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A randomized study of imipenem compared to cefotaxime plus piperacillin as initial therapy of infections in
A Böhme1, G Just-Nübling, L Bergmann
1Medizinische Klinik III, Schwerpunkt Hämatologie, Frankfurt, Germany.
Abstract:
The objective of the presented, randomized study was to compare the efficacy of antimicrobial monotherapy with imipenem (3 x 0.5g/d) to a combination therapy with cefotaxime (3 x 2g/d) plus piperacillin (3 x 4g/d) for empirical treatment of infections in neutropenic patients. In 165 patients, 237 infectious episodes were evaluable. The overall response rate of patients treated with cefotaxime plus piperacillin was 67/115 (58%), of those treated with imipenem 66/122 (54%). In patients not responding to the initial therapy regimen within 2 or 3 days, the antimicrobial therapy was modified. After therapy modification 85/100 patients were cured. Fever of unknown origin (FUO) showed the most favourable course compared to other infection types, with a response in 46/59 (78%) and in 35/50 (70%) cases, respectively. In comparison, pneumonias were successfully treated in only 3/21 (14%) and 7/37 (19%) cases. Even including patients with modified therapy, only 66% (21/32) of pneumonia episodes responded. The unfavourable results in pneumonias is mainly due to the high rate of 13 systemic mycoses in this group (22%). Overall, a similar response was observed in patients treated with cefotaxime plus piperacillin in comparison with imipenem. In primary bacteremias however, an advantage was observed in patients treated with imipenem (20/27; 74%) compared with cefotaxime plus piperacillin (11/23; 48%).
Insights
This randomized study compared imipenem monotherapy to cefotaxime plus piperacillin combination therapy for neutropenic infections. Both regimens showed similar overall efficacy, though imipenem was more effective for primary bacteremias.
Area of Science:
- Infectious Diseases
- Pharmacology
- Hematology
Background:
- Neutropenic patients are highly susceptible to severe infections.
- Empirical antimicrobial therapy is crucial for managing infections in neutropenia.
- Comparing monotherapy and combination therapy is essential for optimizing treatment strategies.
Purpose of the Study:
- To compare the efficacy of imipenem monotherapy versus cefotaxime plus piperacillin combination therapy.
- To evaluate treatment outcomes for empirical infections in neutropenic patients.
- To identify specific infection types where one regimen may be superior.
Main Methods:
- Randomized study design.
- 165 neutropenic patients with 237 infectious episodes.
- Comparison of imipenem (3 x 0.5g/d) versus cefotaxime (3 x 2g/d) plus piperacillin (3 x 4g/d).
- Therapy modification for non-responders.
Main Results:
- Overall response rates: 58% for cefotaxime/piperacillin, 54% for imipenem.
- Fever of unknown origin (FUO) responded well (78% and 70%).
- Pneumonia response was poor (14% and 19%), often linked to systemic mycoses.
- Imipenem showed an advantage in primary bacteremias (74% vs 48%).
Conclusions:
- Antimicrobial monotherapy with imipenem and combination therapy with cefotaxime plus piperacillin demonstrated similar overall efficacy in neutropenic patients.
- Treatment of pneumonia in this cohort was challenging, with a high incidence of systemic mycoses.
- Imipenem monotherapy may be preferred for empirical treatment of primary bacteremias in neutropenic patients.