Imipenem (N-F-Thienamycin) Versus Netilmicin Plus Clindamycin

Abstract

In a randomized study the clinical and bacteriologic effectiveness of imipenem was compared with the classical combination of netilmicin with clindamycin in patients who had surgery for an intraperitoneal infection, localized or generalized, with positive bacteriologic findings of the specimen taken at surgery. Excluded were all patients who received other antibiotics before surgery, or who died within 3 days after antibiotic therapy was started. Imipenem was given at a dose of 500 mg t.i.d., clindamycin 600 mg t.i.d., and netilmicin according to serum levels. The diagnoses ranged from postoperative peritonitis, gallbladder empyema, perforated gastroduodenal ulcer, small bowel perforation with and without obstruction, and perforated appendicitis to perforation of the colon. The bacteriologic work-up included examination of the primary specimen (aerobic and anaerobic), the urine, feces, and serologic testing for Candida albicans once or twice a week and after the course of antibiotic therapy. In addition, pH measurements of abscesses and drainage fluids were performed. Ninety-three patients entered the study. Forty-seven patients were treated with imipenem (test group), and 46 patients were treated with the combination therapy (control group). The two groups did not show significant differences in age, sex, diagnostic groups, risk factors, primary bacteriology, and duration of therapy (mean: 6.7 days). Thirty-eight patients (80.9%) treated with imipenem were cured, six patients (12.8%) were improved, and there were three (6.4%) failures. The respective numbers for the control group were 31 (67.4%), 10 (21.7%), and 5 (10.9%). The mean duration of hospitalization was 19 days for the test group and 24.5 days for the control group. There were four wound infections in the test group and 11 wound infections in the control group. Imipenem is at least as effective in the adjuvant therapy of intra-abdominal infections as the combination of netilmicin with clindamycin.

Optimal Treatment for Complicated Intra-abdominal Infections in the Era of Antibiotic Resistance: A Systematic Review and Meta-Analysis of the Efficacy and Safety of Combined Therapy With Metronidazole

“…When carbapenem first became available for treating microbial infections in the 1980s, clindamycin had long been the golden standard for the treatment of anaerobic infections [ 21 ]. Several RCTs, each comparing carbapenem and a conventional combination therapy with clindamycin and aminoglycoside, consistently reported that carbapenem was an effective antimicrobial drug for monotherapy of IAIs with efficacy similar to or better than the combination of clindamycin and aminoglycoside [ 22 – 25 ]. A meta-analysis of 28 clinical trials also concluded that broad-spectrum β-lactams were more effective than the clindamycin combination therapy in treating IAIs [ 26 ].…”

Piperacillin-tazobactam versus imipenem-cilastatin for treatment of intra-abdominal infections

“…Patients in the imipenem-cilastatin group received imipenem and cilastatin at dosages of 500 mg of each drug every 8 h as a 30-min intravenous infusion. The imipenemcilastatin doses of 500 mg each every 8 h is the usually recommended dose in Scandinavia for the treatment of moderate infections and has previously been demonstrated to be efficacious in prospective comparative trials (6,12,16); this differs from the usual dose of 500 mg every 6 h used in North America (8,13,14). The recommended dose range for imipenem-cilastatin is 0.75 to 4 g of each drug per day.…”

The treatment of severe intra-abdominal infections: The role of piperacillin/tazobactam

“…The efficacy results in the imipenem/cilastatin group are lower than those that have been previously reported [13][14][15][16][17]. The reason for the difference between the two treatments was not apparent in analyzing the microbiology since emergence of imipenem resistance did not occur.…”