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 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In an open, controlled, randomized study the safety and efficacy of imipenem/cilastatin was compared with that of the combination cefotaxime/gentamicin (plus metronidazole in patients with suspected anaerobe infection) in the treatment of 337 patients from 12 German and 5 Austrian centers who had non-life-threatening infections. The evaluation was done on an intention-to-treat basis (i.e. all patients including protocol violators) and according to the protocol (144 patients in the imipenem/cilastatin group and 124 in the cefotaxime/gentamicin group). No significant differences were seen between the two treatment groups in terms of the clinical and bacteriological outcome. The frequency of infusion intolerance and thrombophlebitis was low in both groups (< 2%). The overall rate of adverse events was comparable in the two groups, nausea, vomiting and diarrhea being the most frequent events. Nephrotoxicity, indicated by an increase in serum creatinine, was significantly higher in the cefotaxime/gentamicin group. Imipenem/cilastatin was shown to be as effective as cefotaxime/gentamicin (metronidazole) and appears to be well tolerated.
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PMID:Randomized multicenter clinical trial with imipenem/cilastatin versus cefotaxime/gentamicin in the treatment of patients with non-life-threatening infections. German and Austrian Imipenem/Cilastatin Study Group. 142 26

Imipenem/cilastatin sodium (IPM/CS) was administered to 55 patients with respiratory tract infections (RTI). A clinical evaluation of IPM/CS was carried out in 51 patients, 28 with pneumonia, 4 with pulmonary abscess, 1 with pyothorax, 6 with bronchitis, 9 with bronchiectasis, 1 with diffuse panbronchiolitis and 2 with RTI with chronic obstructive pulmonary disease, and the clinical efficacy rate was 78.4%. Causative organisms were isolated in 23 strains out of 20 patients, such as Staphylococcus aureus 4 strains, Staphylococcus epidermidis 1 strain, Streptococcus pneumoniae 1 strain, Branhamella catarrhalis 1 strain, Haemophilus influenzae 2 strains, Klebsiella pneumoniae 4 strains, Pseudomonas aeruginosa 6 strains, Pseudomonas sp. 1 strain, Acinetobacter calcoaceticus 1 strain, Acinetobacter sp. 1 strain and glucose non-fermentative Gram-negative rod 1 strain. An eradication rate of 70.6% was obtained. An overall eradication rate of main causative organisms in RTI including S. aureus, S. pneumoniae, H. influenzae and K. pneumoniae was 75.0%. Clinical adverse effects were observed in 5 patients, and these were eruption in 2, itching in 1, vomiting in 1 and drug fever in 1. Abnormalities in laboratory test results were observed in 8 patients. These disappeared or returned to normal values after completion or discontinuation of IPM/CS administration. IPM/CS appears to be a useful antibiotic for the treatment of RTI, especially severe infections.
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PMID:[Evaluation of imipenem/cilastatin sodium in the treatment of respiratory tract infections]. 234 50

Imipenem-cilastatin was evaluated for tolerability and efficacy in a multicenter open, noncomparative trial involving 178 infants and children with bacterial infections. Imipenemcilastatin was administered in total daily dosages of 100 mg/kg for patients up to 3 years of age and 60 mg/kg for those more than 3 years of age. Favorable clinical response was achieved in 98 of 100 patients judged evaluable for efficacy. Adverse effects were generally mild and reversible and included diarrhea alone or with vomiting (5.1%), irritation of intravenous infusion site (3.3%) and rash (2.2%). Changes in laboratory test values reported most frequently were thrombocytosis (8.9%), elevations in aspartate aminotransferase (7.9%) and alanine aminotransferase (5.6%) and eosinophilia (8.4%). This safety profile appears to be comparable to that of other beta-lactam antibiotics. Moreover imipenem-cilastatin was effective in infections caused by a broad spectrum of pathogens that include Haemophilus influenzae, Staphylococcus aureus, P. aeruginosa and anaerobes. These attributes suggest that imipenem-cilastatin should be safe and effective in selected pediatric patients.
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PMID:Imipenem-cilastatin in pediatric patients: an overview of safety and efficacy in studies conducted in the United States. 268 88

