Carbapenem vs Ceftazidime Therapy for Severe Melioidosis

摘要

Summary: Since the two clinical trials had showed the efficacies of ceftazidime therapy over the combination of chloramphenicol, co-trimoxazole and doxycycline by at least halving the 70-80% mortality rate of severe melioidosis, a new antimicrobial for further decreasing the mortality has been investigated. Carbapenem is a suitable candidate for its superior in vitro antimicrobial profile. One clinical trial comparing imipenem (n=108) with ceftazidime (n=106) showed comparable overall survival rates (59.3% in imipenem vs 60.4% in ceftazidime groups) or after 48 hours though treatment failure after 48 hours was more common in the ceftazidime group. Another study comparing meropenem (n=63) with ceftazidime (n=154) also revealed similar mortality rates (19% in meropenem vs 18% in ceftazidime groups) despite more-unwell patients in meropenem group. Thus the benefit of carbapenem over ceftazidime needs to be further proven in a clinical trial. To maximize the therapeutic outcome in acute and chronic phases needs a totally new approach of treatment.