Imipenem versus standard therapy in the treatment of serious soft tissue infection

Thirty-five patients with 36 episodes of serious soft tissue infection were entered in a prospective randomised trial to receive treatment with either intravenous imipenem or standard therapy, most commonly i.v. cloxacillin and benzylpenicillin. Eighteen patients received imipenem (Group 1) and eighteen standard therapy (Group 2). In Group 1, fourteen patients were cured, one improved and three failed therapy. The three failures comprised two where imipenem had to be stopped because of side-effects and one changed to standard therapy after 48 h because of lack of response. In Group 2, fourteen patients were cured, three improved and one failed therapy. This last case was due to lack of clinical response. Tolerance of both drugs was good, although eight patients in Group 1 versus none in Group 2 developed infusion phlebitis. All significant bacterial isolates were sensitive to imipenem, although several were resistant to cloxacillin and/or benzylpenicillin. No development of bacterial resistance was noted in isolated pathogens. There was no significant difference in rapidity of response or length of treatment between Groups 1 and 2. Imipenem is a safe and effective alternative to standard regimens in the treatment of serious soft tissue infection, although its side-effects and broad spectrum make it difficult to justify its use for uncomplicated cellulitis.