Doripenem is a new carbapenem antibiotic with a broad spectrum of antimicrobial activity against the pathogens of nosocomial pneumonia. Doripenem is characterized by a number of advantages over previously known carbapenems and other classes of antimicrobial agents used for this indication.

A large-scale prospective, open-label, randomized, phase III study evaluating the efficacy of doripenem compared to piperacillin / tazobactam in nosocomial pneumonia or early ventilator-associated pneumonia (developed before 5 days with mechanical ventilation) involved 448 patients. Patient stratification was performed based on the presence / absence of mechanical ventilation, the severity of the disease and the geographic region. Patients were randomized to receive either doripenem iv for 1 hour at a dose of 500 mg every 8 hours, or piperacillin / tazobactam iv for 30 minutes. at a dose of 4.5 g every 6 hours Patients could be transferred orally to levofloxacin at a dose of 750 mg / day after more than 72 hours of parenteral antibiotic therapy. The maximum duration of antibiotic therapy in this study ranged from 7 to 14 days.

The primary endpoint was the clinical cure rate, which was estimated 7-14 days after the end of treatment and was 81.3% in the doripenem group and 79.8% in the piperacillin / tazobactam group in the patient population that may be subject to clinical evaluation (evaluation was carried out 7 to 14 days after the end of treatment). Resistance of pathogens to dorupenem was less frequent than to piperacillin / tazobactam (P. aeruginosa - 7.7% and 27%, respectively, K. pneumoniae - 0% and 44%, respectively). The favorable frequency of microbiological results for Gram-negative pathogens was higher in the doripenem group compared to piperacillin / tazobactam, but the differences were not statistically significant. Both drugs were characterized by good tolerance - thus, the frequency of adverse events associated with the use of the studied drugs was 16.1% in the doripenem group and 17.6% in the piperacillin / tazobactam group.

Limitations of the study were the open design, the low frequency of monotherapy (the additional use of aminoglycosides, which was necessary in the case of the suspected infection caused by P. aeruginosa) , and the exclusion of most critically ill patients and immunocompromised people. Doripenem is therefore clinically and microbiologically effective in patients with nosocomial pneumonia and early ventilator-associated pneumonia.