Treatment of acute bacterial exacerbations of chronic obstructive pulmonary disease in hospitalised patients -- a comparison of meropenem and imipenem/cilastatin

Abstract

Meropenem and imipenem/cilastatin were compared in an open, randomised prospective multicentre study in the treatment of acute exacerbations of severe chronic obstructive pulmonary disease in hospitalised patients. One-hundred-and-seventy-three patients were enrolled; 164 were evaluable for clinical efficacy and 98 for bacteriological efficacy, with 144 pathogens isolated. The predominant pathogens were Haemophilus influenzae (n = 30), Streptococcus pneumoniae (18), Staphylococcus aureus (12), Pseudomonas aeruginosa (11), Moraxella catarrhalis (8), other Gram-negative bacteria (Neisseria, Klebsiella, Proteus, and Enterobacter spp.) (53) and other Gram-positive bacteria (12). A single bacterial pathogen was identified in 61 patients, whereas two bacterial pathogens were isolated in 31 patients and three in six patients. The clinical response at the end of treatment was very high in both groups with a satisfactory outcome (cured or improved) in 97.6% of the meropenem patients and in 96.3% of the imipenem/cilastatin patients; at follow-up the rates were 89.1% and 89.8%, respectively. The bacterial success (eradication or presumed eradication) was 88.2% in the meropenem group and 89.4% in the comparator group. Nausea or vomiting were reported more frequently in patients treated with imipenem/cilastatin, whereas in the meropenem group an increase in aminotransferases was reported. One patient treated with imipenem/cilastatin was withdrawn from the study due to seizures. Meropenem and imipenem/cilastatin were highly effective for the treatment of severe bacterial exacerbations of chronic bronchitis but meropenem was better tolerated.

Risk factors of superinfection following imipenem/cilastatin therapy in hospitalised patients with acute exacerbations of severe chronic obstructive pulmonary disease

“…In a clinical trial (5) comparing the efficacy of meropenem and imipenem for the treatment of acute bacterial exacerbations of COPD, the superinfection rate of imipenem treatment was only one in 37 patients, much lower than in our study. In our study population, the mean Pco 2 was 69.9 ± 24.1 mmHg, and 35.3% of patients received invasive mechanical ventilation.…”

“…For patients critically ill with acute respiratory failure due to severe COPD, especially those attacked by gram‐negative enteric bacilli producing extended‐spectrum beta‐lactamase (ESBL), imipenem treatment is reasonable and critical. Imipenem has been proved to be efficacious and safe by many randomised multicentre studies in the treatment of hospitalised patients with pneumonia and COPD (4–6). Despite great advances in antimicrobial chemotherapy and supportive care, acute exacerbations of severe COPD and associated acute respiratory failure remain a major practical therapeutic challenge for respiratory intensive care specialists.…”

Imipenem and Meropenem: Comparison of In Vitro Activity, Pharmacokinetics, Clinical Trials and Adverse Effects

“…Imipenem versus meropenem: Comparisons of imipenem versus meropenem for respiratory tract infections are limited to acute bacterial exacerbations of chronic obstructive pulmonary disease. Although Hamacher et al (68) reported "cure or improvement" rates greater than 95% with either antibiotic, the authors absolutely do not recommend the use of either carbapenem for acute exacerbations of chronic bronchitis.…”

Epileptogenic Potential of Carbapenem Agents: Mechanism of Action, Seizure Rates, and Clinical Considerations

“…Four trials reported seizures with rates ranging from 1.1-6%. [34][35][36][37] A total of 1661 patients received imipenem-cilastatin therapy, with 25 patients experiencing seizure activity. Of the 25 patients experiencing seizures, eight had risk factors: history of meningitis (one patient), history of seizures (one patient), and traumatic brain injury (six patients).…”