A randomized study of imipenem compared to cefotaxime plus piperacillin as initial therapy of infections in granulocytopenic patients

Böhme, Angelika; Just‐Nübling, G.; Bergmann, Lothar; Pm, Shah; Stille, W; Hoelzer, Dieter

doi:10.1007/bf01713564

Cited by 14 publications

(10 citation statements)

References 21 publications

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“…In all, 20 clinical trials comprised the final set [ 39 - 58 ] (Table 1 ). Comparator drug subcategories included a β-lactam arm in 16 studies [ 39 - 46 , 48 - 51 , 53 , 54 , 56 , 58 ], fluoroquinolone in 5 studies [ 44 , 46 , 47 , 55 , 57 ], aminoglycoside in 2 studies [ 53 , 56 ], and vancomycin in 1 study [ 52 ]; 6 employed double coverage [ 44 , 45 , 52 - 54 , 56 ]. The primary outcome for 17 of these 20 studies was clinical success [ 39 - 52 , 54 , 57 , 58 ] and 16 of 20 included a microbiological response assessment for underlying pathogens [ 39 - 43 , 45 - 48 , 50 , 52 - 54 , 56 - 58 ] (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

Imipenem resistance of Pseudomonas in pneumonia: a systematic literature review

et al. 2010

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BackgroundPneumonia, and particularly nosocomial (NP) and ventilator-associated pneumonias (VAP), results in high morbidity and costs. NPs in particular are likely to be caused by Pseudomonas aeruginosa (PA), ~20% of which in observational studies are resistant to imipenem. We sought to identify the burden of PA imipenem resistance in pneumonia.MethodsWe conducted a systematic literature review of randomized controlled trials (RCT) of imipenem treatment for pneumonia published in English between 1993 and 2008. We extracted study, population and treatment characteristics, and proportions caused by PA. Endpoints of interest were: PA resistance to initial antimicrobial treatment, clinical success, microbiologic eradication and on-treatment emergence of resistance of PA.ResultsOf the 46 studies identified, 20 (N = 4,310) included patients with pneumonia (imipenem 1,667, PA 251; comparator 1,661, PA 270). Seven were double blind, and 7 included US data. Comparator arms included a β-lactam (17, [penicillin 6, carbapenem 4, cephalosporin 7, monobactam 1]), aminoglycoside 2, vancomycin 1, and a fluoroquinolone 5; 5 employed double coverage. Thirteen focused exclusively on pneumonia and 7 included pneumonia and other diagnoses. Initial resistance was present in 14.6% (range 4.2-24.0%) of PA isolates in imipenem and 2.5% (range 0.0-7.4%) in comparator groups. Pooled clinical success rates for PA were 45.2% (range 0.0-72.0%) for imipenem and 74.9% (range 0.0-100.0%) for comparator regimens. Microbiologic eradication was achieved in 47.6% (range 0.0%-100.0%) of isolates in the imipenem and 52.8% (range 0.0%-100.0%) in the comparator groups. Resistance emerged in 38.7% (range 5.6-77.8%) PA isolates in imipenem and 21.9% (range 4.8-56.5%) in comparator groups.ConclusionsIn the 15 years of RCTs of imipenem for pneumonia, PA imipenem resistance rates are high, and PA clinical success and microbiologic eradication rates are directionally lower for imipenem than for comparators. Conversely, initial and treatment-emergent resistance is more likely with the imipenem than the comparator regimens.

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Section: Resultsmentioning

confidence: 99%

Imipenem resistance of Pseudomonas in pneumonia: a systematic literature review

et al. 2010

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“…Some authors continue intravenous antibiotics until resolution of febrile neutropenia, or at least for 5 days if neutropenia persists [4,[6][7][8]. Others propose to stop antibiotic therapy when the patient is afebrile for more than 24 h and there is evidence of bone marrow recovery, or they change from intravenous to oral antibiotics until ANC is 500/µl or higher [9,10,21,22].…”

Section: Discussionmentioning

confidence: 95%

“…Empirical monotherapy in treating febrile neutropenic cancer patients is attractive because of its ease of handling and potentially lower toxicity, but has been controversially discussed especially because of resistance problems [25,26]. Monotherapy with imipenem, a potent beta-lactam antibiotic, or with ceftazidime, a third-generation cephalosporin, has been successfully tested in a number of trials in febrile neutropenic adults [4,6,7,20,[27][28][29][30] and pediatric cancer patients [8,31] and is also approved by the Infectious Diseases Society of America (IDSA) [32]. A retrospective analysis of several prospective open and randomized trials evaluating imipenem in neutropenic cancer patients did not show the emergence of drug resistance [33].…”

Section: Discussionmentioning

confidence: 99%

“…However, the optimal duration of intravenous antibiotic treatment in febrile neutropenic patients is not clear at all, in particular in patients with fever of unexplained origin (FUO), who represent the majority of febrile neutropenic patients. Because of the risk of recurrent fever, most authors consider the resolution of neutropenia or evidence of bone marrow recovery necessary before empirical therapy can be discontinued [4,[6][7][8][9][10]. This, however, increases costs, extends the duration of hospitalization and may subject patients to the acquisition of resistant organisms.…”

Section: Introductionmentioning

confidence: 95%

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Short Courses of Intravenous Empirical Antibiotic Treatment in Selected Febrile Neutropenic Children with Cancer

2002

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“…Imipenem: Imipenem has been extensively studied in the management of febrile neutropenia (94)(95)(96)(97)(98)(99). In the largest prospective, randomized, single-blind study, Leyland et al (100) treated 252 febrile episodes with either imipenem or a combination of piperacillin and gentamicin (Table 7).…”

Section: Febrile Neutropeniamentioning

confidence: 99%