Doribax: increased dose for hospital-acquired pneumonia

The dose and duration of Doribax (doripenem) treatment recommended for patients with nosocomial pneumonia has been increased.

Hospital-acquired pneumonia occurs more frequently in patients on ventilators | SCIENCE PHOTO LIBRARY
Hospital-acquired pneumonia occurs more frequently in patients on ventilators | SCIENCE PHOTO LIBRARY
A study in 233 patients with late-onset ventilator-associated pneumonia (VAP) was stopped early when a 7-day course of doripenem (1g by intravenous infusion every 8 hours) failed to display non-inferiority to a 10-day course of imipenem/cilastatin (1g by intravenous infusion every 8 hours). Detailed analysis indicated that the short fixed duration of treatment with doripenem was insufficient and was a major contributing factor to the inferior outcome.

New dosing recommendations

Based on these results, in combination with data from additional phase I and II trials using a 1g dosing regimen and from the pivotal phase III studies that used the 500mg dose, the following recommendations have been made:

  • The usual treatment duration for nosocomial pneumonia (including VAP) should be 10–14 days, preferably 14 days in infections due to non-fermenting organisms (eg, Pseudomonas or Acinetobacter spp.).
  • A dose of 1g by intravenous infusion over four hours at 8-hourly intervals should be considered if the patient has creatinine clearance ≥150ml/min or if infection is due to non-fermenting organisms.
  • Caution should be exercised when choosing doripenem as treatment, taking into account the appropriateness of a carbapenem antibacterial based on severity of infection, prevalence of resistance to other suitable antibacterials and the risk of selecting for carbapenem-resistant bacteria.
  • Consideration should be used when giving concomitant aminoglycosides (for example, if co-infection with P. aeruginosa is suspected or proven).

View Doribax drug record

Further information: Janssen-Cilag Ltd

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