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Meropenem versus imipenem/cilastatin in intra-abdominal infections requiring surgery. Meropenem Study Group
1Department of Surgery, University Hospital, Zurich, Switzerland.
Abstract:
In a multicentre, open, randomised study, the efficacy and tolerability of intravenous meropenem (1 g every 8 h, infusion or bolus) was compared with that of intravenous imipenem/cilastatin (1 g every 8 h, infusion) in 232 hospitalised patients with moderate to severe intra-abdominal infections. At the end of therapy, a satisfactory clinical response (cure or improvement) was seen in 79/82 (96%) evaluable meropenem patients and 83/88 (94%) imipenem/cilastatin patients; this was still seen at follow-up (57/63; 90% and 58/66; 88%, respectively). A satisfactory bacteriological response (elimination or presumed elimination) was seen in 69/82 (84%) meropenem patients and 71/88 (81%) imipenem/cilastatin patients at the end of therapy and in 52/62 (84%) and 55/70 (79%), respectively, at follow-up. There was a high level of clinical cure or improvement (95% for both treatment groups) in the 120 patients (60 in each group) who had polymicrobial infections. A similar incidence of adverse events was seen in each group: 45/116 patients in the meropenem group (72 events) and 42/116 patients in the imipenem/cilastatin group (65 events); the adverse event profiles were also similar, with injection site inflammation and elevated transaminases the most frequent in both groups. The results of this study indicate that monotherapy with meropenem was as effective and as well tolerated as the combination of imipenem/cilastatin in the treatment of moderate to severe intra-abdominal infections.
Insights
Meropenem monotherapy demonstrated comparable efficacy and tolerability to imipenem/cilastatin for treating intra-abdominal infections. Both treatments achieved high clinical and bacteriological success rates with similar adverse event profiles.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Intra-abdominal infections (IAIs) are a significant cause of morbidity and mortality in hospitalized patients.
- Effective antibiotic therapy is crucial for managing IAIs, with carbapenems being a key class of agents.
- Meropenem and imipenem/cilastatin are broad-spectrum carbapenems used for severe bacterial infections.
Purpose of the Study:
- To compare the efficacy and tolerability of intravenous meropenem with intravenous imipenem/cilastatin in patients with moderate to severe IAIs.
- To evaluate clinical and bacteriological response rates at the end of therapy and during follow-up.
- To assess the safety and adverse event profiles of both treatment regimens.
Main Methods:
- A multicentre, open-label, randomised study was conducted.
- 232 hospitalised patients with moderate to severe IAIs were enrolled.
- Patients received either meropenem (1 g every 8 h) or imipenem/cilastatin (1 g every 8 h).
Main Results:
- Satisfactory clinical response was observed in 96% of meropenem patients and 94% of imipenem/cilastatin patients at end of therapy.
- Bacteriological success rates were 84% for meropenem and 81% for imipenem/cilastatin.
- Adverse event incidence and profiles were similar between the two groups, with injection site inflammation and elevated transaminases being most frequent.
Conclusions:
- Meropenem monotherapy is as effective and well-tolerated as imipenem/cilastatin combination therapy for moderate to severe IAIs.
- Both regimens show high clinical and bacteriological efficacy, including in cases of polymicrobial infections.
- The safety profiles are comparable, suggesting meropenem as a viable alternative treatment option.