The treatment of severe intra-abdominal infections: the role of piperacillin/tazobactam.
Intra-abdominal infections require treatment effective against both aerobic and anaerobic bacteria. Piperacillin/tazobactam, a beta-lactam/beta-lactamase-inhibitor combination, has a spectrum that includes Gram-positive and Gram-negative aerobic and anaerobic organisms. In one comparative study of piperacillin/tazobactam and gentamicin/clindamycin, 88% of patients treated with piperacillin/tazobactam had a favorable clinical outcome at endpoint compared to 74% of patients treated with gentamicin plus clindamycin. Bacteriological response at endpoint was 87% in the piperacillin/tazobactam group and 74% in the gentamicin plus clindamycin group. In a comparative trial of piperacillin/tazobactam versus imipenem/cilastatin, the clinical cure rate was 91% in the piperacillin/tazobactam group and 69% in the imipenem/cilastatin group (p = 0.005). Among microbiologically evaluable patients, the infecting organism was eradicated in 93% of piperacillin/tazobactam-treated patients compared to 76% eradication among imipenem/cilastatin-treated patients (p = 0.029). Results of these clinical trials and others have shown that piperacillin/tazobactam is a safe and effective alternative to either combination or monotherapy for intra-abdominal infections.
Department of Immunology, Hddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
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D000005:Abdomen; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D002986:Clinical Trials as Topic; D004338:Drug Combinations; D006801:Humans; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use*; D000078142:Tazobactam; D065093:beta-Lactamase Inhibitors
D004338:Drug Combinations; D065093:beta-Lactamase Inhibitors; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin