RESUMEN
A multicentre, open, randomised, parallel group study was carried out to assess the efficacy and safety of meropenem monotherapy versus the combination of ceftazidime plus amikacin in the treatment of serious bacterial infections. Adult, hospitalised patients (n = 237) were included if they had infections at one or more of the following sites: lower respiratory tract (89 community-acquired; 84 hospital-acquired), urinary tract (59 complicated; 3 uncomplicated), skin and skin structures (n = 8), or septicaemia (n = 29). Patients were randomised to receive either iv meropenem (1 g every 8 h) as monotherapy or iv ceftazidime (2 g every 8 h) plus iv amikacin (15 mg/kg/day in two or three divided doses). Meropenem had comparable clinical efficacy to ceftazidime plus amikacin in: community-acquired lower respiratory tract infection (LRTI) (40/43, 93% vs 31/39, 79% cured or improved); hospital-acquired LRTI (30/37, 81% vs 23/32, 72%); septicaemia (10/12, 83% vs 16/17, 94%) and complicated urinary tract infection (UTI) (13/15, 87% vs 25/25, 100%). A similar proportion of patients in each treatment group experienced adverse events, the most frequent being transient elevations in serum transaminases. Seven patients in the meropenem group and eight patients in the ceftazidime plus amikacin group died during the study period from reasons unrelated to study medication, and seven patients (five meropenem, two ceftazidime plus amikacin) were withdrawn due to adverse events. Empirical monotherapy with meropenem is as well tolerated and as effective as the combination of ceftazidime plus amikacin in the treatment of serious infections.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Carbapenémicos/uso terapéutico , Tienamicinas/uso terapéutico , Adolescente , Adulto , Anciano , Amicacina/uso terapéutico , Infecciones Bacterianas/microbiología , Ceftazidima/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Quimioterapia Combinada , Tolerancia a Medicamentos , Hospitalización , Humanos , Meropenem , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/microbiología , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Factores de Tiempo , Resultado del Tratamiento , Infecciones Urinarias/complicaciones , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiologíaAsunto(s)
Lesión Renal Aguda/etiología , Gripe Humana/complicaciones , Mioglobinuria/etiología , Adulto , Femenino , HumanosAsunto(s)
Antibacterianos/uso terapéutico , Calidad de la Atención de Salud , Fiebre Reumática/epidemiología , Francia , Humanos , Fiebre Reumática/tratamiento farmacológico , Fiebre Reumática/prevención & control , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológicoRESUMEN
This work regroups an important number of acute pneumococcal infections with septicemia, which recalls that these infections are of current importance, owing to their frequency and poor prognosis. Present diagnositc, clinical, radiological and bacteriological methods are discussed and criticised. An important, but not exclusive place, is reserved for routine blood culture. Finally, the authors discuss future prospects of acute pneumococcal infections, mainly diagnostic and prophylactic.