title: Meropenem versus cefuroxime plus gentamicin for treatment of serious infections in elderly patients.
abstract: In this multicenter study, the efficacy of and tolerability for meropenem were compared with those for the combination of cefuroxime-gentamicin (+/- metronidazole) for the treatment of serious bacterial infections in patients > or = 65 years of age. A total of 79 patients were randomized; thirty-nine received meropenem (1 g/8 h), and 40 received cefuroxime (1.5 g/8 h) plus gentamicin (4 mg/kg of body weight daily) for 5 to 10 days. Metronidazole (500 mg/6 h) could be added to the cefuroxime-gentamicin regimen for the treatment of intra-abdominal infections (n = 10). Seventy patients were evaluable for clinical efficacy; the primary diagnoses were as follows: pneumonia in 41 patients (20 treated with meropenem, 21 treated with cefuroxime-gentamicin), intra-abdominal infection in 10 patients (7 meropenem, 3 cefuroxime-gentamicin-metronidazole), urinary tract infection (UTI) in 11 patients (6 meropenem, 5 cefuroxime-gentamicin), sepsis syndrome in 7 patients (4 meropenem, 3 cefuroxime-gentamicin), and "other" in 1 patient (cefuroxime-gentamicin). The pathogens isolated from 18 patients with bacteremia were as follows: Staphylococcus spp. (n = 2), Streptococcus spp. (n = 2), members of the family Enterobacteriaceae (n = 11), and Bacteroides spp. (n = 3). A satisfactory clinical response at the end of therapy was achieved in 26 of 37 (70%) and 24 of 33 (73%) evaluable patients treated with meropenem and combination therapy, respectively. Clinical success was achieved in 23 of 31 (74%) and 21 of 28 (75%) evaluable patients with infections other than UTIs, respectively. A satisfactory microbiological response occurred in 15 of 22 (68%) patients in the meropenem group compared with 12 of 19 (63%) treated with combination therapy. Renal failure occurred during therapy in 2 of 39 (5%) meropenem recipients compared with 5 of 40 (13%) of those treated with combination therapy. The findings in this small study indicate that meropenem is as efficacious for and as well tolerated by elderly patients as the combination of cefuroxime-gentamicin (+/- metronidazole).
authors.affiliation: Department of Medicine, University Hospital Utrecht, The Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: Jaspers
authors.forename: H
authors.initials: H
authors.lastname: Kieft
authors.forename: B
authors.initials: B
authors.lastname: Speelberg
authors.forename: A
authors.initials: A
authors.lastname: Buiting
authors.forename: M
authors.initials: M
authors.lastname: van Marwijk Kooij
authors.forename: G J
authors.initials: GJ
authors.lastname: Ruys
authors.forename: H H
authors.initials: HH
authors.lastname: Vincent
authors.forename: M C
authors.initials: MC
authors.lastname: Vermeulen
authors.forename: A G
authors.initials: AG
authors.lastname: Olink
authors.forename: I M
authors.initials: IM
authors.lastname: Hoepelman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000188:drug therapy*; D002444:Cefuroxime / Q000008:administration & dosage / Q000009:adverse effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D000077731:Meropenem; D013845:Thienamycins / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005839:Gentamicins; D013845:Thienamycins; D000077731:Meropenem; D002444:Cefuroxime