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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


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.


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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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).

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