MK-0787 (Imipenem)/MK-0791 (Cilastatin sodium), a new compound of Thienamycin, was administered in treatment of 35 patients (36 cases) with chronic complicated UTI or for prevention of serious infections with much complicated factors. The patients were principally treated at a daily dose of 1 g for over 10 days. The efficacy rate of 26 patients who were evaluable in the early phase (4-7 days) was 88.5%, while it became up to 92.3% in the final phase judgment. As for clinical usefulness, the result was obtained to be as high as that of the clinical efficacy. In bacteriological study, 35 strains were clinically isolated including 7 strains of P. aeruginosa from UTI. All the strains disappeared with an eradication rate of 100% after treatment. Strains appearing after Imipenem/Cilastatin sodium treatment mainly consisted of fungi. Usefulness judgements tended to be greater in the final phase than in the early phase. As for side effects, vomiting was recorded in one case, in which the administration was discontinued. In laboratory findings there were 3 cases with elevated GPT, 2 cases with elevated GOT, one case with elevated gamma-GTP, one with thrombocytopenia, and one with eosinophilia each, but these abnormal values were slight and transient. In summary our clinical study showed that Imipenem/Cilastatin sodium was a very effective antibiotic in treatment on moderate or serious UTI or preventive use for infections in compromised hosts. Considering the features of this agent, it might be more effective and useful for clinical use in treatment on polymicrobial infections including stubborn organisms than any other antimicrobial compounds. Furthermore, it was safe and well tolerable in a long term treatment.
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PMID:[A clinical evaluation of MK-0787/MK-0791 for long-term administration in urological infections]. 310 48

Imipenem/cilastatin, which combines a broad-spectrum antibiotic derived from thienamycin with a specific enzyme inhibitor, was administered in dosages of 1 to 4 gm/day to 717 patients in a multicenter noncomparative trial. Ninety-nine percent of the bacterial pathogens tested were susceptible to imipenem, and 86% were eradicated. Clinical outcome was favorable in 85% or more of the cases when assessed according to the site of infection, and 92% of the cases responded to treatment overall. Development of resistance was rare except for Pseudomonas aeruginosa, which became resistant in 19% of the patients infected with that organism. More than half the patients with resistant P aeruginosa had a favorable clinical outcome, however. Superinfection occurred in approximately 4% of all patients. The adverse clinical experiences occurring most frequently were related to gastrointestinal function (nausea, vomiting, and diarrhea). In general, the safety profile of imipenem/cilastatin was similar to that of other beta-lactam antibiotics.
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PMID:Imipenem/cilastatin therapy of serious infections: a U.S. multicenter noncomparative trial. 388 44

Imipenem/cilastatin was compared with the combination of gentamicin plus clindamycin in terms of efficacy and safety for the treatment of moderate to severe infections in an open, randomized study. The rates of cure achieved with the two regimens were similar. Gentamicin/clindamycin treatment failed only in two of four instances of severe infection. Patients given imipenem/cilastatin seemed to respond more rapidly to treatment; this observation applied both to the entire group treated and to the subgroup with moderate intraabdominal infections. Susceptible etiologic agents were more frequently eradicated by imipenem/cilastatin (95%) than by gentamicin/clindamycin (79%). The most common adverse reactions were nausea or vomiting in patients given imipenem/cilastatin and urinary abnormalities in those given gentamicin/clindamycin. Self-limited diarrhea was observed with equal frequency in the two groups. No adverse reactions required the discontinuation of treatment. Colonization or superinfection with resistant organisms and Pseudomonas aeruginosa occurred significantly more often among patients given gentamicin/clindamycin. These results suggest that imipenem/cilastatin is a promising alternative to the combination of gentamicin and clindamycin for the treatment of moderate to severe infections in hospitalized patients.
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PMID:Imipenem/cilastatin vs. gentamicin/clindamycin for the treatment of moderate to severe infections in hospitalized patients. 390 Dec 9

Imipenem (N-formimidoyl thienamycin) is a new carbapenem beta-lactam antibiotic with a broad antibacterial spectrum. Forty-five patients were treated with either 500 or 1,000 mg of imipenem/cilastatin four times daily, the duration varying according to clinical response. The diagnoses were urinary tract infection, 10 patients; septicemia, six; intraabdominal sepsis, six; pneumonia, six (two cases of Legionnaires' disease); skin and soft tissue infection, four; and other diagnoses, 13. Of the 32 clinically assessable patients, 17 were cured, nine improved, three died, and three were withdrawn from the trial. Of 21 patients who were microbiologically assessable, 13 were cured. In six cases of complicated urinary tract infection, the organism--which had been eradicated from the urine during treatment--reappeared after completion of antibiotic therapy. Two patients developed adverse clinical reactions that were thought to be drug-related (drug-induced fever and nausea plus vomiting, respectively). Both patients had mildly abnormal results in liver function tests, and one developed a positive direct Coombs' test. Fifty-seven percent of the patients developed some degree of phlebitis, which was moderate to severe in 19%. In this study imipenem/cilastatin proved to be a highly effective agent for the treatment of a variety of serious bacterial infections.
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PMID:Imipenem/cilastatin in the treatment of serious bacterial infections. 390 Dec 12

