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Meropenem monotherapy versus cefotaxime plus metronidazole combination treatment for serious intra-abdominal infections

Meropenem Monotherapie im Vergleich zu Cefotaxim plus Metronidazol in der Therapie schwerer intraabdomineller Infektionen

Summary

In an open, randomised, multicentre trial, the efficacy and tolerability of empirical meropenem monotherapy (1 g intravenously every 8 hours) and cefotaxime (2 g every 8 hours) plus metronidazole (0.5 g intravenously every 8 hours) for 5 to 10 days was compared in 94 patients with serious intra-abdominal infection who required surgery. Eighty-three patients had an evaluable clinical response. Significantly more patients in the meropenem group had a satisfactory clinical response at the end of treatment (41/43 [95.3%] vs 30/40 [75.0%]; p=0.008). The bacteriological response was also higher in the meropenem group (31/33 vs 26/32). In the bacteriologically evaluable population, a satisfactory clinical response was observed in 31/33 of those who received meropenem compared to 24/32 of the cefotaxime/metronidazole recipients (p=0.03). Empirical meropenem monotherapy should prove a useful alternative to the currently standard combination treatment for serious intraabdominal infections.

Zusammenfassung

In einer offenen, randomisierten Multicenter-Studie wurden die Wirksamkeit und Verträglichkeit einer initialen Monotherapie mit Meropenem (MEM, 1 g 3 × tägl. i.v.) mit der etablierten Kombinationstherapie Cefotaxim (CTX) plus Metronidazol (MTR) (2 g CTX+0.5 g MTR 3×tägl. i.v.) verglichen. 94 Patienten mit operationspflichtigen schweren intraabdominellen Infektionen wurden einbezogen. Davon waren 83 Patienten bezüglich klinischem Ansprechen auswertbar. Die klinische Wirksamkeit war in der MEM-Gruppe signifikant höher (41/43 Pat.=95.3% vs 30/40 Pat.=75%; p=0.008). Das bakteriologische Ansprechen war in der MEM-Gruppe ebenfalls höher im Vergleich zur Kombinationsgruppe (31/33 vs 26/32), der Unterschied war jedoch statistisch nicht signifikant. In der bakteriologisch auswertbaren Population war das klinische Ansprechen in der MEM-Gruppe signifikant höher als im Vergleichskollektiv (31/33 vs 24/32; p=0.03). MEM erscheint somit für die initiale empirische Monotherapie bei schweren intraabdominellen Infektionen geeignet.

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References

  1. 1.

    Levison, M. E., Bush, L. M. Peritonitis and other intra-abdominal infections. In:Mandell, G. L., Douglas, R. F., Bennett, J. E. (eds): Principles and practice of infectious diseases 3rd edition. Churchill Livingstone, London 1990, pp. 636–670.

  2. 2.

    Barth, X., Hayoun, H., Rat, P., Hoen, J. P., Favre, J. P., Lombard-Platet, R. Comparaison de deux associations d'antibiotiques au cours des péritonites: cefotaxime + clindamycin versus cefotaxime + metronidazole. Presse Méd. 20 (1991) 57–60.

  3. 3.

    Edwards, J. R., Turner, P. J., Wannop, C., Withnell, E. S., Grindey, A. J., Nairn, K. In vitro antimicrobial activity of SM-7338, a carbapenem antibiotic with stability to dehydropeptidase I. Antimicrob. Agents Chemother. 33 (1989) 215–222.

  4. 4.

    Kager, L., Nord, C. E. Imipenem/cilastatin in the treatment of intra-abdominal infections. A review of worldwide experience. Rev. Infect. Dis. 7 (Suppl. 3) (1985) 518–521.

  5. 5.

    Geroulanos, S. J., and the Merrem Study Group: Meropenem versus imipenem/cilastatin in the treatment of intra-abdominal infections requiring surgery. J. Antimicrob. Chemother. Suppl. (1995).

  6. 6.

    Huizinga, W. K. J., Warren, B. L., Baker, L. W., Valeur, P., Pezet, D. M., Hoogkamp-Korstanje, J. A. A., Karran, S. J.: Antibiotic monotherapy with meropenem in the surgical management of intra-abdominal infections. J. Antimicrob. Chemother. Suppl. (1995).

