15 results on '"Imipenem therapeutic use"'
Search Results
2. [Pulmonary nocardiasis with abscesses spreading to cerebrum, cerebellum and orbits].
- Author
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Borchers M, von der Mülbe B, Teikemeier F, and Theegarten D
- Subjects
- Aged, Amikacin therapeutic use, Anti-Bacterial Agents therapeutic use, Biopsy, Needle methods, Brain Abscess drug therapy, Brain Abscess pathology, Cerebellar Diseases drug therapy, Cerebellar Diseases pathology, Diagnosis, Differential, Drug Therapy, Combination, Female, Humans, Imipenem therapeutic use, Lung Abscess drug therapy, Lung Abscess pathology, Magnetic Resonance Imaging, Nocardia Infections diagnosis, Nocardia Infections drug therapy, Orbital Diseases drug therapy, Orbital Diseases pathology, Pneumonia, Bacterial diagnosis, Pneumonia, Bacterial drug therapy, Tomography, X-Ray Computed, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Brain Abscess microbiology, Cerebellar Diseases microbiology, Lung Abscess microbiology, Nocardia Infections complications, Orbital Diseases microbiology, Pneumonia, Bacterial complications
- Abstract
History and Admission Findings: A 71-year-old woman presented with suspected tuberculosis. She reported having productive coughs, unwanted weight loss and subfebrile temperature in the preceding 3 months. She was known to have chronic obstructive pulmonary disease treated with corticoids given systemically and by inhalation. She was a heavy smoker., Investigations: Computed tomography revealed a left apical lung abscess. In the further course of the disease magnetic resonance imaging of the head demonstrated multiple abscesses in both cerebral hemispheres and an abscess, 3.4 cm in diameter, in the right side of the cerebellum, as well as a intra-orbital tumor on the right. Needle aspirate of the eyeball grew Nocardia farcinica., Treatment and Course: Over 3 weeks antimicrobial treatment was given with imipenem and amikacin, followed by oral cotrimoxazole for 12 months. The abscesses completely regressed and after 12 months no recurrence was demonstrated either radiologically or clinically., Conclusion: Although nocardiasis is rare in Germany it must be included in the differential diagnosis of pneumonia with abscesses. This is especially so if acid-fast bacilli are found. As the resistance pattern of N. farcinica to antibiotics varies, early treatment is essential with antibiotics to which it is sensitive.
- Published
- 2006
- Full Text
- View/download PDF
3. [Pneumonia induced by nocardia -- a case report].
- Author
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Frickmann H, Jungblut S, Böddinghaus B, and Bargon J
- Subjects
- Amikacin therapeutic use, Humans, Imipenem therapeutic use, Male, Middle Aged, Nocardia genetics, Nocardia isolation & purification, Nocardia Infections drug therapy, Pneumonia, Bacterial drug therapy, Polymerase Chain Reaction, Treatment Outcome, Drug Therapy, Combination therapeutic use, Nocardia Infections diagnosis, Pneumonia, Bacterial diagnosis
- Abstract
We describe a case of lung manifestation of nocardiosis with upper lobe shrinking of the right lung in a 45 year old patient without evident signs of an immuno-compromising illness. The patient came to the hospital in a reduced general state of health with severe cough, red and brown sputum and exertional dyspnoea. X-ray pictures of the thorax showed inflammatory infiltration and shrinking of the upper left lobe of the right lung. Gram-positive, branching rods were detected in the patient's bronchial secretion with the microscope and in cultures. Nocoardia transvalensis was identified via polymerase chain reaction (PCR). The antibiotic therapy was planned according to the bacterial resistance pattern. Imipenem was administered for 5 weeks and Amikacin was added for 3 weeks in the 3 (rd) week of therapy. The patient left the hospital in a good general state of health. There was no relapse.
- Published
- 2004
- Full Text
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4. [The case of a patient with multiple superinfected necrosis of both legs caused by vasculitis disease].
