title: Comparison of imipenem and ceftazidime as therapy for severe melioidosis.
abstract: An open, prospective, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of high-dose intravenous imipenem and ceftazidime for acute severe melioidosis. Adult Thai patients with suspected acute, severe melioidosis were randomized to receive either imipenem, at a dosage of 50 mg/(kg x d), or ceftazidime, at a dosage of 120 mg/(kg x d), for a minimum of 10 days. The main outcome measures were death or treatment failure. Of the 296 patients enrolled, 214 had culture-confirmed melioidosis, and 132 (61.7%) of them had positive blood cultures. Mortality among patients with melioidosis was 36.9% overall. There were no differences in survival overall (P = .96) or after 48 hours (P = .3). Treatment failure after 48 hours was more common among patients treated with ceftazidime (P = .011). Both treatments were well tolerated. Imipenem is a safe and effective treatment for acute severe melioidosis and may be considered an alternative to ceftazidime.
authors.affiliation: Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. fnajs@diamond.mahidol.ac.th
authors.forename: A J
authors.initials: AJ
authors.lastname: Simpson
authors.forename: Y
authors.initials: Y
authors.lastname: Suputtamongkol
authors.forename: M D
authors.initials: MD
authors.lastname: Smith
authors.forename: B J
authors.initials: BJ
authors.lastname: Angus
authors.forename: A
authors.initials: A
authors.lastname: Rajanuwong
authors.forename: V
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: P A
authors.initials: PA
authors.lastname: Howe
authors.forename: A L
authors.initials: AL
authors.lastname: Walsh
authors.forename: W
authors.initials: W
authors.lastname: Chaowagul
authors.forename: N J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002442:Ceftazidime / Q000009:adverse effects / Q000627:therapeutic use*; D002511:Cephalosporins / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015378:Imipenem / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008554:Melioidosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D013845:Thienamycins / Q000009:adverse effects / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002511:Cephalosporins; D013845:Thienamycins; D015378:Imipenem; D002442:Ceftazidime