Prospective study comparing imipenem-cilastatin with clindamycin and gentamicin for the treatment of serious surgical infections.
Surgical infection remains a leading cause of hospital morbidity and mortality. We compared the efficacy and toxicity of imipenem-cilastatin sodium in 32 patients with that of clindamycin phosphate and gentamicin sulfate in 25 patients. In the imipenem-cilastatin group, 87.5% had a favorable outcome, with a 12.5% failure rate and 13 adverse reactions. In the clindamycin-gentamicin group, 80% had a favorable outcome, with a 20% failure rate and ten adverse reactions. Two significant superinfections with Pseudomonas and Candida were noted in patients treated with impenem-cilastatin. Each group had one case of Clostridium difficile-associated colitis. Cost analysis showed no differences between treatment arms, except in the appendicitis subgroup. For serious surgical infections, single-agent therapy with imipenem-cilastatin appears to be as efficacious as combination therapy with clindamycin and gentamicin.
Hackford
A W
AW
Department of Surgery, Tufts University School of Medicine, Boston, MA.
Tally
F P
FP
Reinhold
R B
RB
Barza
M
M
Gorbach
S L
SL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001420:Bacteria, Aerobic / Q000302:isolation & purification; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D015377:Cilastatin; D000077728:Cilastatin, Imipenem Drug Combination; D002981:Clindamycin / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003521:Cyclopropanes / Q000009:adverse effects / Q000627:therapeutic use; D004338:Drug Combinations / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015378:Imipenem; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation; D013845:Thienamycins / Q000009:adverse effects / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D003521:Cyclopropanes; D004338:Drug Combinations; D005839:Gentamicins; D013845:Thienamycins; D015377:Cilastatin; D002981:Clindamycin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination