TREATMENT OF ACUTE BACTERIAL EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY-DISEASE IN HOSPITALIZED-PATIENTS - A COMPARISON OF MEROPENEM AND IMIPENEM-CILASTATIN

Meropenem and imipenem/cilastatin were compared in an open, randomised prospective multicentre study in the treatment of acute exacerbations of severe chronic obstructive pulmonary disease in hospitalised patie nts. One-hundred-and-seventy-three patients were enrolled; 164 were ev aluable for clinical efficacy and 98 for bacteriological efficacy, wit h 144 pathogens isolated. The predominant pathogens were Haemophilus i nfluenzae (n = 30), Streptococcus pneumoniae (18), Staphylococcus aure us (12), Pseudomonas aeruginosa (11), Moraxella catarrhalis (8), other Gram-negative bacteria (Neisseria, Klebsiella, Proteus, and Enterobac ter spp.) (53) and other Gram-positive bacteria (12). A single bacteri al pathogen was identified in 61 patients, whereas two bacterial patho gens were isolated in 31 patients and three in six patients. The clini cal response at the end of treatment was very high in both groups with a satisfactory outcome (cured or improved) in 97.6% of the meropenem patients and in 96.3% of the imipenem/cilastatin patients; at follow-u p the rates were 89.1% and 89.8%, respectively. The bacterial success (eradication or presumed eradication) was 88.2% in the meropenem group and 89.4% in the comparator group. Nausea or vomiting were reported m ore frequently in patients treated with imipenem/cilastatin, whereas i n the meropenem group an increase in aminotransferases was reported. O ne patient treated with imipenem/cilastatin was withdrawn from the stu dy due to seizures. Meropenem and imipenem/cilastatin were highly effe ctive for the treatment of severe bacterial exacerbations of chronic b ronchitis but meropenem was better tolerated.