title: Randomized, double-blind, controlled study of cefoperazone-sulbactam plus cotrimoxazole versus ceftazidime plus cotrimoxazole for the treatment of severe melioidosis.
abstract: We conducted a prospective randomized, double-blind, controlled study of cefoperazone-sulbactam (ratio, 1:1; cefoperazone 25 mg/kg/day) plus cotrimoxazole (trimethoprim-sulfamethoxazole [TMP-SMZ] at a ratio of 80:400; TMP, 8 mg/kg/day) versus ceftazidime (100 mg/kg/day) plus cotrimoxazole (TMP, 8 mg/kg/day) for the treatment of severe melioidosis. Of 219 patients enrolled in the study, 102 (47%) had culture-proven melioidosis. These patients were assigned randomly to 2 treatment groups, each with 50 patients (2 patients were excluded). Mortality rates were not significantly different between the 2 groups: 18% in the cefoperazone-sulbactam group versus 14% in the ceftazidime group. The crude difference in the mortality rate was 4%, but when adjusted for type of infection the difference was 0.9% (95% confidence interval, -3.6% to 5.4%; P = .696). The duration of defervescence and the bacteriological response of successfully treated patients were similar in both groups, and both treatment regimens were well tolerated. Cefoperazone-sulbactam plus cotrimoxazole might be used as an alternative to ceftazidime plus cotrimoxazole as treatment for severe melioidosis.
authors.affiliation: Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. ploencha@kku1.kku.ac.th
authors.forename: P
authors.initials: P
authors.lastname: Chetchotisakd
authors.forename: S
authors.initials: S
authors.lastname: Porramatikul
authors.forename: P
authors.initials: P
authors.lastname: Mootsikapun
authors.forename: S
authors.initials: S
authors.lastname: Anunnatsiri
authors.forename: B
authors.initials: B
authors.lastname: Thinkhamrop
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016957:Burkholderia pseudomallei / Q000302:isolation & purification; D002438:Cefoperazone / Q000627:therapeutic use*; D002442:Ceftazidime / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D008875:Middle Aged; D011446:Prospective Studies; D013407:Sulbactam / Q000627:therapeutic use*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D002438:Cefoperazone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D002442:Ceftazidime; D013407:Sulbactam