Comparative clinical evaluation of imipenem/cilastatin vs. cefotaxime in treatment of severe bacterial infections.

Adult patients with severe bacterial infections caused by organisms susceptible to imipenem and cefotaxime were given either imipenem/cilastatin sodium (MK0787/MK0791) or cefotaxime as a part of a multiclinic randomized study to evaluate the effectiveness, safety, and tolerability of imipenem/cilastatin. Clinical diagnoses included bacteremia, urinary tract infection, osteomyelitis, mediastinitis, lower respiratory tract infection, and soft tissue infection. Efficacy was evaluated for 10 patients given imipenem/cilastatin and for 10 patients given cefotaxime. Major pathogens isolated included Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella species, Streptococcus pneumoniae, Bacteroides fragilis, and Peptostreptococcus species. Satisfactory clinical responses were noted in 90% of the patients in both treatment groups. Eradication of the pathogen was achieved in nine of 10 patients treated with imipenem/cilastatin and in 10 of 10 patients treated with cefotaxime. No major adverse effects were found in patients in each treatment group. The results of this study suggest that imipenem/cilastatin sodium is a relatively safe and effective antibiotic for the treatment of adult patients with severe infections caused by susceptible organisms.