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Imipenem therapy of brain abscesses
V Asensi1, J A Carton, J A Maradona
1Department of Internal Medicine, Hospital Covadonga, Oviedo University School of Medicine, Spain.
Abstract:
The efficacy of imipenem versus standard chemotherapy (both in addition to neurosurgery) in the treatment of brain abscess was compared in a retrospective study. Cure was obtained in 52 of 60 (86.7%) patients in the standard group, and in 15 of 15 (including 5 patients with multiple brain abscesses) in the imipenem group. Cure without neurosurgery was observed in 2 of 60 (3.3%) and 3 of 15 (20%) of the cases, respectively (p = 0.08). Levels of imipenem in blood, cerebrospinal fluid, and brain pus were above the minimum inhibitory concentrations of most of the abscess isolates. Side effects of imipenem were rare and tolerance was excellent. Imipenem monotherapy (3-4 g/day) for five weeks seems a reasonable therapeutic choice for treatment of bacterial brain abscesses.
Insights
Imipenem demonstrated high efficacy in treating brain abscesses, achieving a cure in all 15 patients. This antibiotic shows promise as a monotherapy option, potentially reducing the need for neurosurgery.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Pharmacology
Background:
- Brain abscesses are serious infections requiring effective treatment.
- Standard chemotherapy combined with neurosurgery is a common treatment approach.
- Exploring novel therapeutic options is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the efficacy of imipenem with standard chemotherapy for brain abscess treatment.
- To evaluate the potential of imipenem monotherapy in reducing the need for neurosurgery.
- To assess imipenem levels in relevant bodily fluids and its safety profile.
Main Methods:
- Retrospective study design.
- Comparison of treatment outcomes between imipenem and standard chemotherapy groups.
- Analysis of cure rates, with and without neurosurgery.
- Measurement of imipenem concentrations in blood, cerebrospinal fluid, and brain pus.
Main Results:
- Imipenem achieved a 100% cure rate in 15 patients, including those with multiple abscesses.
- Standard chemotherapy resulted in an 86.7% cure rate in 60 patients.
- A higher proportion of patients treated with imipenem (20%) were cured without neurosurgery compared to the standard group (3.3%).
- Imipenem levels exceeded minimum inhibitory concentrations for most isolates, with rare side effects and excellent tolerance.
Conclusions:
- Imipenem monotherapy (3-4 g/day for five weeks) is a viable and effective treatment for bacterial brain abscesses.
- Imipenem offers a promising alternative, potentially decreasing the necessity for invasive neurosurgical intervention.
- The favorable safety profile and pharmacokinetic properties support imipenem's role in managing brain abscesses.