Integrated analysis of CANVAS 1 and 2: phase 3, multicenter, randomized, double-blind studies to evaluate the safety and efficacy of ceftaroline versus vancomycin plus aztreonam in complicated skin and skin-structure infection.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of complicated skin and skin-structure infection (cSSSI). Increasing antimicrobial resistance in cSSSI has led to a need for new safe and effective therapies. Ceftaroline was evaluated as treatment for cSSSI in 2 identical phase 3 clinical trials, the pooled analysis of which is presented here. The primary objective of each trial was to determine the noninferiority of the clinical cure rate achieved with ceftaroline monotherapy, compared with that achieved with vancomycin plus aztreonam combination therapy, in the clinically evaluable (CE) and modified intent-to-treat (MITT) patient populations. METHODS: Adult patients with cSSSI requiring intravenous therapy received ceftaroline (600 mg every 12 h) or vancomycin plus aztreonam (1 g each every 12 h) for 5-14 days. RESULTS: Of 1378 patients enrolled in both trials, 693 received ceftaroline and 685 received vancomycin plus aztreonam. Baseline characteristics of the treatment groups were comparable. Clinical cure rates were similar for ceftaroline and vancomycin plus aztreonam in the CE (91.6% vs 92.7%) and MITT (85.9% vs 85.5%) populations, respectively, as well as in patients infected with MRSA (93.4% vs 94.3%). The rates of adverse events, discontinuations because of an adverse event, serious adverse events, and death also were similar between treatment groups. CONCLUSIONS: Ceftaroline achieved high clinical cure rates, was efficacious against cSSSI caused by MRSA and other common cSSSI pathogens, and was well tolerated, with a safety profile consistent with the cephalosporin class. Ceftaroline has the potential to provide a monotherapy alternative for the treatment of cSSSI. TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT00424190 for CANVAS 1 and NCT00423657 for CANVAS 2.

In situ concentration of semi-volatile aerosol using water-condensation technology

The effect of concentrating semi-volatile aerosols using a water-condensation technology was investigated using the Versatile Aerosol Concentration Enrichment System (VACES) and the Aerodyne Aerosol Mass Spectrometer (AMS) during measurements of ambient aerosol in Pittsburgh, PA. It was found that the shape of the sulfate mass-weighed size distribution was approximately preserved during passage through the concentrator for all the experiments performed, with a mass enhancement factor of about 10-20 depending on the experiment. The size distributions of organics, ammonium and nitrate were preserved on a relatively clean day (sulfate concentration around 7μg/m3), while during more polluted conditions the concentration of these compounds, especially nitrate, was increased at small sizes after passage through the concentrator. The amount of the extra material, however, is rather small in these experiments: between 2.4% and 7.5% of the final concentrated PM mass is due to "artifact" condensation. An analysis of thermodynamic processes in the concentrator indicates that the extra particle material detected can be explained by redistribution of gas-phase material to the aerosol phase in the concentrator. The analysis shows that the condensation of extra material is expected to be larger for water-soluble semi-volatile material, such as nitrate, which agrees with the observations. The analysis also shows that artifact formation of nitrate will be more pronounced in ammonia-limited conditions and virtually undetectable in ammonia-rich conditions. © 2004 Elsevier Ltd. All rights reserved.