A randomized controlled trial of filgrastim as an adjunct to antibiotics for treatment of hospitalized patients with community-acquired pneumonia. CAP Study Group

Because of the critical role of neutrophils in host defenses, it was hypothesized that stimulation of neutrophil production and function with Filgrastim would improve the outcome of hospitalized patients with community-acquired pneumonia. To test this hypothesis, a randomized, placebo-controlled, mu...

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Bibliographic Details
Published in:The Journal of infectious diseases 1998-10, Vol.178 (4), p.1075-1080
Main Authors: Nelson, S, Belknap, S M, Carlson, R W, Dale, D, DeBoisblanc, B, Farkas, S, Fotheringham, N, Ho, H, Marrie, T, Movahhed, H, Root, R, Wilson, J
Format: Article
Language:English
Subjects:
Aged
Anti-Bacterial Agents - therapeutic use
APACHE
Australia
Canada
Community-Acquired Infections - complications
Community-Acquired Infections - drug therapy
Community-Acquired Infections - mortality
Demography
Double-Blind Method
Female
Filgrastim
Granulocyte Colony-Stimulating Factor - therapeutic use
Hospitalization
Humans
Inpatients
Leukocyte Count
Male
Middle Aged
Neutrophils - cytology
Pneumonia, Bacterial - complications
Pneumonia, Bacterial - drug therapy
Pneumonia, Bacterial - mortality
Recombinant Proteins
Risk Factors
Sputum - microbiology
United States
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Summary:Because of the critical role of neutrophils in host defenses, it was hypothesized that stimulation of neutrophil production and function with Filgrastim would improve the outcome of hospitalized patients with community-acquired pneumonia. To test this hypothesis, a randomized, placebo-controlled, multicenter trial of Filgrastim (300 micrograms/day up to 10 days) as an adjunct to antibiotics was conducted for these patients. Outcome measures included time to resolution of morbidity (TRM, a composite measure of temperature, respiratory rate, blood oxygenation, and chest radiograph), 28-day mortality, length of stay, and adverse events. Filgrastim increased blood neutrophils 3-fold, but TRM, mortality, and length of hospitalization were not affected. Treatment, however, accelerated radiologic improvement and appeared to reduce serious complications (e.g., empyema, adult respiratory distress syndrome, and disseminated intravascular coagulation). Filgrastim administration was safe and well tolerated in these patients. Additional trials are needed to establish the value of this approach to treatment of infectious diseases.
ISSN:0022-1899