title: Ceftazidime vs. amoxicillin/clavulanate in the treatment of severe melioidosis.
abstract: An open, paired, randomized, controlled trial of high-dose parenteral ceftazidime (120 mg/[kg.d]) vs. amoxicillin/clavulanate (160 mg/[kg.d]) for the treatment of severe melioidosis was conducted in Ubon Ratchatani in northeastern Thailand. Of 379 patients enrolled in the study, 212 (56%) had culture-proven melioidosis; 106 patients were in each treatment group. The overall mortality rate (47%) was similar for both treatment groups. However, 4 of 75 surviving patients in the ceftazidime group compared with 16 of 69 surviving patients in the amoxicillin/clavulanate group were switched to the alternate regimen because of an unsatisfactory clinical response after > or = 72 hours of treatment (P = .004). The overall therapeutic failure rate (i.e., treatment failure or death due to uncontrolled melioidosis) was significantly higher for the amoxicillin/clavulanate group than for the ceftazidime group (P = .02). Clinical and bacteriologic responses for successfully treated patients were similar in both groups, and both treatments were well tolerated. Parenteral amoxicillin/clavulanate is a safe and effective initial treatment, but parenteral ceftazidime remains the treatment of choice for severe melioidosis.
authors.affiliation: Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Y
authors.initials: Y
authors.lastname: Suputtamongkol
authors.forename: A
authors.initials: A
authors.lastname: Rajchanuwong
authors.forename: W
authors.initials: W
authors.lastname: Chaowagul
authors.forename: D A
authors.initials: DA
authors.lastname: Dance
authors.forename: M D
authors.initials: MD
authors.lastname: Smith
authors.forename: V
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: A L
authors.initials: AL
authors.lastname: Walsh
authors.forename: S
authors.initials: S
authors.lastname: Pukrittayakamee
authors.forename: N J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination; D002442:Ceftazidime / Q000627:therapeutic use*; D002969:Clavulanic Acids / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000188:drug therapy* / Q000382:microbiology; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D017211:Treatment Failure
chemical_list: D002969:Clavulanic Acids; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin; D002442:Ceftazidime