AN EVALUATION OF THE EFFICACY, SAFETY, AND SOURCE CONTROL OF ONCE-DAILY ERTAPENEM, COMPARED WITH PIPERACILLIN/TAZOBACTAM, IN PATIENTS WITH COMPLICATED INTRA-ABDOMINAL INFECTIONS
Main Article Content
Keywords
Ertapenem, Complicated intra-abdominal infection, Piperacillin/tazobactam, Source control, Polymicrobial infection.
Abstract
Infections in the abdominal cavity that require both surgical source control as well as antibiotic treatment are extremely challenging to treat. An ertapenem/piperacillin/tazobactam every six-hour trial compared the efficacy and safety of one-gram of ertapenem (1g) once-daily in hospitalized adults with one-gram of piperacillin/tazobactam administered every six hours. A microbiologic specimen was obtained from each patient for culturing after operative or percutaneous intervention. An analysis was conducted with microbiologically evaluable and modified intent-to-treat populations to assess clinical and microbiologic outcomes. Infection sites and pathogen profiles among groups, which predominantly consisted of Bacteroides and Escherichia coli, were similar. In addition to treating nonappendiceal infections, generalized peritonitis, postoperative infections, and enterococcus infections, ertapenem showed equivalent clinical and microbiological cure rates to piperacillin/tazobactam. An expert panel that was blinded and performed a source control analysis was crucial to determining the effectiveness of the treatment. For complex intraabdominal infections acquired in the community, Ertapenem is an effective monotherapy option due to its broad-spectrum activity, favorable safety profile, and convenient once-daily dosing schedule.
References
2. Yellin AE, Heseltine PN, Berne TV, et al. The role of Pseudomonas species in patients treated with ampicillin and Sulbactam for gangrenous and perforated appendicitis. Surg Gynecol Obstet 1985; 161: 303–307.
3. Solomkin JS, Dellinger EP, Christou NV, et al. Results of a multicenter trial comparing imipenem/cilastatin to tobramycin/clindamycin for intra-abdominal infections. Ann Surg 1990; 212: 581–591.
4. Mosdell DM, Morris DM, Voltura A, et al. Antibiotic treatment for surgical peritonitis. Ann Surg 1991; 214: 543–549.
5. Lorber B, Swenson RM. The bacteriology of intra-abdominal infections. Surg Clin North Am 1975; 55: 1349–1354.
6. Bartlett JG, Onderdonk AB, Louie T, et al. A review. Lessons from an animal model of intra-abdominal sepsis. Arch Surg 1978; 113: 853–857.
7. Nichols RL, Muzik AC. Enterococcal infections in surgical patients: the mystery continues. Clin Infect Dis 1992; 15: 72–76.
8. Onderdonk AB, Bartlett JG, Louie T, et al. Microbial synergy in experimental intra-abdominal abscess. Infect Immun 1976; 13: 22–26.
9. Gill CJ, Jackson JJ, Gerckens LS, et al. In vivo activity and pharmacokinetic evaluation of a novel long-acting carbapenem antibiotic, MK-826 (L-749,345). Antimicrob Agents Chemother 1998; 42: 1996–2001.
10. Sundelof JG, Hajdu R, Gill CJ, et al. Pharmacokinetics of L-749,345, a long-acting carbapenem antibiotic, in primates. Antimicrob Agents Chemother 1997; 41: 1743–1748.
11. Goldstein EJ, Citron DM, Vreni MC, et al. Comparative in vitro activities of ertapenem (MK-0826) against 1,001 anaerobes isolated from human intra-abdominal infections. Antimicrob Agents Chemother 2000; 44: 2389–2394.
12. Fuchs PC, Barry AL, Brown SD. In vitro activities of ertapenem (MK-0826) against clinical bacterial isolates from 11 North American medical centers. Antimicrob Agents Chemother 2001; 45: 1915–1918.
13. Livermore DM, Carter MW, Bagel S, et al. In vitro activities of ertapenem (MK-0826) against recent clinical bacteria collected in Europe and Australia. Antimicrob Agents Chemother 2001; 45: 1860–1867.
14. Wilson SE, Nord CE. Clinical trials of extended spectrum penicillin/beta-lactamase inhibitors in the treatment of intra-abdominal infections. European and North American experience. Am J Surg 1995; 169: 21S–26S.
15. Bohnen JM, Marshall JC, Fry DE, et al. Clinical and scientific importance of source control in abdominal infections: summary of a symposium. Can J Surg 1999; 42: 122–126
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Venkata Ramana Pindi B
Assistant Professor, Department of General Surgery, Sri Lakshmi Narayana Institute of Medical Sciences & Hospital, Puducherry - 605502
