J Antimicrob Chemother. 1995 Jul;36(1):185-200. doi: 10.1093/jac/36.1.185.
The efficacies of meropenem, a novel carbapenem, and ceftazidime, as empirical therapy of febrile neutropenic patients, were compared in a prospective, randomized clinical trial. One hundred and twelve adult patients were given meropenem 1 g tds iv for 153 episodes of fever, while 109 patients received ceftazidime 2 g tds iv for 151 episodes. All patients survived the first 3 days of therapy and, by the end of the treatment courses, 67 (44%) episodes had responded to meropenem, compared with 62 (41%) to ceftazidime. Eighty (53%) episodes initially treated with ceftazidime and 63 (41%) episodes treated with meropenem were considered to have failed treatment because it was thought necessary to administer additional antibacterial agents; however, modifications were made twice as often because of fever that persisted beyond 2-3 days than because of obvious causes of failure such as persistent infection. Three patients in the ceftazidime group and five in the meropenem group died. Meropenem was well tolerated, with no reports of nausea or toxicity to the central nervous system. Although ceftazidime was shown in the present study to be as effective as meropenem, the broader spectrum of activity of meropenem against Gram-positive cocci suggests that it might be more appropriate as empirical therapy of febrile neutropenic patients who are at high risk of acquiring infections caused by these bacteria.
在一项前瞻性随机临床试验中，比较了新型碳青霉烯类药物美罗培南和头孢他啶作为发热性中性粒细胞减少患者经验性治疗药物的疗效。112例成年患者接受美罗培南1g静脉滴注，每日3次，共治疗153例发热病例；109例患者接受头孢他啶2g静脉滴注，每日3次，共治疗151例发热病例。所有患者在治疗的前3天均存活，在治疗疗程结束时，美罗培南治疗的67例（44%）病例有反应，而头孢他啶治疗的有62例（41%）有反应。最初用头孢他啶治疗的80例（53%）病例和用美罗培南治疗的63例（41%）病例被认为治疗失败，因为认为有必要加用其他抗菌药物；然而，因发热持续超过2 - 3天而调整治疗的频率是因明显的失败原因（如持续感染）而调整的两倍。头孢他啶组有3例患者死亡，美罗培南组有5例患者死亡。美罗培南耐受性良好，未报告有恶心或中枢神经系统毒性。虽然在本研究中头孢他啶显示出与美罗培南同样有效，但美罗培南对革兰氏阳性球菌更广泛的抗菌谱表明，对于有感染由这些细菌引起高风险的发热性中性粒细胞减少患者，美罗培南可能更适合作为经验性治疗药物。
