INTRAMUSCULAR MEROPENEM IN THE TREATMENT OF BACTERIAL-INFECTIONS OF THE URINARY AND LOWER RESPIRATORY TRACTS

In three open, multicentre, prospective randomised studies, the effica cy and safety of meropenem were assessed and compared with ceftazidime (Study 1) and imipenem/cilastatin (Studies 2 and 3) in 864 patients; 417 with urinary tract infections (UTI) and 447 with community acquire d lower respiratory tract infections (LRTI). All the antibiotics were administered by intramuscular injection.Clinical and bacteriological r esponses were assessed at the end of therapy and at follow-up (2-4 wee ks for LRTI, 4-6 weeks for UTI). The clinical response rate in UTI at the end of therapy was 93-100% for meropenem 500 mg tds compared with 94-95% for ceftazidime 500 mg tds; for meropenem 500 mg bd it was 97%, significantly higher than that for imipenem/cilastatin 500 mg bd whic h was 90% (P = 0.03). At follow-up, the response rates were 90% for me ropenem tds compared with 81-85% for ceftazidime 500 mg tds and 81% fo r meropenem bd compared with 78% for imipenem/cilastatin 500 mg bd. Th e clinical response rate in LRTI at end of therapy was 93% for meropen em 500 mg tds, compared with 92% for ceftazidime 1 g tds; for meropene m 500 mg bd the clinical response rate was 96%, compared with 91% for imipenem/cilastatin 500 mg bd (P = 0.054). At follow-up, the clinical response rates were 96%, 89%, 93% and 96%, respectively. The bacteriol ogical response rates at 5-9 days post-therapy in UTI were 61-84% in p atients treated with meropenem 500 mg tds, compared to 73-82% in patie nts treated with ceftazidime 500 mg tds; the rates for meropenem 500 m g bd and imipenem/cilastatin 500 mg bd were each 75%. At follow-up, th e response rates were 40-72%, 57-70%, 51% and 49%, respectively. In LR TI, bacteriological response rates at the end of therapy were 91% for both meropenem 500 mg tds and ceftazidime 1 g tds, and 91% for meropen em 500 mg bd compared with 86% for imipenem/ cilastatin 500 mg bd. At follow-up, the response rates were 87%, 77%, 84% and 79%, respectively . All treatments were well tolerated. In these studies, intramuscular meropenem proved to be an effective and well tolerated treatment for L RTI and UTI.