Carbapenems: monotherapy in intra-abdominal sepsis

Meropenem is the first of a new class of dehydropeptidase-stable carbapenems which is highly active against the microflora associated with intra-abdominal infection. Three randomised, prospective multicentre studies, have compared meropenem monotherapy with imipenem/cilastatin and cefotaxime plus metronidazole in the treatment of intra-abdominal infections: meropenem (1 g) versus cefotaxime (2 g) plus metronidazole (500 mg); meropenem (1 g) versus imipenem/cilastatin (1 g); meropenem (500 mg) versus imipenem/cilastatin (500 mg), all administered intravenously every 8 hours. Of the 641 patients with intra-abdominal infections randomised to treatment, 555 (87%) were clinically evaluable and 445 (69%) were bacteriologically evaluable. At the end of treatment a majority of the patients in each of the 3 studies was clinically cured or improved (91-100%). There were no clinically significant differences between the treatment regimens. Meropenem was effective over a range of intra-abdominal infections and as well tolerated as imipenem/cilastatin, and cefotaxime plus metronidazole.