Shah P M, Heller A, Fuhr H G, Walther F, Halir S, Schaumann R, Böhme A, Jung B, Köhler A, Lips-Schulte C, Stille W
Medizinische Klinik III, Schwerpunkt Infektiologie, Frankfurt, Germany.
Infection. 1996 Nov-Dec;24(6):480-4. doi: 10.1007/BF01713054.
In a nonblind, randomised, parallel-group study, initial empirical monotherapy with meropenem 1 g intravenously every 8 h was compared to an identical dosage of imipenem/cilastatin for the treatment of 66 febrile episodes in 61 adult neutropenic patients. 25/31 episodes treated with meropenem and 24/30 imipenem/cilastatin-treated episodes were still receiving unmodified therapy at 72 h (primary endpoint); this difference was not statistically significant. By the end of the treatment courses, 18/31 meropenem-treated episodes had responded clinically (cured or improved) compared with 18/30 episodes treated with imipenem/cilastatin. Another ten episodes initially treated with meropenem and six episodes treated with imipenem/cilastatia were cured after an additional antimicrobial agent had been administered (cured with modification). Satisfactory bacteriological responses (eradication plus presumed eradication) at the end of unmodified therapy was 9/11 in the meropenem group and 14/16 in the comparator group. Both regimes were well tolerated; however, there were more reports of nausea and/or vomiting in the impenem/cilastatin group (7/33 vs. 2/33 in the meropenem group). The carbapenems meropenem and imipenem/cilastatin appear to be suitable agents for empirical monotherapy of febrile episodes in neutropenic patients. Meropenem may be better tolerated than imipenem/cilastatin, allowing optimal dosing in this patient population.
在一项非盲法、随机、平行组研究中，将每8小时静脉注射1克美罗培南的初始经验性单药治疗与相同剂量的亚胺培南/西司他丁用于治疗61例成年中性粒细胞减少患者的66次发热发作进行比较。在72小时时，接受美罗培南治疗的25/31次发作和接受亚胺培南/西司他丁治疗的24/30次发作仍在接受未调整的治疗（主要终点）；这种差异无统计学意义。到治疗疗程结束时，接受美罗培南治疗的18/31次发作临床有反应（治愈或改善），而接受亚胺培南/西司他丁治疗的为18/30次发作。另外，最初接受美罗培南治疗的10次发作和接受亚胺培南/西司他丁治疗的6次发作在加用另一种抗菌药物后治愈（调整后治愈）。在未调整治疗结束时，美罗培南组的满意细菌学反应（根除加假定根除）为9/11，对照剂组为14/16。两种治疗方案耐受性均良好；然而，亚胺培南/西司他丁组恶心和/或呕吐的报告更多（美罗培南组为2/33，亚胺培南/西司他丁组为7/33）。碳青霉烯类药物美罗培南和亚胺培南/西司他丁似乎是中性粒细胞减少患者发热发作经验性单药治疗的合适药物。美罗培南的耐受性可能比亚胺培南/西司他丁更好，从而能在该患者群体中实现最佳给药。
