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Prospective, randomised, multicentre study of meropenem versus imipenem/cilastatin as empiric monotherapy in severe nosocomial infections

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Abstract

The clinical and bacteriological efficacy and the tolerability of meropenem versus imipenem/cilastatin (both 1 g t.i.d.) in severe nosocomial infections were compared in a multicentre, randomised, nonblinded study. A total of 151 patients were recruited; 133 (66 meropenem, 67 imipenem/cilastatin) were clinically evaluable and 84 (42 meropenem, 42 imipenem/cilastatin) bacteriologically evaluable. Most clinically evaluable patients (90%) were in intensive care units, required mechanical ventilation (72%), and had received previous antibiotic therapy (62%). The mean (±SD) APACHE II score was 15.2 (±6.6) in the meropenem group and 17.8 (±6.8) in the imipenem/cilastatin group. The primary infections were nosocomial lower respiratory tract infections (56% of patients), intra-abdominal infections (15%), septicaemia (21%), skin/skin structure infections (5%), and complicated urinary tract infections (3%); 35% of the patients had two or more infections. There was no significant difference between the meropenem and imipenem/cilastatin groups in the rates of satisfactory clinical (weighted percentage 87% vs. 74%) or bacteriological (weighted percentage 79% vs. 71%) response. There was a slightly higher rate of clinical success with meropenem against primary or secondary lower respiratory tract infection (89% vs. 76%). Drug-related adverse events occurred in 17% and 15% of meropenem and imipenem/cilastatin patients, respectively. Meropenem (1 g t.i.d.) was as efficacious as the same dose of imipenem/cilastatin in this setting, and both drugs were well tolerated.

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Authors and Affiliations

  1. Department of Medicine, Hospital Mútua de Terrassa, Plaza del Dr. Robert 5, 08221, Barcelona, Spain

    J. Garau

  2. Intensive Care Service, Hospital Clínico, Valencia, Spain

    J. Blanquer

  3. Intensive Care Service, Hospital de Cruces, Barakaldo, Bizkaia, Spain

    L. Cobo

  4. Intensive Care Service, Hospital Clinico, Seville, Spain

    S. Corcia

  5. Intensive Care Service, Hospital Príncipie de Asturias, Alcalá de Henares, Madrid, Spain

    M. Daguerre

  6. Intensive Care Service, Hospital Vall d'Hebrón, Barcelona, Spain

    F. J. de Latorre

  7. Intensive Care Service, Hospital de Valme, Seville, Spain

    C. León

  8. Intensive Care Service, Hospital Severo Ochoa, Leganés, Madrid, Spain

    F. Del Nogal

  9. Intensive Care Service, Hospital de la Sta Creu i Sant Pau, Barcelona, Spain

    A. Net

  10. Intensive Care Service, Consorci Hospitalari del Parc Taulí, Sabadell, Barcelona, Spain

    J. Rello

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  1. J. Garau
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Garau, J., Blanquer, J., Cobo, L. et al. Prospective, randomised, multicentre study of meropenem versus imipenem/cilastatin as empiric monotherapy in severe nosocomial infections. Eur. J. Clin. Microbiol. Infect. Dis. 16, 789–796 (1997). https://doi.org/10.1007/BF01700407

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  • DOI: https://doi.org/10.1007/BF01700407

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