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Comparison of Meropenem-based triple therapy vs Minocycline-based Triple therapy for Carbapenem Resistant
Jinal Prajapati1, Tanvi Meshram2, Ankur Sharma3
1Department of Anesthesiology & Critical Care, AIIMS, Delhi, India.
Background:
Ventilator-associated pneumonia (VAP) resulted from Carbapenem-Resistant Acinetobacter baumannii (CRAB) poses serious treatment challenges. Our objective was to assess two triple medication combinations for VAP caused by CRAB.
Methods:
This prospective observational research was performed in the critical care unit of an academic medical center from January 2024 to March 2025. Two hundred adult patients with culture-proven CRAB-VAP were enrolled and treated with either minocycline-polymyxin-sulbactam or meropenem-polymyxin-sulbactam. Various outcomes assessed were clinical recovery, 7 and 28-day mortality, microbiological eradication, duration of ICU and hospital stay.
Results:
The clinical recovery rates were comparable in both groups (54% minocycline vs. 47% meropenem, p=0.322). The microbiological eradication rate was similar (39 % ) at day 28 in both groups. Patients treated with the minocycline regimen had significantly shorter ICU stay (16 vs. 18 days, p=0.003) and hospital stays (24 vs. 28 days, p<0.001) than the meropenem group. There was no significant difference between 7-day mortality (21% vs. 32%, p=0.078) or 28-day mortality (46% vs. 53%, p=0.322).
Conclusion:
Minocycline-based triple therapy was comparable to meropenem-based therapy in treating CRAB-VAP, with potential advantages in reducing duration of ICU and hospital stay. Minocycline may be a suitable alternative for CRAB-VAP in resource-limited settings.