A randomized, double-blind clinical trial comparing cefepime plus metronidazole with imipenem-cilastatin in the treatment of complicated intra-abdominal infections. Cefepime Intra-abdominal Infection Study Group.
OBJECTIVE
To evaluate the safety and efficacy of cefepime hydrochloride plus metronidazole vs the combination of imipenem and cilastatin sodium in the treatment of complicated intra-abdominal infections in adult patients.


METHODS
Prospective, randomized, double-blind multicenter study.


METHODS
University-affiliated hospitals in the United States and Canada.


METHODS
Three hundred twenty-three patients with complicated intra-abdominal infections in whom an operative procedure or percutaneous drainage was required for diagnosis and management.


METHODS
Cefepime, 2 g, was administered intravenously every 12 hours (n= 164) in addition to metronidazole, 500 mg (or 7.5 mg/kg) intravenously every 6 hours. Imipenen-cilastatin sodium, 500 mg, was administered intravenously every 6 hours (n= 159). Surgical infection management was determined by the patients' surgeons. MAIN OUTCOME ASSESSMENTS: Clinical cure, defined as elimination of all signs and symptoms relevant to the original infection; and treatment failure, defined as persistence, increase or worsening of signs and symptoms resulting in an antibiotic change, requirement of an additional surgical procedure to cure the infection, or a wound infection with fever.


RESULTS
Of the initial isolates, 84% were susceptible to cefepime and 92% were susceptible to imipenem-cilastatin. Among the 217 protocol-valid patients, those treated with cefepime+metronidizole were deemed clinical cures (88%) more frequently than were imipenem-cilastatin-treated patients (76%) (P=.02). Using multivariate analysis to adjust for identified clinical risk factors for an adverse outcome (severity of presenting illness, isolation of enterococcus, type of infection, and duration of prestudy hospitalization), there was a trend (P=.06) toward a higher cure rate favoring cefepime+metronidazole. Pathogens were eradicated in significantly (P=.01) more patients treated with combined cefepime and metronidazole (89%) than with imipenem-cilastatin (76%).


CONCLUSIONS
The combination of cefepime plus metronidazole is safe and effective therapy for patients with severe intra-abdominal infections.
Barie
P S
PS
Department of Surgery, Cornell University, New York, NY, USA. pbarie@mail.med.cornell.edu
Vogel
S B
SB
Dellinger
E P
EP
Rotstein
O D
OD
Solomkin
J S
JS
Yang
J Y
JY
Baumgartner
T F
TF
D000005:Abdomen; D018784:Abdominal Abscess / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000994:Antitrichomonal Agents / Q000627:therapeutic use*; D001064:Appendicitis / Q000188:drug therapy; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D015377:Cilastatin / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D007239:Infections / Q000188:drug therapy*; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy; D016896:Treatment Outcome
D000994:Antitrichomonal Agents; D002511:Cephalosporins; D008795:Metronidazole; D015377:Cilastatin; D015378:Imipenem; D000077723:Cefepime