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ISSN 2448-8909 (Print)

2003, Number 3

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Med Crit 2003; 17 (3)

Comparative study between cefepime/metronidazole versus cefotaxime/metronidazole for the treatment of complicated intra-abdominal infections

Molinar RF, Vázquez HMI, Olvera GH, Baltazar TJA, Esquivel CA, Cuéllar NF

Language: Spanish
References: 20
Page: 91-97
PDF size: 84.29 Kb.


ABSTRACT

Objective: To establish a comparison between cefepime/metronidazole and cefotaxime/metronidazole in the treatment of complicated intraabdominal infections.
Design: Case series report.
Setting: ICU of a tertiary care hospital, Mexico City.
Patients: Sixty patients with intraabdominal infections (27 men, 33 women, mean age 51.4 ± 17.3 yrs) were studied.
Interventions: The two groups of patients received metronidazole 1 g/kg IV (initial dose) and thereafter 7.5 mg/kg every 6 hours, and randomly received cefepime 2g IV every 12 hours (group 1) and cefotaxime 2 g IV every 8 hours (group 2) during hospital stay.
Results: It was observed APACHE II score 11.2 ± 6.3 vs 11.7 ± 6.4 points (p = 0.764); clinical improvement 19, 61.3% vs 21, 72.4% (p = 0.375); and bacteriological improvement 10, 32.3% vs 10, 34.5% (p = 0.754); no patient had side effects related with the use of antibiotics. Mortality rate was 5, 16.1% vs 6, 20.7% (p = 0.651).
Conclusion: The combination cefepime/metronidazole and cefotaxime/metronidazole had similar efficacy and safety in the treatment of patients with intraabdominal infections.


REFERENCES

  1. Lorber B, Swenson RM. The bacteriology of intraabdominal infections. Surg Clin North Am 1975;55:1349-1354.

  2. Asbel L, Levison M. Cephalosporins, carbapenems and monobactams. Inf Dis Clin N A 2000;14(2):171-178.

  3. Hardman J, Limbird L. (eds.) Goodman & Gilman’s The pharmacological basis of therapeutics. 10th ed. Mc Graw-Hill 2001.

  4. Solomkin JS, Hemsell DL, Sweet R et al. General guidelines for evaluation of new anti-infective drugs for the treatment of intra-abdominal and pelvic infections. Clin Inf Dis 1992;15(suppl 1):S33-42.

  5. Solomkin JS, Hemsell DL, Sweet R et al. General guidelines for the evaluation of new anti-infective drugs for the treatment of intra-abdominal infections. In: Beam TR, Gibert DN, Kunin CM, eds. European Guidelines for the Clinical Evaluation of Anti-infective Drug Products 1993. Brussels, Belgium: European Society of Clinical Microbiology and Infectious Diseases; 1993.

  6. Mosdell DM, Morris DM, Voltura A et al. Antibiotic treatment for surgical peritonitis. Ann Surg 1991;214:543-549.

  7. Christou NV, Barie PS, Dellinger EP et al. Surgical Infection Society Intra-abdominal Infection Study. Arch Surg 1993;128:193-99.

  8. Levison MA, Ziegler D. Correlation of APACHE II score, drainage technique, and outcome in postoperative intra-abdominal abscess. Surg Gynecol Obstet 1991;172:89-94.

  9. Ohmann C, Wittmann DH, Wacha H. Prospective evaluation of prognostic scoring systems in peritonitis. Eur J Surg 1993;159:267-274.

  10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829.

  11. Schein M, Gecelter G, Freinkel Z, Gerding H. APACHE II in emergency operation for perforated ulcers. Am J Surg 1990;159:309-313.

  12. Burnett RJ, Haverstock DC, Dellinger EP et al. Definition of the role of Enterococcus in intra-abdominal infection. Surgery 1995;118:716-721.

  13. Barie PS. Emerging problems in gram-positive infections in the postoperative patient. Surg Gynecol Obstet 1993;177 (suppl):S55-S64.

  14. Barie PS, Chistou NV, Dellinger EP et al. Pathogenicity of the Enterococcus in surgical infections. Ann Surg 1990;212: 155- 159.

  15. Weigelt JA, Easley SM, Thal ER et al. Abdominal surgical infection is lowered with improved perioperative Enterococcus and Bacteroides therapy. J Trauma 1993;34:579-584.

  16. Solomkin JS, Reinhart HH, Dellinger EP et al. Results of a randomized trial comparing sequential intravenous/oral treatment with ciprofloxacin plus metronidazole to imipenem/cilastatin for intra-abdominal infections. Ann Surg 1996;233:303-315.

  17. Barie PS, Vogel SB, Dellinger EP et al. A randomized, double-blind clinical trial comparing cefepime plus metronidazole with imipenem-cilastatin in the treatment of complicated intraabdominal infections. Arch Surg 1997;132:1294-1302.

  18. Okamoto MP, Chin M, Gill MA et al. Analysis of cefepime tissue penetration into human appendix. Pharmacotherapy 1991;11:353-358.

  19. Giamarellou H. Fourth generation cephalosporins in the antimicrobial chemotherapy of surgical infections. Journal of Chemotherapy 1999;11(6):486-93.

  20. Christou NV, Turgeon P, Wassef R et al. Management of intra-abdominal infections. Arch Surg 1996;131:1193-1201.




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