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Meropenem versus cefuroxime plus gentamicin for treatment of serious infections in elderly patients
C A Jaspers1, H Kieft, B Speelberg
1Department of Medicine, University Hospital Utrecht, The Netherlands.
Abstract:
In this multicenter study, the efficacy of and tolerability for meropenem were compared with those for the combination of cefuroxime-gentamicin (+/- metronidazole) for the treatment of serious bacterial infections in patients > or = 65 years of age. A total of 79 patients were randomized; thirty-nine received meropenem (1 g/8 h), and 40 received cefuroxime (1.5 g/8 h) plus gentamicin (4 mg/kg of body weight daily) for 5 to 10 days. Metronidazole (500 mg/6 h) could be added to the cefuroxime-gentamicin regimen for the treatment of intra-abdominal infections (n = 10). Seventy patients were evaluable for clinical efficacy; the primary diagnoses were as follows: pneumonia in 41 patients (20 treated with meropenem, 21 treated with cefuroxime-gentamicin), intra-abdominal infection in 10 patients (7 meropenem, 3 cefuroxime-gentamicin-metronidazole), urinary tract infection (UTI) in 11 patients (6 meropenem, 5 cefuroxime-gentamicin), sepsis syndrome in 7 patients (4 meropenem, 3 cefuroxime-gentamicin), and "other" in 1 patient (cefuroxime-gentamicin). The pathogens isolated from 18 patients with bacteremia were as follows: Staphylococcus spp. (n = 2), Streptococcus spp. (n = 2), members of the family Enterobacteriaceae (n = 11), and Bacteroides spp. (n = 3). A satisfactory clinical response at the end of therapy was achieved in 26 of 37 (70%) and 24 of 33 (73%) evaluable patients treated with meropenem and combination therapy, respectively. Clinical success was achieved in 23 of 31 (74%) and 21 of 28 (75%) evaluable patients with infections other than UTIs, respectively. A satisfactory microbiological response occurred in 15 of 22 (68%) patients in the meropenem group compared with 12 of 19 (63%) treated with combination therapy. Renal failure occurred during therapy in 2 of 39 (5%) meropenem recipients compared with 5 of 40 (13%) of those treated with combination therapy. The findings in this small study indicate that meropenem is as efficacious for and as well tolerated by elderly patients as the combination of cefuroxime-gentamicin (+/- metronidazole).
Insights
Meropenem demonstrated comparable efficacy and tolerability to cefuroxime-gentamicin for treating serious bacterial infections in elderly patients. This study suggests meropenem is a suitable option for geriatric patients with severe infections.
Area of Science:
- Infectious Diseases
- Geriatric Medicine
- Pharmacology
Background:
- Serious bacterial infections pose significant risks in elderly patients.
- Optimizing antibiotic therapy in geriatric populations is crucial due to age-related physiological changes.
Purpose of the Study:
- To compare the efficacy and tolerability of meropenem versus cefuroxime-gentamicin (+/- metronidazole) in patients aged 65 years and older with serious bacterial infections.
Main Methods:
- A multicenter randomized study involving 79 elderly patients.
- Patients received either meropenem (1g/8h) or cefuroxime (1.5g/8h) plus gentamicin (4mg/kg/day) for 5-10 days.
- Metronidazole was optionally added for intra-abdominal infections.
Main Results:
- Clinical success rates were similar: 70% for meropenem vs. 73% for combination therapy.
- Microbiological response rates were 68% for meropenem and 63% for combination therapy.
- Meropenem showed a lower incidence of renal failure (5%) compared to combination therapy (13%).
Conclusions:
- Meropenem is as efficacious and well-tolerated as cefuroxime-gentamicin for treating serious bacterial infections in elderly patients.
- Meropenem represents a viable therapeutic option for serious infections in the geriatric population.
- The study highlights the importance of evaluating antibiotic regimens specifically in elderly patient populations.