Ceftazidime vs. amoxicillin/clavulanate in the treatment of severe melioidosis

Clin Infect Dis. 1994 Nov;19(5):846-53. doi: 10.1093/clinids/19.5.846.

Abstract

An open, paired, randomized, controlled trial of high-dose parenteral ceftazidime (120 mg/[kg.d]) vs. amoxicillin/clavulanate (160 mg/[kg.d]) for the treatment of severe melioidosis was conducted in Ubon Ratchatani in northeastern Thailand. Of 379 patients enrolled in the study, 212 (56%) had culture-proven melioidosis; 106 patients were in each treatment group. The overall mortality rate (47%) was similar for both treatment groups. However, 4 of 75 surviving patients in the ceftazidime group compared with 16 of 69 surviving patients in the amoxicillin/clavulanate group were switched to the alternate regimen because of an unsatisfactory clinical response after > or = 72 hours of treatment (P = .004). The overall therapeutic failure rate (i.e., treatment failure or death due to uncontrolled melioidosis) was significantly higher for the amoxicillin/clavulanate group than for the ceftazidime group (P = .02). Clinical and bacteriologic responses for successfully treated patients were similar in both groups, and both treatments were well tolerated. Parenteral amoxicillin/clavulanate is a safe and effective initial treatment, but parenteral ceftazidime remains the treatment of choice for severe melioidosis.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Amoxicillin / therapeutic use
  • Amoxicillin-Potassium Clavulanate Combination
  • Ceftazidime / therapeutic use*
  • Clavulanic Acids / therapeutic use
  • Drug Therapy, Combination / therapeutic use*
  • Female
  • Humans
  • Male
  • Melioidosis / drug therapy*
  • Melioidosis / microbiology
  • Middle Aged
  • Pseudomonas aeruginosa / isolation & purification
  • Treatment Failure

Substances

  • Clavulanic Acids
  • Amoxicillin-Potassium Clavulanate Combination
  • Amoxicillin
  • Ceftazidime