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Antimicrobial Agents and Chemotherapy, May 1998, p. 1233-1238, Vol. 42, No. 5
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Meropenem versus Cefuroxime plus Gentamicin for Treatment of Serious Infections in Elderly Patients

C. A. J. J. Jaspers,1,2 H. Kieft,3 B. Speelberg,4 A. Buiting,5 M. van Marwijk Kooij,6 G. J. H. M. Ruys,7 H. H. Vincent,8 M. C. A. Vermeulen,9 A. G. Olink,10 and I. M. Hoepelman1,11,*

Department of Medicine, Division of Infectious Diseases and AIDS,1 and Kendle/U-gene Research,10 and Eijkman-Winkler Institute,11 University Hospital Utrecht and Department of Medicine, Central Military Hospital,2 Utrecht, Department of Intensive Care,4 and Department of Microbiology,5 St. Elisabeth Hospital, Tilburg, Department of Intensive Care,3 Department of Medicine,6 and Department of Microbiology,7 Sophia Hospital, Zwolle, Department of Medicine, St. Antonius Hospital, Nieuwegein,8 and Department of Medicine, Elkerliek Hospital, Helmond,9 The Netherlands

Received 27 October 1997/Returned for modification 22 December 1997/Accepted 9 March 1998

In this multicenter study, the efficacy of and tolerability for meropenem were compared with those for the combination of cefuroxime-gentamicin (±metronidazole) for the treatment of serious bacterial infections in patients >= 65 years of age. A total of 79 patients were randomized; thirty-nine received meropenem (1 g/8 h), and 40 received cefuroxime (1.5 g/8 h) plus gentamicin (4 mg/kg of body weight daily) for 5 to 10 days. Metronidazole (500 mg/6 h) could be added to the cefuroxime-gentamicin regimen for the treatment of intra-abdominal infections (n = 10). Seventy patients were evaluable for clinical efficacy; the primary diagnoses were as follows: pneumonia in 41 patients (20 treated with meropenem, 21 treated with cefuroxime-gentamicin), intra-abdominal infection in 10 patients (7 meropenem, 3 cefuroxime-gentamicin-metronidazole), urinary tract infection (UTI) in 11 patients (6 meropenem, 5 cefuroxime-gentamicin), sepsis syndrome in 7 patients (4 meropenem, 3 cefuroxime-gentamicin), and "other" in 1 patient (cefuroxime-gentamicin). The pathogens isolated from 18 patients with bacteremia were as follows: Staphylococcus spp. (n = 2), Streptococcus spp. (n = 2), members of the family Enterobacteriaceae (n = 11), and Bacteroides spp. (n = 3). A satisfactory clinical response at the end of therapy was achieved in 26 of 37 (70%) and 24 of 33 (73%) evaluable patients treated with meropenem and combination therapy, respectively. Clinical success was achieved in 23 of 31 (74%) and 21 of 28 (75%) evaluable patients with infections other than UTIs, respectively. A satisfactory microbiological response occurred in 15 of 22 (68%) patients in the meropenem group compared with 12 of 19 (63%) treated with combination therapy. Renal failure occurred during therapy in 2 of 39 (5%) meropenem recipients compared with 5 of 40 (13%) of those treated with combination therapy. The findings in this small study indicate that meropenem is as efficacious for and as well tolerated by elderly patients as the combination of cefuroxime-gentamicin (±metronidazole).

* Corresponding author. Mailing address: University Hospital Utrecht, Dept. of Medicine, Division of Infectious Diseases and AIDS, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. Phone: 31-30-2506228. Fax: 31-30-2518328. E-mail: I.M.Hoepelman{at}digd.azu.nl.

Antimicrobial Agents and Chemotherapy, May 1998, p. 1233-1238, Vol. 42, No. 5
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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