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Imipenem/cilastatin in the treatment of serious bacterial infections
Abstract:
Imipenem (N-formimidoyl thienamycin) is a new carbapenem beta-lactam antibiotic with a broad antibacterial spectrum. Forty-five patients were treated with either 500 or 1,000 mg of imipenem/cilastatin four times daily, the duration varying according to clinical response. The diagnoses were urinary tract infection, 10 patients; septicemia, six; intraabdominal sepsis, six; pneumonia, six (two cases of Legionnaires' disease); skin and soft tissue infection, four; and other diagnoses, 13. Of the 32 clinically assessable patients, 17 were cured, nine improved, three died, and three were withdrawn from the trial. Of 21 patients who were microbiologically assessable, 13 were cured. In six cases of complicated urinary tract infection, the organism--which had been eradicated from the urine during treatment--reappeared after completion of antibiotic therapy. Two patients developed adverse clinical reactions that were thought to be drug-related (drug-induced fever and nausea plus vomiting, respectively). Both patients had mildly abnormal results in liver function tests, and one developed a positive direct Coombs' test. Fifty-seven percent of the patients developed some degree of phlebitis, which was moderate to severe in 19%. In this study imipenem/cilastatin proved to be a highly effective agent for the treatment of a variety of serious bacterial infections.
Insights
Imipenem/cilastatin demonstrated high effectiveness against serious bacterial infections, including urinary tract infections and pneumonia. While generally safe, some patients experienced phlebitis or mild drug reactions.
Area of Science:
- Infectious Diseases
- Pharmacology
- Internal Medicine
Background:
- Imipenem (N-formimidoyl thienamycin) is a novel carbapenem beta-lactam antibiotic.
- It possesses a broad antibacterial spectrum, indicating potential for treating diverse infections.
Purpose of the Study:
- To evaluate the efficacy and safety of imipenem/cilastatin in treating various serious bacterial infections.
- To assess clinical and microbiological outcomes in patients receiving imipenem/cilastatin therapy.
Main Methods:
- A study involving 45 patients with diagnoses including urinary tract infection, septicemia, intraabdominal sepsis, and pneumonia.
- Patients received imipenem/cilastatin at 500 or 1,000 mg doses four times daily, with treatment duration tailored to clinical response.
Main Results:
- Of 32 clinically assessable patients, 17 were cured and nine improved.
- Microbiological cure was achieved in 13 of 21 assessable patients.
- Adverse events included drug-related fever, nausea, vomiting, abnormal liver function tests, and phlebitis in 57% of patients.
Conclusions:
- Imipenem/cilastatin is a highly effective agent for treating a range of serious bacterial infections.
- Potential adverse effects such as phlebitis and mild systemic reactions should be monitored.
- Further investigation into recurrence of infection after therapy completion may be warranted.