EMPIRICAL MONOTHERAPY WITH MEROPENEM VERSUS IMIPENEM CILASTATIN FOR FEBRILE EPISODES IN NEUTROPENIC PATIENTS/

In a nonblind, randomised, parallel-group shady, initial empirical mon otherapy with meropenem 1 g intravenously every 8 h was compared to an identical dosage of imipenem/cilastatin for the treatment of 66 Febri le episodes in 61 adult neutropenic patients, 25/31 episodes treated w ith meropenem and 24/30 imipenem/cilastatin-treated episodes were stil l receiving unmodified therapy at 72 h (primary endpoint); this differ ence was not statistically significant, By the end of the treatment co urses, 18/31 meropenem-treated episodes had responded clinically (cure d or improved) compared with 18/30 episodes treated with imipenem/cila statin. Another ten episodes initially treated with meropenem and six episodes treated with imipenem/cilastatin were cured after an addition al antimicrobial agent had been administered (cured with modification) , Satisfactory bacteriological responses (eradication plus presumed er adication) at the end of unmodified therapy was 9/11 in the meropenem group and 14/16 in the comparator group, Both regimes were well tolera ted; however, there were more reports of nausea and/or vomiting in the imipenem/cilastatin group C7/33 vs, 2/33 in the meropenem group). The carbapenems meropenem and imipenem/cilastatin appear to be suitable a gents for empirical monotherapy of febrile episodes in neutropenic pat ients. Meropenem may be better tolerated than imipenem/cilastatin, all owing optimal dosing in this patient population.