INTRAVENOUS MEROPENEM VERSUS IMIPENEM CILASTATIN IN THE TREATMENT OF SERIOUS BACTERIAL-INFECTIONS IN HOSPITALIZED-PATIENTS/

Meropenem was compared with imipenem/cilastatin for the treatment of s erious bacterial infections in a randomized, prospective multicentre s tudy. Both study drugs were given intravenously 1 g every 8 h and no o ther antimicrobial agents were permitted concomitantly. Of the 204 pat ients enrolled, the treatment of 177 was evaluable for clinical effica cy and 115 for bacteriological efficacy. In the clinically evaluable t reatment population, 75 (83%) of the 90 patients in the meropenem grou p and 78 (90%) of the 87 in the imipenem/cilastatin group had a single site of infection whereas the remainder had two or more sites of infe ction. Infections of the lower respiratory tract and peritoneal cavity predominated accounting for 95 and 75 cases respectively. Other infec tions included skin and soft tissue infections, complicated urinary tr act infections, bacteraemia and a case of meningitis treated with mero penem and one of mediastinitis treated with imipenem/cilastatin. One h undred and nineteen (67%) patients were in an intensive care unit, 105 (59%) were receiving assisted ventilation and 93 (53%) of the patient s had failed previous antibiotic therapy. One hundred and ten organism s were identified as pathogens in the meropenem group and 109 in the i mipenem/cilastatin group. Overall, treatment with meropenem was clinic ally successful in 68 (76%) of 90 cases and imipenem/cilastatin in 67 (77%) of 87 cases and the corresponding eradication rates of bacteria were 85 of 110 (77%) and 90 of 109 (83%) respectively. Superinfections due to resistant bacteria occurred in two patients treated with merop enem and three cases given imipenem/cilastatin. No statistically signi ficant differences in the clinical or bacteriological outcome were obs erved between the treatment groups for any of the infection sites anal ysed. Both drugs were well tolerated with adverse events considered to be related to therapy being recorded for 10 (9%) of 106 patients trea ted with meropenem and 12 (12%) of 98 of those who had been given imip enem/cilastatin. Empirical monotherapy with meropenem was therefore as effective and as well tolerated as that with imipenem/cilastatin for the treatment of serious bacterial infections.