Comparison of imipenem and ceftazidime as therapy for severe melioidosis

Clin Infect Dis. 1999 Aug;29(2):381-7. doi: 10.1086/520219.

Abstract

An open, prospective, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of high-dose intravenous imipenem and ceftazidime for acute severe melioidosis. Adult Thai patients with suspected acute, severe melioidosis were randomized to receive either imipenem, at a dosage of 50 mg/(kg x d), or ceftazidime, at a dosage of 120 mg/(kg x d), for a minimum of 10 days. The main outcome measures were death or treatment failure. Of the 296 patients enrolled, 214 had culture-confirmed melioidosis, and 132 (61.7%) of them had positive blood cultures. Mortality among patients with melioidosis was 36.9% overall. There were no differences in survival overall (P = .96) or after 48 hours (P = .3). Treatment failure after 48 hours was more common among patients treated with ceftazidime (P = .011). Both treatments were well tolerated. Imipenem is a safe and effective treatment for acute severe melioidosis and may be considered an alternative to ceftazidime.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Ceftazidime / adverse effects
  • Ceftazidime / therapeutic use*
  • Cephalosporins / adverse effects
  • Cephalosporins / therapeutic use*
  • Female
  • Humans
  • Imipenem / adverse effects
  • Imipenem / therapeutic use*
  • Male
  • Melioidosis / drug therapy*
  • Melioidosis / mortality
  • Melioidosis / physiopathology
  • Middle Aged
  • Prospective Studies
  • Thienamycins / adverse effects
  • Thienamycins / therapeutic use*
  • Treatment Failure
  • Treatment Outcome

Substances

  • Cephalosporins
  • Thienamycins
  • Imipenem
  • Ceftazidime