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Treatment of ventilator-associated pneumonia with piperacillin-tazobactum and amikacin vs cefepime and levofloxacin: A randomized prospective study Ahmed, S.M.; Choudhary, J.; Ahmed, M.; Arora, V. & Parul, Ali S. Abstract Study Objectives: To compare the survival benefits and cost effectiveness of cefepime-levofloxacin (C-L) as an alternative empirical antibiotic therapy for ventilator associated pneumonia (VAP) with the most widely recommended combination of piperacillin-tazobactam and amikacin (P-T-A). Design: Prospective, observational, cohort study. Materials and Methods: A total number of 879 patients were admitted in the ICU during 1st April 2004 to 31 st March 2005 and were screened for the study. Ninety-three patients were clinically suspected to develop early onset VAP. The patients were randomly divided into two groups receiving Cefepime-Levofloxacin (C-L) or Piperacillin-Tazobactam-Amikacin (P-T-A) as empirical antibiotic therapy. Treatment outcome was compared between the groups, which included ICU mortality, duration of mechanical ventilation, duration of ICU stay and total cost incurred on antibiotics. Results: The epidemiological characteristics including mean age and APACHE II score were comparable between the two groups. The mortality rates in the two groups were similar. The duration of mechanical ventilation was shorter in C-L group (5-8 days) as compared to P-T-A group (6-11 days). Also, the mean duration of ICU stay was reduced in C-L group (16±2.1 days) as compared to P-T-A group (19±3.4 days). Further, the overall cost of antibiotics in C-L group was 1/3 rd of the cost in P-T-A group. Eleven patients were found to be receiving inappropriate antibiotics and seven patients developed ARF during the course of antibiotic therapy. These patients were excluded from the study. Conclusion: Cefepime-Levofloxacin combination is an effective alternative to piperacillin-tazobactam-amikacin for empirical treatment of VAP. It reduces the duration of mechanical ventilation, number of days of ICU stay and overall cost of antibiotics Keywords Antibiotics, cefepime, levofloxacin, piperacillin-tazobactam, ventilator associated pneumonia

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