAP) is a common nosocomial infection in the intensive care unit (ICU). This study was performed in the Reanimation and Emergency ICUs of the Ankara D›flkap› Education and Research Hospital between January 1997 and January 2000. In a randomized, prospective trial, we compared imipenem-cilastatin (500 mg four times a day) + amikacin (1 g single dose a day) with ticarcillin/clavulanate (3.1 g four times a day) + amikacin (1 g single dose a day) for the treatment of VAP in 35 adult ICU patients. In this study, there was no statistically significant difference between the mortality rates and risk factors of the group I patients and group II patients (p> 0.05). Our results demonstrate that in patients with VAP, there is no significant difference between combination therapy with ticarcillin-clavulanate/amikacin and imipenem-cilastatin/amikacin in terms of bacteriological eradication and clinical response

Combination antifungal therapy with voriconazole for persistent candidemia in very low birth weight neonates

The purpose of this article is to report our experience with intravenous voriconazole therapy in the treatment of persistent Candida septicemia in very low birth weight (VLBW) neonates. Candidiasis was defined if an infant had a positive blood culture. Ten VLBW newborns developed Candida sepsis, and candidemia persisted in 6 of them despite 3 to 21 days of antifungal therapy with amphotericin B, either conventional or liposomal, and fluconazole. After the addition of voriconazole, clearance of Candida was achieved within 3-7 days of treatment. Antifungal therapy combination with liposomal amphotericin B and voriconazole was continued for at least two weeks after two negative cultures 48 hours apart. We conclude that considering the hazardous effects of Candida infections in preterm newborns, voriconazole can be added to the treatment of fungal sepsis in newborns who still have persistent candidemia despite conventional antifungal management. More clinical information is needed before voriconazole can be used as a first-line drug in antifungal therapy in newborns