- Author
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Safak O, Volkering C, Regauer M, and Kessler S
- Subjects
- Anti-Bacterial Agents adverse effects, Anti-Bacterial Agents therapeutic use, Dermatologic Surgical Procedures, Equipment Design, Female, Humans, Imipenem adverse effects, Imipenem therapeutic use, Leg Dermatoses chemically induced, Microcomputers, Middle Aged, Necrosis, Reoperation instrumentation, Surgery, Computer-Assisted instrumentation, Vacuum, Vasculitis chemically induced, Wound Healing physiology, Debridement instrumentation, Leg Dermatoses surgery, Occlusive Dressings, Skin pathology, Skin Transplantation, Suture Techniques instrumentation, Vasculitis complications
- Abstract
Vasculitis can lead to skin necrosis, which typically shows decayed recovery tendency and is able to lead to local as well as systemic inflammation. By repeated necrosectomy, vacuum therapy, split skin graft transplantation as well as simultaneous immunosuppression and systemic antibiotics, the cutaneous manifestations of vasculitis where cured.
- Published
- 2004
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5. [SARI: surveillance of antibiotic use and bacterial resistance in German intensive care units. Correlation between antibiotic use and the emergence of resistance].
- Author
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Meyer E, Jonas D, Schwab F, Gastmeier P, Rüden H, and Daschner FD
- Subjects
- Anti-Bacterial Agents administration & dosage, Benchmarking, Ciprofloxacin administration & dosage, Ciprofloxacin pharmacology, Ciprofloxacin therapeutic use, Drug Resistance, Multiple, Bacterial, Genetic Variation, Germany, Humans, Imipenem administration & dosage, Imipenem pharmacology, Imipenem therapeutic use, Models, Theoretical, Population Surveillance, Pseudomonas aeruginosa drug effects, Pseudomonas aeruginosa genetics, Quality Control, Staphylococcus aureus drug effects, Time Factors, World Health Organization, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Bacteria drug effects, Drug Resistance, Bacterial, Drug Utilization, Intensive Care Units standards
- Abstract
Intensive care units (ICUs) are considered to be high-risk areas for the emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, on the use of antibiotics in ICUs, or on the correlation between antibiotic use and the emergence of resistance. Project SARI (surveillance of antibiotic use and bacterial resistance in ICUs), which as a part of the epidemiological network Spread of Nosocomial Infections and Resistant Pathogens (SIR) is supported by the German Ministry of Science and Education, started in February 2000 and meanwhile includes data on antibiotic use and resistance rates in 38 medical, surgical, and interdisciplinary ICUs. To date (February 2000-June 2003), a total of 1142 months, 413,065 patient days, and 550,288 defined daily doses (DDDs in accordance with the WHO) have been covered with a mean antibiotic usage density (AD) of 1335 DDDs/1000 patient days and resistance data on 37,612 isolates from ICUs. Ciprofloxacin use and MRSA correlate significantly, as do imipenem use and the rate of imipenemresistant P. aeruginosa. The genodiversity of P. aeruginosa is lower in ICUs with high resistance rates and low use of imipenem than in ICUs with high resistance rates and high use. This is an indirect parameter of transmission of identical strains. The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).
- Published
- 2004
- Full Text
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6. [Impediment of cellular immune response under treatment with ticlopidine in a patient with Staphylococcus aureus endocarditis].
