title: Empirical monotherapy with meropenem versus imipenem/cilastatin for febrile episodes in neutropenic patients.
abstract: In a nonblind, randomised, parallel-group study, initial empirical monotherapy with meropenem 1 g intravenously every 8 h was compared to an identical dosage of imipenem/cilastatin for the treatment of 66 febrile episodes in 61 adult neutropenic patients. 25/31 episodes treated with meropenem and 24/30 imipenem/cilastatin-treated episodes were still receiving unmodified therapy at 72 h (primary endpoint); this difference was not statistically significant. By the end of the treatment courses, 18/31 meropenem-treated episodes had responded clinically (cured or improved) compared with 18/30 episodes treated with imipenem/cilastatin. Another ten episodes initially treated with meropenem and six episodes treated with imipenem/cilastatia were cured after an additional antimicrobial agent had been administered (cured with modification). Satisfactory bacteriological responses (eradication plus presumed eradication) at the end of unmodified therapy was 9/11 in the meropenem group and 14/16 in the comparator group. Both regimes were well tolerated; however, there were more reports of nausea and/or vomiting in the impenem/cilastatin group (7/33 vs. 2/33 in the meropenem group). The carbapenems meropenem and imipenem/cilastatin appear to be suitable agents for empirical monotherapy of febrile episodes in neutropenic patients. Meropenem may be better tolerated than imipenem/cilastatin, allowing optimal dosing in this patient population.
authors.affiliation: Medizinische Klinik III, Schwerpunkt Infektiologie, Frankfurt, Germany.
authors.forename: P M
authors.initials: PM
authors.lastname: Shah
authors.forename: A
authors.initials: A
authors.lastname: Heller
authors.forename: H G
authors.initials: HG
authors.lastname: Fuhr
authors.forename: F
authors.initials: F
authors.lastname: Walther
authors.forename: S
authors.initials: S
authors.lastname: Halir
authors.forename: R
authors.initials: R
authors.lastname: Schaumann
authors.forename: A
authors.initials: A
authors.lastname: Böhme
authors.forename: B
authors.initials: B
authors.lastname: Jung
authors.forename: A
authors.initials: A
authors.lastname: Köhler
authors.forename: C
authors.initials: C
authors.lastname: Lips-Schulte
authors.forename: W
authors.initials: W
authors.lastname: Stille
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015377:Cilastatin / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007958:Leukocyte Count; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D013845:Thienamycins / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination; D000077731:Meropenem