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Isepamicin versus amikacin in the treatment of urinary tract infection
Abstract:
In a series of three prospective, randomised, multicentre trials, isepamicin (15 mg/kg or 8 mg/kg once daily depending on severity of infection) was compared with amikacin (7.5 mg/kg twice daily) in a total 252 adult hospitalised patients (mean age 51-54 years) with urinary tract infection. Pretreatment pathogens included Escherichia coli, which was isolated from approximately 50% of patients, and Pseudomonas aeruginosa, which was isolated from approximately 10% of patients with severe infections. The most commonly occurring primary diagnoses were complicated pyelonephritis, uncomplicated pyelonephritis and complicated lower urinary tract infection. For the patients included in the efficacy population, elimination of the pathogens occurred for all infections combined, in 92/101 (91%) patients in the isepamicin group and 51/55 (93%) patients in the amikacin group. Adverse events occurred in 15% of isepamicin patients and 6% of amikacin patients. Ototoxicity at the > or = dB threshold was noted in one isepamicin and two amikacin patients, but none of these patients had associated clinical signs of auditory or vestibular toxicity. Four isepamicin and four amikacin patients had potentially significant increases in serum creatinine indicative of possible nephrotoxicity.
Insights
Isepamicin demonstrated comparable efficacy to amikacin in treating hospitalised patients with urinary tract infections (UTIs). While both antibiotics were effective, isepamicin showed a higher incidence of adverse events, though severe toxicities were rare for both treatments.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Trials
Background:
- Urinary tract infections (UTIs) are common, often caused by pathogens like Escherichia coli and Pseudomonas aeruginosa.
- Effective antibiotic treatment is crucial for managing UTIs, especially in hospitalised patients.
- Comparing novel antibiotics like isepamicin with established ones like amikacin is essential for clinical practice.
Purpose of the Study:
- To compare the efficacy and safety of isepamicin versus amikacin in treating adult hospitalised patients with UTIs.
- To evaluate pathogen elimination rates and adverse event profiles for both antibiotics.
- To assess potential nephrotoxicity and ototoxicity associated with isepamicin and amikacin.
Main Methods:
- Three prospective, randomised, multicentre trials were conducted.
- A total of 252 adult hospitalised patients with UTIs were enrolled.
- Isepamicin (15 or 8 mg/kg once daily) was compared with amikacin (7.5 mg/kg twice daily).
Main Results:
- Pathogen elimination occurred in 91% of patients treated with isepamicin and 93% with amikacin.
- Adverse events were reported in 15% of isepamicin recipients and 6% of amikacin recipients.
- Ototoxicity and nephrotoxicity were infrequent and generally without clinical signs for both treatments.
Conclusions:
- Isepamicin is an effective alternative to amikacin for treating hospitalised UTIs.
- While efficacy is comparable, careful monitoring for adverse events is recommended with isepamicin.
- Both antibiotics demonstrate a favourable safety profile regarding severe renal and auditory toxicities.
Related Concept Videos
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:27Acute Pyelonephritis I: Introduction
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Urine Studies II: Urine Culture and Sensitivity Test