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Imipenem versus tobramycin--antianaerobe antibiotic therapy in intra-abdominal infections
D Poenaru1, M De Santis, N V Christou
1Department of Surgery, McGill University, Montreal, PQ.
Abstract:
The authors compared broad-spectrum monotherapy with imipenem to an aminoglycoside-based antibiotic regimen for the management of intra-abdominal infections. One hundred and four patients who had intra-abdominal infection were randomly allocated to receive imipenem (52) or tobramycin plus clindamycin or metronidazole (52). Patients treated with imipenem had fewer febrile episodes and occurrences of breakthrough bacteremia, less antibiotic resistance and need for drug change; their hospital stay was shorter. The death rate from sepsis was 4% in patients who received imipenem and 13% in those who received the combined regimen (p = 0.08). Treatment was successful in 79% of patients on imipenem versus 67% of those receiving an aminoglycoside. Patient stratification by the APACHE II system and probability of death calculation using delayed-type hypersensitivity scores predicted a similar death rate for the two treatment groups. Imipenem appears to be a safe and efficacious alternative broad-spectrum antibiotic for treating patients who are seriously ill with intra-abdominal infection.
Insights
Imipenem monotherapy offers a safe and effective treatment for intra-abdominal infections, showing better outcomes than traditional aminoglycoside regimens. This broad-spectrum antibiotic reduced complications and improved patient recovery.
Area of Science:
- Infectious Diseases
- Pharmacology
- Critical Care Medicine
Background:
- Intra-abdominal infections (IAIs) are a significant cause of morbidity and mortality.
- Effective antibiotic management is crucial for favorable patient outcomes.
- Broad-spectrum antibiotic monotherapy is increasingly explored as an alternative to combination regimens.
Purpose of the Study:
- To compare the efficacy and safety of imipenem monotherapy versus an aminoglycoside-based regimen for IAIs.
- To evaluate clinical outcomes, including fever, bacteremia, and treatment success rates.
- To assess the impact on antibiotic resistance and hospital stay duration.
Main Methods:
- A randomized controlled trial involving 104 patients with IAIs.
- Patients were allocated to receive either imipenem (n=52) or tobramycin plus clindamycin/metronidazole (n=52).
- Outcomes were assessed, including clinical response, febrile episodes, bacteremia, and mortality. APACHE II scores were used for patient stratification.
Main Results:
- Imipenem group showed fewer febrile episodes and breakthrough bacteremia.
- Lower rates of antibiotic resistance and need for drug changes were observed with imipenem.
- Shorter hospital stays and a trend towards lower sepsis-related mortality (4% vs. 13%) were noted for imipenem.
- Treatment success was higher with imipenem (79%) compared to the aminoglycoside regimen (67%).
Conclusions:
- Imipenem demonstrates a favorable safety and efficacy profile as a broad-spectrum monotherapy for IAIs.
- It offers advantages over traditional aminoglycoside-based regimens in managing serious intra-abdominal infections.
- Imipenem represents a viable alternative for critically ill patients with IAIs.