Ceftazidime versus tobramycin plus ticarcillin in the treatment of soft-tissue infections

Case report forms from a multicenter, randomized trial comparing ceftazidime (50 patients) with tobramycin plus ticarcillin (control group, 44 patients) in the treatment of skin and soft-tissue infections were reviewed. Two subsets of patients were identified. The target patient population (group I) comprised older patients with predisposing chronic disease (eg, diabetes mellitus) and an average of 1.8 bacterial pathogens per patient. Necrotizing soft-tissue and postoperative wound infections predominated. Group II comprised younger patients with acute onset of monomicrobial cellulitis or staphylococcal or streptococcal abscess. Clinical cure or improvement was achieved in 93% of ceftazidime-treated and 94% of control group I patients. Bacteriological eradication of the initial pathogens without superinfection was obtained in 85% and 82%, respectively, of the two treatment groups. In group II, each of the nine ceftazidime-treated patients was cured or improved and bacteria were eradicated; in the control group, nine of ten patients were clinically and bacteriologically cured. Among all patients, Staphylococcus aureus was eradicated in 18 of 19 treated with ceftazidime and in 14 of 15 treated with the control agents. The results of the study demonstrate the efficacy of ceftazidime as initial monotherapy for soft-tissue infections in patients with compromised vascularity.