Imipenem/cilastatin versus aminoglycoside plus amoxicillin plus clindamycin in the treatment of serious postoperative infections.
In a prospective, controlled and randomized study, the clinical and bacteriological efficacy of imipenem/cilastatin was compared to that of a standard combination of an aminoglycoside (tobramycin or netilmicin), amoxicillin and clindamycin in patients with life-threatening postoperative infections. Doses used were imipenem/cilastatin 1 g q 8 h, amoxicillin 2 g q 8 h and clindamycin 0.6 g q 6 h. Aminoglycoside doses were individual and monitored six times weekly with serum concentration assays. Thirty-eight patients were entered into the study; 19 in each group. Diagnoses were pneumonia (five in the imipenem/cilastatin group and four in the combination group), peritonitis (eight in the imipenem/cilastatin and 13 in the combination group) and septicemia (five in the imipenem/cilastatin and two in the combination group). The two groups were comparable with respect to sex, age, underlying diseases and duration of antibiotic therapy. In the imipenem/cilastatin group, 14 patients were cured and one improved (79%). In the combination group, 11 were cured and 5 improved (74%). Four patients in the imipenem/cilastatin and five in the combination group failed to respond to treatment. In the former group 77% of the bacterial isolates were eradicated and 15% were suppressed. Corresponding frequencies in the combination group were 67% and 22%, respectively. Persistence of isolated pathogens was seen in 8% and 11%, respectively. It is concluded that imipenem/cilastatin seems to be an effective and well tolerated alternative to antibiotic combinations in the treatment of life-threatening postoperative infections. It also offers the advantages of fever antibiotic doses and renunciation of aminoglycoside serum concentration monitoring.
Christen
D
D
Department of Surgery, University Hospital of Zurich, Switzerland.
Buchmann
P
P
Geroulanos
S
S
D000328:Adult; D000617:Aminoglycosides; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D015377:Cilastatin; D000077728:Cilastatin, Imipenem Drug Combination; D002981:Clindamycin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D003521:Cyclopropanes / Q000627:therapeutic use; D004338:Drug Combinations / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D015378:Imipenem; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D011897:Random Allocation; D013845:Thienamycins / Q000627:therapeutic use
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D003521:Cyclopropanes; D004338:Drug Combinations; D013845:Thienamycins; D015377:Cilastatin; D002981:Clindamycin; D015378:Imipenem; D000658:Amoxicillin; D000077728:Cilastatin, Imipenem Drug Combination