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Abstract

A comparison of aztreonam and tobramycin was carried out in 49 hospitalized patients with lower respiratory tract infections caused by gram-negative bacilli. Patients wererandomly assigned to the treatment drug. Clindamycin was given concomitantly until the pathogen was identified and the presence of a gram-positive microorganism was ruled out. Samples of sputum were obtained for culture from the lung parenchyma by deep expectoration or transtracheal aspiration. A pathogen was defined as an organism that showed heavygrowth and predominated in the culture. Pseudomonas aeruginosa wasthe most frequently isolated pathogen, followed by Haemophilus influenzae and Proteus mirabilis. A variety of lesscommon pathogens wererepresented. Thirty-fivepatients were treated with intravenous aztreonam (1–2 g every8 hr) and 14 with intravenous tobramycin (3–5 mg/kg per day) until they were afebrile and sputum cultures had been free of the pathogen for 48 hr. The minimum duration of treatment was five days. In the aztreonam group, only two (5%) of the 37 gram-negative pathogens-one P. aeruginosa and one Escherichia coli-persisted. In the tobramycin group, seven (50%) of the 14 pathogens, persisted. Clinical response paralleled microbiologic response. Adverse effectsin both treatment groups wereminor and transient. In this trial aztreonam was effective and safe for treatment of lower respiratory tract infections caused by P. aeruginosa and a variety of other gram-negative bacilli.

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© 1985 by The University of Chicago
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Session III. Lower Respiratory Tract Infections
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