title: Halving of mortality of severe melioidosis by ceftazidime.
abstract: An open randomised trial was conducted to compare ceftazidime (120 mg/kg/day) with "conventional therapy" (chloramphenicol 100 mg/kg/day, doxycycline 4 mg/kg/day, trimethoprim 10 mg/kg/day, and sulphamethoxazole 50 mg/kg/day) in the treatment of severe melioidosis. A paired restricted sequential trial designed to detect a reduction in mortality from 80 to 40% in culture-positive patients surviving greater than 48 hours was stopped after 22 months. Of the 161 patients entered into the study, 65 had bacteriologically confirmed melioidosis and 54 of these were septicaemic. Ceftazidime treatment was associated with a 50% (95% CI 19-81%) lower overall mortality than conventional treatment (74% vs 37%; p = 0.009) and should now become the treatment of choice for severe melioidosis.
authors.affiliation: Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand.
authors.forename: N J
authors.initials: NJ
authors.lastname: White
authors.forename: D A
authors.initials: DA
authors.lastname: Dance
authors.forename: W
authors.initials: W
authors.lastname: Chaowagul
authors.forename: Y
authors.initials: Y
authors.lastname: Wattanagoon
authors.forename: V
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: N
authors.initials: N
authors.lastname: Pitakwatchara
mesh_terms: D000206:Actuarial Analysis; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D002442:Ceftazidime / Q000627:therapeutic use*; D002648:Child; D002701:Chloramphenicol / Q000008:administration & dosage / Q000031:analogs & derivatives; D002986:Clinical Trials as Topic; D004318:Doxycycline / Q000008:administration & dosage; D004341:Drug Evaluation; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008554:Melioidosis / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation; D018805:Sepsis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013420:Sulfamethoxazole / Q000008:administration & dosage; D013997:Time Factors; D014295:Trimethoprim / Q000008:administration & dosage
chemical_list: D002701:Chloramphenicol; D002442:Ceftazidime; D014295:Trimethoprim; D013420:Sulfamethoxazole; D004318:Doxycycline; C026016:chloramphenicol succinate