- Author
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Alter P, Schaefer JR, and Maisch B
- Subjects
- Agranulocytosis chemically induced, Angioplasty, Balloon, Coronary, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Clarithromycin administration & dosage, Clarithromycin therapeutic use, Coronary Disease prevention & control, Coronary Disease therapy, Drug Therapy, Combination administration & dosage, Drug Therapy, Combination therapeutic use, Echocardiography, Doppler, Endocarditis, Bacterial diagnostic imaging, Endocarditis, Bacterial drug therapy, Endocarditis, Bacterial immunology, Gentamicins administration & dosage, Gentamicins therapeutic use, Humans, Imipenem administration & dosage, Imipenem therapeutic use, Immunity, Cellular immunology, Leukocyte Count, Leukocytes drug effects, Leukopenia chemically induced, Male, Middle Aged, Staphylococcal Infections drug therapy, Staphylococcal Infections immunology, Thienamycins administration & dosage, Thienamycins therapeutic use, Time Factors, Vancomycin administration & dosage, Vancomycin therapeutic use, Endocarditis, Bacterial etiology, Fibrinolytic Agents adverse effects, Immunity, Cellular drug effects, Leukocytes immunology, Platelet Aggregation Inhibitors adverse effects, Staphylococcal Infections etiology, Ticlopidine adverse effects
- Abstract
A 52-year-old male with coronary artery disease was admitted with acute aortic valve endocarditis and a temperature up to 39.5 degrees C caused by Staphylococcus aureus. The patient was treated with ticlopidine (Tiklyd) after percutaneous transluminal coronary angioplasties to reduce restenosis by inhibiting thrombocyte aggregation. Upon admission c-reactive protein (CRP) was 389 mg/l. Interleukin-6 (IL-6) and Interleukin-2-receptor (IL-2-rec) were distinctly increased. Monoclonal antimyocardial antibodies were found. Leukocyte count never exceeded 9.8 G/l; however, transesophageal echocardiography validated a soft vegetation of the aortic valve. Antibiotic therapy was initiated with imipenem, gentamicin and vancomycin; clarithromycin was added after five days. Temperature normalized after 24 days. The c-reactive protein decreased from 389 mg/l to 6 mg/l, and the elevated cytokine levels decreased accordingly. Agranulocytosis or pancytopenia by ticlopidine through a toxic mechanism have been described, which are normally reversible within three weeks; there has not yet been a description of a missing leukocyte response in endocarditis as in this case report. This is a special situation with lack of or impeded immunological response, which limits the use of ticlopidine, especially since a therapeutic alternative with clopidogrel is available.
- Published
- 2000
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7. [Imipenem resistance in Pseudomonas aeruginosa].
- Author
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Fille M, Bauernfeind A, Eberlein E, Jungwirth R, Schneider I, Speer G, Dierich MP, and Allerberger F
- Subjects
- Austria epidemiology, Bacterial Typing Techniques, Cross Infection epidemiology, Cross Infection microbiology, Drug Resistance, Microbial, Humans, Meropenem, Polymorphism, Restriction Fragment Length, Pseudomonas Infections epidemiology, Pseudomonas Infections microbiology, Thienamycins therapeutic use, Cross Infection drug therapy, Imipenem therapeutic use, Pseudomonas Infections drug therapy
- Abstract
In 1997 in western Austria, 9.9% of Pseudomonas aeruginosa strains from patients of general practitioners were resistant to imipenem as well as 18.2% of the isolates from hospitals and 20.2% of the strains at a university teaching hospital. Within the hospital the imipenem resistance varied from 9.9% among out-patients to 28.7% in isolates from intensive care units. In medical/surgical words, up to 15.1% of P. aeruginosa strains were resistant to imipenem. The incidence of imipenem-resistant P. aeruginosa strains correlates to the use of carbapenems. In June 1997, 10 consecutive isolates from 8 patients were obtained and typed using restriction fragment length polymorphism analysis (RFLP) and Pyocin typing. All 10 isolates were resistant to meropenem as well as to imipenem. The finding (by RFLP and Pyocin typing) of individual bacterial types in each isolate strongly contradicts the spread of infection by cross infection. However, all patients were proven to have been treated with imipenem during the 3 months prior to testing. In 1997, 13,880 g of imipenem were used at the university hospital in Innsbruck. The use of carbapenems appears to be the main cause for the increased incidence of imipenem-resistant P. aeruginosa strains.
