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Antimicrobial management of postoperative infections in abdominal surgery: single or combination regimen?
S Geroulanos1, A Stern, D Christen
1Department of Surgery, University Hospital, Zurich, Switzerland.
Abstract:
In a prospective, controlled, randomized study, the clinical and bacteriologic efficacy of imipenem/cilastatin was compared with that of a standard combination of an aminoglycoside, amoxicillin, and clindamycin in patients with serious postoperative infections. Doses used were imipenem/cilastatin 1 gm q 8 hr, amoxicillin 2 gm q 8 hr, and clindamycin 0.6 gm q 6 hr. Aminoglycoside doses were individualized and monitored six times weekly with serum concentration assays. Sixty-three patients were entered into the study: 31 in the imipenem/cilastatin group and 32 in the combination group. Diagnoses included pneumonia (ten in the imipenem/cilastatin group and seven in the combination group), peritonitis (eight in the imipenem/cilastatin group and 15 in the combination group), and septicemia (eight in the imipenem/cilastatin group and three in the combination group). The two groups were comparable with respect to sex, age, underlying diseases, and duration of antibiotic therapy. In the imipenem/cilastatin group, 26 patients were cured and one improved (87%). In the combination group, 21 were cured and five improved (81%). Four patients receiving imipenem/cilastatin and six receiving the combination therapy failed to respond to treatment. Eighty percent of the bacterial isolates were eradicated, and 15% were suppressed in the imipenem/cilastatin group. Corresponding frequencies in the combination group were 84% and 11%, respectively. Isolated pathogens persisted in 5% of the patients in each group. It is concluded that imipenem/cilastatin appears to be an effective and well-tolerated alternative to a triple antibiotic combination in the treatment of serious postoperative infections.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Imipenem/cilastatin showed comparable clinical and bacteriologic efficacy to a standard triple antibiotic combination for serious postoperative infections. This study suggests imipenem/cilastatin is a well-tolerated alternative treatment option.
Area of Science:
- Infectious Diseases
- Clinical Pharmacology
- Microbiology
Background:
- Serious postoperative infections require effective antibiotic therapy.
- Standard treatment often involves combinations like aminoglycoside, amoxicillin, and clindamycin.
- Novel antibiotic agents are continuously evaluated for improved efficacy and tolerability.
Purpose of the Study:
- To compare the clinical and bacteriologic efficacy of imipenem/cilastatin versus a standard triple antibiotic combination.
- To evaluate the safety and tolerability of imipenem/cilastatin in patients with serious postoperative infections.
- To determine the effectiveness of imipenem/cilastatin in eradicating or suppressing bacterial isolates.
Main Methods:
- Prospective, controlled, randomized study design.
- Comparison between imipenem/cilastatin and a combination of aminoglycoside, amoxicillin, and clindamycin.
- Individualized aminoglycoside dosing with serum concentration monitoring.
- Inclusion of patients with pneumonia, peritonitis, and septicemia.
Main Results:
- Imipenem/cilastatin achieved an 87% cure/improvement rate, compared to 81% for the combination therapy.
- Bacterial eradication rates were 80% for imipenem/cilastatin and 84% for the combination.
- Pathogen persistence occurred in 5% of patients in both treatment groups.
- Imipenem/cilastatin demonstrated good tolerability.
Conclusions:
- Imipenem/cilastatin is an effective alternative to standard triple antibiotic therapy for serious postoperative infections.
- The drug is well-tolerated, offering a viable treatment option.
- Further research may explore broader applications and resistance patterns.