INITIAL TREATMENT OF SEPSIS IN NON-NEUTROPENIC PATIENTS - CEFTAZIDIMEALONE VERSUS BEST GUESS COMBINED ANTIBIOTIC-THERAPY

We conducted a prospective, randomized, multicentric study in communit y hospitals. Patients with clinical sepsis, rectal temperature greater than or equal to 38 degrees C and pulse rate greater than or equal to 100 bpm were randomized to receive ceftazidime (group CAZ) or a combi nation of antibiotics freely chosen by the clinician following his 'be st guess' (group COMB). On specified grounds, the clinician could also treat patients in an open group with a free combination of antibiotic s (group OPEN). The severity of disease at study admission was assesse d by a clinical estimation and an Apache II score. There were 128 pati ents included: 56 randomized in group CAZ, 50 in group COMB, and 22 in the OPEN group. Ninety-one patients were evaluable: 41 in group CAZ, 30 in group COMB, 20 in OPEN group. At the end of the period of empiri cal treatment (48-72 h), the clinical success rates (improvement of st atus) were 93, 93 and 75% (p for group OPEN vs. groups CAZ or COMB: 0. 10). The bacteriological success rates (sterile blood cultures) were 9 1, 88 and 80% (p not significant). The mean Apache II score was 16.7 a nd the score correlated significantly with outcome, as did clinical ev aluation. In conclusion, ceftazidime alone was a safe antibiotic thera py in this study and we could not demonstrate a superiority of a combi ned antibiotic therapy chosen by the clinician following his 'best gue ss' over ceftazidime.