Comparison of imipenem and ceftazidime as therapy for severe melioidosis

An open, prospective, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of high-dose intravenous imipenem and ceftazidime for acute severe melioidosis. Adult Thai patients with suspecte d acute, severe melioidosis were randomized to receive either imipenem, at a dosage of 50 mg/(kg.d), or ceftazidime, at a dosage of 120 mg/(kg.d), for a minimum of 10 days. The main outcome measures were death or treatment fa ilure. Of the 296 patients enrolled, 214 had culture-confirmed melioidosis, and 132 (61.7%) of them had positive blood cultures. Mortality among patie nts with melioidosis was 36.9% overall. There were no differences in surviv al overall (P = .96) or after 48 hours (P = .3), Treatment failure after 48 hours was more common among patients treated with ceftazidime (P = .011), Both treatments were well tolerated. Imipenem is a safe and effective treat ment for acute severe melioidosis and may be considered an alternative to c eftazidime.