- Published
- 1998
8. [Comparative study of the cost-effectiveness of initial therapy with imipenem/cilastatin in secondary peritonitis].
- Author
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Rodloff AC, Kujath P, Lünstedt B, and Gaus W
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Cilastatin adverse effects, Cilastatin therapeutic use, Cost-Benefit Analysis, Drug Therapy, Combination adverse effects, Drug Therapy, Combination economics, Drug Therapy, Combination therapeutic use, Female, Humans, Imipenem adverse effects, Imipenem therapeutic use, Male, Middle Aged, Peritonitis drug therapy, Prospective Studies, Surgical Wound Infection drug therapy, Cilastatin economics, Drug Costs, Imipenem economics, Peritonitis economics, Surgical Wound Infection economics
- Abstract
The total costs of the hospital treatment of patients with secondary peritonitis were investigated with a prospective, randomized, multicenter study. Moreover, the cost-effectiveness of an initial therapy with Imipenem/Cilastatin was compared to selected alternative antibiotic regimens. Altogether 154 patients (77 Imipenem/Cilastatin group, 77 alternative group) that displayed Mannheim Peritonitis Scores between 16 and 26 (average 20.8) were analyzed. The average total cost of treatment was DM 11,140 per patient (range DM 2794-45,526). Patients receiving an initial therapy with Imipenem/Cilastatin incurred average costs of DM 10,455, while patients with alternative regimens caused average costs of DM 11,826. The difference between the two treatment groups was statistically significant (P = 0.037).
- Published
- 1998
- Full Text
- View/download PDF
9. [Right-heart endocarditis after pacemaker implantation as a cause of a round pulmonary infiltrate].
- Author
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Müller P and Wertenbruch R
- Subjects
- Anti-Bacterial Agents therapeutic use, Drug Therapy, Combination therapeutic use, Echocardiography, Transesophageal, Endocarditis, Bacterial diagnosis, Endocarditis, Bacterial drug therapy, Follow-Up Studies, Gentamicins therapeutic use, Humans, Imipenem therapeutic use, Male, Middle Aged, Sepsis etiology, Staphylococcal Infections diagnosis, Staphylococcal Infections drug therapy, Teicoplanin therapeutic use, Thienamycins therapeutic use, Time Factors, Endocarditis, Bacterial etiology, Pacemaker, Artificial adverse effects, Radiography, Thoracic, Staphylococcal Infections etiology
- Abstract
History and Clinical Findings: A 57-year-old man developed intermittent fever and fatigue 11 months after a two-chamber cardiac pacemaker had been implanted because of 2 degrees and 3 degrees A-V block. Antituberculosis treatment was initiated as tuberculosis was suspected. The infiltrate regressed, but the other symptoms persisted. Four months later he was admitted as an emergency because of septicaemia., Investigations: In addition to a recently discovered cardiac murmur there was a raised erythrocyte sedimentation rate (116 mm) and leucocytosis (13 600/microliters) with shift to the left. Coagulase-negative staphylococci were grown on several blood cultures. Transoesophageal echocardiography (TOE) demonstrated vegetation on the tricuspid valve, the pacing wires and the right ventricular outflow tract., Diagnosis, Treatment and Course: After the diagnosis of infective endocarditis had been established, antibiotic treatment was give with imipenem, gentamycin and teicoplanin, the pacemaker system and adherent thrombotic material were removed and a DDD pacemaker implanted from the other side. The patient remained free of symptoms during a follow-up period of 12 months., Interpretation: Delayed diagnosis of infective endocarditis is not uncommon, because of the scarcity of typical symptoms. Repeated blood cultures and TOE are essential for the diagnosis.
- Published
- 1998
- Full Text
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10. [Peritonitis: dual treatment strategy of operation and antibiotics].
