Ceftazidime treatment in intensive care patients

In the intensive care unit 39 patients were treated with ceftazidime for 52 infections (38 broncho-pulmonary infections, 4 intra-abdominal abscesses, 6 septicaemia, 3 urinary tract infections and 1 mediastinitis). All patients were ventilated mechanically. Three patients (6 infections) were not evaluable. In all cases except one, ceftazidime was administered after clinical failure of other antibiotics, including aminoglycosides. Ceftazidime was successful in 32 out of 46 evaluable infections (70%), while its success rate in infections previously treated with aminoglycosides (alone or in combination with cephalothin or cefotaxime) was 78% (21 out of 27 infections). In the higher dosage group (2000 mg tds) the drug was successful in 20 out of 23 infections compared with 12 out of 21 infections in the lower dosage group (1000 mg tds). Altogether 69 bacterial strains were cultured including 30 strains of Pseudomonas aeruginosa. Ceftazidime was clinically successful against 49 and 25 strains, respectively (71 and 83%, respectively). Bacterial overgrowth was present in 13 patients (14 strains) with broncho-pulmonary infections, but in only 7 was a change to another antibiotic required. Elevation of liver function enzymes was recorded in 4 patients, but it was not necessary to stop ceftazidime prematurely. This drug is an effective and relatively safe agent for the treatment of serious infections caused by Gram-negative bacilli including Pseudomonas aeruginosa in critically ill patients.