  7. 7.

    Solomkin, J. S., Dellinger, E. P., Christou, N. V., Busuttil, R. W. Results of a multicenter trial comparing imipenem/cilastatin to tobramycin/clindamycin for intra-abdominal infections. Ann. Surg. 212 (1990) 581–591.

  8. 8.

    Bedikian, A., Okamoto, M. P., Nakahir, R. K., Farino, J., Heseltine, P. N. R., Appleman, M. D., Yellin, A. E., Berne, T. V., Gill, M. A. Pharmacokinetics of meropenem in patients with intra-abdominal infections. Antimicrob. Agents Chemother. 38 (1994) 151–154.

  9. 9.

    Dowzicky, M., Nadler, H., Pitkin, D., Sheikh, W., Wilson, S.: Comparative activity and pathogen responses of meropenem vs clindamycin plus tobramycin for treatment of intra-abdominal infections in N. American clinical trials. Am. Congr. Anaer. Bact. Anaer. Inf. (1994) abs. 86.

  10. 10.

    Brismar, B., Malmborg, A. S., Tunevall, G., Lindgren, V., Bergman, L., Mentzing, L. O., Nyström, P. O., Ånséhn, S., Bächstrand, B., Skau, T., Andåcker, L., Gustafsson, P. O., Kasholm-Tengve, B., Sjöberg, L., Olsson-Liljequist, B., Eklund, A. E., Nord, C. E. Meropenem versus imipenem/cilastatin in the treatment of intra-abdominal infections. J. Antimicrob. Chemother. 35 (1995) 139–148.

  11. 11.

    Wilson, S. E. Carbapenems: Monotherapy in intra-abdominal sepsis. Scand. J. Infect. Dis. Suppl. 96 (1995) 28–33.

  12. 12.

    Freifeld, A. G., Walsh, T., Marshall, D., Gress, J., Steinberg, S. M., Hathorn, J., Rubin, M., Jarosinski, P., Gill, V., Young, R. C., Pizzo, P. A. Monotherapy for fever and neutropenia in cancer patients: a randomized comparison of ceftazidime versus imipenem. J. Clin. Oncol. 13 (1995) 165–176.

  13. 13.

    Bauernfeind, A., Wittmann, D. H. Erregerspezifische Pathogenitätsfaktoren der Mikroflora bei Peritonitiden. FAC Fort-schritte der Antimikrobiellen und Antineoplastischen Chemotherapie 2–3 (1983) 431–436.

  14. 14.

    Baron, E. J., Bennion, R., Thompson, J., Strong, C., Summanen, P., McTeague, M., Finegold, S. M. A microbiological comparison between acute and complicated appendicitis. Clin. Infect. Dis. 14 (1992) 227–231.

  15. 15.

    Nichols, R. L., Smith, J. W. Wound and intra-abdominal infections: Microbiological considerations and approaches to treatment. Clin. Infect. Dis. 16 Suppl. 4 (1993) 266–272.

  16. 16.

    Bauernfeind, A., Jungwirth, R., Schweighart, S. In-vitro activity of meropenem, imipenem, the penem HRE 664 and ceftazidime against clinical isolates from West Germany. J. Antimicrob. Chemother. 24 Suppl. A (1989) 73–84.

  17. 17.

    Donowitz, G. R., Mandell, G. L. Beta-lactam antibiotics (Second of Two Parts). N. Engl. J. Med. 318 (1988) 490–500.

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On behalf of the German Peritonitis Study Group: Dr.Griesenbeck, Prof. Dr.Wendling, Prof. Dr.Männl, Prof. Dr.Rückert, Germany.

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Kempf, P., Blum, J., Bauernfeind, A. et al. Meropenem monotherapy versus cefotaxime plus metronidazole combination treatment for serious intra-abdominal infections. Infection 24, 473–479 (1996). https://doi.org/10.1007/BF01713053

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Keywords

  • Metronidazole
  • Cefotaxime
  • Meropenem
  • Intraabdominal Infection
  • Bacteriological Response