Imipenem/cilastatin versus Meropenem on Fever Defervescence in Septic Febrile Patient: A Comparative Prospective Study
AbstractObjective: Meropenem efficacy and tolerability was reported to measure up toimipenem/cilastatin, though some data reported that it may be more efficient incertain clinical and bacteriological settings. Our aim here is to demonstrate anypossible difference between the two carbapenems in major septic clinical scenarios.Fever defervescence was selected as a clinical primary “broad” parameter to comparethe effectiveness of imipenem/cilastatin and meropenem on fever defervescencein febrile septic patients.Methods: A prospective multicenter, observational, comparative open label study.The study was conducted in three hospitals between February – September 2009 inAmman-Jordan. Data were collected for patients whom were started on imipenem/cilastatin or meropenem; the study team did not contribute to the antibacterialselection for patients.Results: Seventy patients were evaluated, thirty-two imipenem/cilastatin and thirty-eight meropenem treated patients. Age mean was 60 and 57.6 years for Imipenem/cilastatin and meropenem respectively. The APACHE II score was similar, mean14.4 for both study arms. There was no significant difference in rates of clinicaldiagnoses for both study arms; ventilator-associated pneumonia (VAP), urinary tractinfection (UTI), intra-abdominal infections (IAI), blood stream infection (BSI) or forothers sources. Additional anti-gram negative agents were administered in 10 and9 patients, added anti-MRSA agents in 11 and 12 patients, and antifungal agentsin 3 and 1 patient in imipenem/cilastatin and meropenem treated patients respectively.There was no significant difference between the mean temperatures (38,60C for both), antimicrobial utilization days (8.33 versus 6.67), mean days for feverdefervescence (3.31 versus 2.37, p = 0.36, 95% C.I. (-1.09 - 2.98) for imipenem/cilastatin and meropenem treated patients respectively, mortality was the same.Conclusion: There is no evidence to support the notion that there is clinical differencein fever defervescence between Imipenem/cilastatin and meropenem inthis evaluated group.
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