Clinical Efficacy and Cost-Effectiveness Analysis of Cefepime or Piperacillin/tazobactam both with Ciprofloxacin in MICU Patients with Severe Pneumonia

Background: Patients with severe community-acquired pneumonia usually need ICU admission and have high mortality rate (up to 50%). Cefepime and piperacillin/tazobactam are active against Pseudomonas aeruginsa as well as Streptococcus pneumoniae but not recommended as primary therapy unless the patient has a risk for P. aeruginosa. But risks are not well established and it may be difficult for house staff to make a clinical decision and to narrow a spectrum of therapy might not be harmful. Methods: Patients with severe community-acquired pneumonia who was admitted in MICU have been recruited from Dec. 1, 2016 to Aug. 31, 2017. Patients who had absolute neutrophil count less than 1000/mm³ and received antibiotic therapy less than 72 hr were excluded. Each group received either cefepime or piperacillin/tazobactam, both with ciprofloxacin and changed to narrow spectrum antibiotic according to clinical evaluation. Results: 48 patients were screened and 43 patients (90%) were assessed. 21 patients were assigned to cefepime group and 22 were piperacillin/tazobactam group. APACHE II score were 18.7 ± 7.2 and 19.7 ± 7.9 (p=0.67). Clinical success rates were 86% and 82% for patients treated with cefepime and piperacillin/tazobactam respectively, and 3 (14%) and 4 patients (18%) were died, which showed no statistical significance. 9 patients (43%) in cefepime group and 5 (23%) in piperacillin/tazobactam group were superinfected (p=0.08). Conclusion: There were no significant differences in clinical efficacy in both groups. They would be acceptable strategies in terms of mortality but have concerns for superinfection.