Treatment of nosocomial pneumonia: monotherapy versus combination therapy

Pneumonia accounts for 15% of all nosocomial infections, and mortality case rates are as high as 60%. Aspiration of oropharyngeal flora is the most common antecedent to nosocomial pneumonia. Patients with chronic lung disease, depressed levels of consciousness, or who are intubated are at increased risk of developing pneumonia. We conducted two comparative, prospective studies using monotherapy with third-generation cephalosporins--the first comparing cefoperazone with combination therapy, and the second comparing cefoperazone monotherapy with ceftazidime monotherapy--for the treatment of nosocomial pneumonia in mildly to moderately ill patients. We found that both cefoperazone monotherapy and ceftazidime monotherapy were as effective as standard two-drug combinations (clindamycin/gentamicin or cefazolin/gentamicin). When total antibiotic costs were compared, cefoperazone monotherapy was the least expensive regimen.