Imipenem is the first of a new class of beta-lactam antimicrobial agents with remarkable and extremely potent in vitro activity against most commonly isolated bacterial pathogens, including Staphylococcus aureus, enterococcus, members of the family Enterobacteriaceae, Pseudomonas aeruginosa, Bacteroides fragilis, and Hemophilus influenzae. The clinical efficacy and toxicity of imipenem were evaluated in 35 patients with 38 different infections. The overall clinical response was favorable (infections cured or improved) in 89% of the infections (34 of 38). Of the 17 infections with P. aeruginosa, 15 were cured or improved. However, P. aeruginosa isolates resistant to imipenem emerged during the therapy of six infections, and two cases of P. aeruginosa septicemia later relapsed after imipenem therapy. Gastrointestinal toxicity (nausea with or without emesis) occurred in 17% of the patients (6 of 35) but was ameliorated by slowing the rate of intravenous infusion or lowering the dose of imipenem. Except for certain severe P. aeruginosa infections, imipenem is effective and relatively safe therapy for infections caused by susceptible organisms.
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PMID:Imipenem therapy of Pseudomonas aeruginosa and other serious bacterial infections. 659 61

A retrospective, open, 3-year trend analysis of imipenem use in bone marrow transplant (BMT) patients was conducted at a 1000-bed tertiary care hospital. Broad-spectrum antibacterial drugs are routinely used to treat infections in the febrile neutropenic host. The antibacterial activity and acceptable tolerance profile of imipenem makes this agent a potentially useful addition to the traditional armamentarium which includes aminoglycosides, cephalosporins, and glycopeptides. Some authorities recommend imipenem as monotherapy in the treatment of fever of unknown origin in this select patient population. Eighty-three treatment courses (one treatment course per patient) were evaluated. The major indications for initiating therapy were fever of neutropenia (28%), suspected infection in the absence of fever (55%), and documented infection (17%). Imipenem was used as a first-line agent in 42% of patients, although imipenem monotherapy was not common. Concurrent antibacterials were usually vancomycin and tobramycin. Seventeen patients required modification of the initial regimen with vancomycin and/or tobramycin for additional coverage after an average of 8 days of imipenem therapy. Forty-eight bacterial isolates were obtained in cultures from 35 patients during the study, with gram-positive organisms predominating (in particular, staphylococci and streptococci). Pretherapy and superinfecting organisms were primarily gram-positive. Overall clinical success or improvement occurred in 42% of patients. Microbiologic outcome was indeterminate in 89% of patients, microbiologic eradication occurred in 1%, and superinfection occurred in 6%. Imipenem was relatively well tolerated. Rash and nausea/vomiting were reported most often; 29% of those patients who had adverse reactions discontinued therapy.
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PMID:A retrospective evaluation of imipenem use in bone marrow transplant patients. 785 35

Toxic Shock Syndrome (TSS) secondary to mastitis is seldom described. We present a case of TSS due to postpartum mastitis caused by Methicillin-resistant Staphylococcus aureus (MRSA). Five weeks after giving birth to a healthy boy, a 23-year-old secundipara was readmitted to the hospital with a fever, systemic erythema, nausea, vomiting, diarrhea, diffuse myalgia, generalized itching, orthostatic syncopes, photophobia, oligurea and pain in the left breast. Laboratory data on admission revealed deteriorated renal and coagulation function. Administration of Vancomycin, Imipenem, dopamin and nafamostat mesilate was started immediately after admission, that was effective. The patient recuperated steadily over the next week with apparent desquamation of the skin on her face, breast and extremities especially palms and soles. MRSA isolated from her milk was coagulase type II producing toxic shock syndrome toxin-1 (TSST-1) and enterotoxin C. Also immunoglobulin G against TSST-1 was not detected from her sera both on admission and on discharge, which suggested that the patient belongs to the high risk group of TSS recurrence.
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PMID:[A case of toxic shock syndrome secondary to mastitis caused by methicillin-resistant Staphylococcus aureus]. 1171 66


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