Summary
In an open, randomised, multicentre trial, the efficacy and tolerability of empirical meropenem monotherapy (1 g intravenously every 8 hours) and cefotaxime (2 g every 8 hours) plus metronidazole (0.5 g intravenously every 8 hours) for 5 to 10 days was compared in 94 patients with serious intra-abdominal infection who required surgery. Eighty-three patients had an evaluable clinical response. Significantly more patients in the meropenem group had a satisfactory clinical response at the end of treatment (41/43 [95.3%] vs 30/40 [75.0%]; p=0.008). The bacteriological response was also higher in the meropenem group (31/33 vs 26/32). In the bacteriologically evaluable population, a satisfactory clinical response was observed in 31/33 of those who received meropenem compared to 24/32 of the cefotaxime/metronidazole recipients (p=0.03). Empirical meropenem monotherapy should prove a useful alternative to the currently standard combination treatment for serious intraabdominal infections.
Zusammenfassung
In einer offenen, randomisierten Multicenter-Studie wurden die Wirksamkeit und Verträglichkeit einer initialen Monotherapie mit Meropenem (MEM, 1 g 3 × tägl. i.v.) mit der etablierten Kombinationstherapie Cefotaxim (CTX) plus Metronidazol (MTR) (2 g CTX+0.5 g MTR 3×tägl. i.v.) verglichen. 94 Patienten mit operationspflichtigen schweren intraabdominellen Infektionen wurden einbezogen. Davon waren 83 Patienten bezüglich klinischem Ansprechen auswertbar. Die klinische Wirksamkeit war in der MEM-Gruppe signifikant höher (41/43 Pat.=95.3% vs 30/40 Pat.=75%; p=0.008). Das bakteriologische Ansprechen war in der MEM-Gruppe ebenfalls höher im Vergleich zur Kombinationsgruppe (31/33 vs 26/32), der Unterschied war jedoch statistisch nicht signifikant. In der bakteriologisch auswertbaren Population war das klinische Ansprechen in der MEM-Gruppe signifikant höher als im Vergleichskollektiv (31/33 vs 24/32; p=0.03). MEM erscheint somit für die initiale empirische Monotherapie bei schweren intraabdominellen Infektionen geeignet.
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On behalf of the German Peritonitis Study Group: Dr.Griesenbeck, Prof. Dr.Wendling, Prof. Dr.Männl, Prof. Dr.Rückert, Germany.
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Kempf, P., Blum, J., Bauernfeind, A. et al. Meropenem monotherapy versus cefotaxime plus metronidazole combination treatment for serious intra-abdominal infections. Infection 24, 473–479 (1996). https://doi.org/10.1007/BF01713053
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DOI: https://doi.org/10.1007/BF01713053