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. 1995;23(6):349–355. doi: 10.1007/BF01713564

A randomized study of imipenem compared to cefotaxime plus piperacillin as initial therapy of infections in granulocytopenic patients

Randomisierte Studie mit Imipenem versus Cefotaxim/Piperacillin in der Initialtherapie von Infektionen granulozytopenischer Patienten

Angelika Böhme 1, L Bergmann 1, D Hoelzer 1, G Just-Nübling 2, P M Shah 2, W Stille 2
PMCID: PMC7102022  PMID: 8655205

Summary

The objective of the presented, randomized study was to compare the efficacy of antimicrobial monotherapy with imipenem (3×0.5g/d) to a combination therapy with cefotaxime (3×2g/d) plus piperacillin (3×4g/d) for empirical treatment of infections in neutropenic patients. In 165 patients, 237 infectious episodes were evaluable. The overall response rate of patients treated with cefotaxime plus piperacillin was 67/115 (58%), of those treated with impienem 66/122 (54%). In patients not responding to the initial therapy regimen within 2 or 3 days, the antimicrobial therapy was modified. After therapy modification 85/100 patients were cured. Fever of unknown origin (FUO) showed the most favourable course compared to other infection types, with a response in 46/59 (78%) and in 35/50 (70%) cases, respectively. In comparison, pneumonias were successfully treated in only 3/21 (14%) and 7/37 (19%) cases. Even including patients with modified therapy, only 66% (21/32) of pneumonia episodes responded. The unfavourable results in pneumonias is mainly due to the high rate of 13 systemic mycoses in this group (22%). Overall, a similar response was observed in patients treated with cefotaxime plus piperacillin in comparison with imipenem. In primary bacteremias however, an advantage was observed in patients treated with imipenem (20/27; 74%) compared with cefotaxime plus piperacillin (11/23; 48%).

Keywords: Cefotaxime, Imipenem, Initial Therapy, Piperacillin, Neutropenic Patient

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