Open study of ceftazidime in serious infections due to multiply-resistant bacteria

We treated 37 infections in 32 patients who had one or more significant underlying diseases. Most of the responsible micro-organisms were multiresistant, but were initially sensitive to ceftazidime. They included 16 Pseudomonas spp., 10 Serratia spp., 6 Klebsiella spp., 7 other Enterobacteriaceae, 3 Staphylococcus spp., 3 strict anaerobes and 1 Acinetobacter anitratus. Indications for ceftazidime encompassed a broad spectrum of diseases: 10 complicated UTI, 13 skeletal and soft tissue infections, 4 bronchopulmonary infections, 6 intra-abdominal infections, 3 septicaemias, 1 brain abscess with meningitis. Ceftazidime was administered without other antimicrobials, except for metronidazole in two patients with intra-abdominal abscesses. Doses varied from 2 to 12 g/day (median: 3 g), given for 3-31 days (median: 12 days). Clinical cure was recorded in 26 patients (81%), 24 (75%) having also a bacteriological cure. In six patients, clinical findings subsided significantly but with incomplete resolution or relapse during follow-up. Four organisms developed resistance during therapy: 2 Pseudomonas, 1 Enterobacter cloacae and 1 Bacteroides vulgatus. Three patients developed mild superinfections (2 Candida, 1 Staph. epidermidis). Ceftazidime was well tolerated; adverse events were mild and reversible. Local thrombophlebitis was observed twice, two patients had a positive reaction to the direct Coombs' test, two had transitory elevation of transaminases and one suffered from drowsiness during intravenous injections. Ceftazidime appeared to be a valuable weapon for fighting severe infections in compromised patients, especially when Gram-negative bacilli were involved.