Imipenem/cilastatin versus gentamicin/clindamycin for treatment of serious bacterial infections. Report from a Scandinavian Study Group.
In a randomised, coordinated six-centre study 163 patients with serious systemic infections received treatment with either imipenem (N-formimidoyl thienamycin) plus cilastatin, an inhibitor of its renal metabolism (77, I/C group) or gentamicin and clindamycin (86, G/C group); 56 and 62, respectively, were evaluable. Significantly more G/C than I/C patients failed to respond to treatment (9 vs 2) and 1 G/C patient died of infection. The frequency of elimination of causative pathogens was higher in the I/C group (88% vs 77%). Clinical and biochemical adverse reactions were less common in the I/C than the G/C group. Treatment had to be discontinued because of adverse reactions in 3 I/C patients and in 7 G/C patients. Clinical superinfections were noted in 1 I/C and in 2 G/C patients. Thrombophlebitis was significantly more common in the I/C group. In terms of clinical and bacteriological efficacy and safety, the I/C combination was superior to gentamicin/clindamycin.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D015377:Cilastatin; D002981:Clindamycin / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D003521:Cyclopropanes / Q000008:administration & dosage*; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D015378:Imipenem; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D013845:Thienamycins / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D003521:Cyclopropanes; D005839:Gentamicins; D013845:Thienamycins; D015377:Cilastatin; D002981:Clindamycin; D015378:Imipenem