Comparative evaluation of netilmicin-ticarcillin and tobramycin-ticarcillin in the treatment of serious systemic infections in elderly patients.
The effectiveness and safety of two antibiotic regimens, netilmicin-ticarcillin (NT) and tobramycin-ticarcillin (TT), were compared in a prospective, randomized, blind-evaluator study involving 60 elderly patients with serious systemic infections. Fifty-three patients were evaluated for treatment effectiveness; 25 (93%) of 27 patients in the NT group and 24 (92%) of 26 patients in the TT group had complete clinical resolution or improvement of their infections. There were two clinical failures in each group. Bacteriological responses were comparable in both treatment groups, with 87% (58/67) of the pathogens eliminated from patients in the NT group and 83% (59/71) eliminated from the patients in the TT group. The elimination rate for Pseudomonas aeruginosa, the organism most frequently isolated, was 88% (14/16) in the NT group and 77% (10/13) in the TT group. The differences between response rates of the treatment groups were not statistically significant. Auditory toxicity, detected by pure tone audiometry, was observed in two of the 24 patients treated with TT and in none of the patients treated with NT. Dizziness or vertigo, possibly resulting from aminoglycoside administration, occurred in one of the 29 patients given NT and in four of the 31 patients given TT. Nephrotoxicity, detected by serial serum creatinine determinations, developed in none of the patients in the NT group and in five of the 31 patients in the TT group, the difference being statistically significant (P = 0.05). The results of this study indicate that NT and TT are comparable in efficacy and that NT is less likely than TT to cause nephrotoxicity or disturbances in eighth cranial nerve function.
D000368:Aged; D001424:Bacterial Infections / Q000097:blood / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006320:Hearing Tests; D006801:Humans; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008297:Male; D009428:Netilmicin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010406:Penicillins / Q000627:therapeutic use*; D011897:Random Allocation; D013982:Ticarcillin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014031:Tobramycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D005839:Gentamicins; D010406:Penicillins; D009428:Netilmicin; D013982:Ticarcillin; D014031:Tobramycin