- Subjects
- Adult, Cilastatin economics, Cilastatin therapeutic use, Cilastatin, Imipenem Drug Combination, Combined Modality Therapy, Cost-Benefit Analysis, Drug Combinations, Drug Therapy, Combination economics, Humans, Imipenem economics, Imipenem therapeutic use, Microbial Sensitivity Tests, Peritonitis etiology, Peritonitis mortality, Survival Rate, Treatment Outcome, Debridement economics, Drug Therapy, Combination therapeutic use, Peritonitis therapy
- Published
- 1997
11. [Recurrent fever in a patient treated with immunosuppressive therapy for Takayasu arteritis].
- Author
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Schneider T, Strupp R, Kühnen E, Jochem C, and Boesken WH
- Subjects
- Abdominal Abscess drug therapy, Abdominal Abscess immunology, Adult, Cyclophosphamide administration & dosage, Cyclophosphamide adverse effects, Diagnosis, Differential, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Humans, Imipenem therapeutic use, Immunosuppressive Agents administration & dosage, Liver Abscess drug therapy, Liver Abscess immunology, Nocardia Infections drug therapy, Nocardia Infections immunology, Opportunistic Infections drug therapy, Opportunistic Infections immunology, Prednisolone administration & dosage, Prednisolone adverse effects, Recurrence, Splenic Diseases drug therapy, Splenic Diseases immunology, Takayasu Arteritis immunology, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Abdominal Abscess diagnosis, Fever of Unknown Origin etiology, Immunosuppressive Agents adverse effects, Liver Abscess diagnosis, Nocardia Infections diagnosis, Nocardia asteroides drug effects, Opportunistic Infections diagnosis, Splenic Diseases diagnosis, Takayasu Arteritis drug therapy
- Published
- 1997
- Full Text
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12. [Systemic Nocardia asteroides infection with endocardial involvement in a patient undergoing immunosuppressive therapy].
- Author
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Niehues R, Schlüter S, Kramer A, Klein RM, Strauer BE, Schaal KP, and Horstkotte D
- Subjects
- Anti-Bacterial Agents therapeutic use, Brain Diseases complications, Cilastatin therapeutic use, Cyclosporine adverse effects, Cyclosporine therapeutic use, Doxycycline therapeutic use, Drug Therapy, Combination, Echocardiography, Transesophageal, Endocarditis, Bacterial complications, Endocarditis, Bacterial drug therapy, Eye Infections, Bacterial complications, Fatal Outcome, Humans, Imipenem therapeutic use, Immunosuppressive Agents adverse effects, Immunosuppressive Agents therapeutic use, Kidney Transplantation, Male, Methylprednisolone adverse effects, Methylprednisolone therapeutic use, Middle Aged, Nocardia Infections drug therapy, Pneumonia complications, Protease Inhibitors therapeutic use, Status Epilepticus etiology, Thienamycins therapeutic use, Endocarditis, Bacterial etiology, Immunocompromised Host, Nocardia Infections etiology, Nocardia asteroides isolation & purification
- Abstract
History: A 62 year-old male patient developed malaise, unproductive cough and high temperature (39.5 degrees C) during immunosuppressive therapy with methylprednisolon and cyclosporin A six months after kidney transplantation for glomerulonephritis., Investigations: Clinical examination revealed an endophthalmitis and chest X ray a left-sided lobar pulmonic infiltration. Computed tomography and magnetic resonance imaging examination performed because of recurrent petit-mal-convulsions demonstrated multiple intracranial infiltrations. Transoesophageal echocardiography revealed floating vegetations up to 8 mm in diameter predominantly attached to the aortic valve. A total of 39 consecutive blood cultures drawn during several days remained sterile. However, Nocardia asteroides (Biovar A1) was isolated from a small cutaneous tumor excised from the right thigh., Treatment and Course: After initiation of a specific antibiotic treatment with imipenem/cilastatin (each 1 g three times daily), and doxycyclin (100 mg twice daily), computed tomography and magnetic resonance imaging showed a reduction in size and number of the intracranial infiltrations. Neurological symptoms were progressive despite maximal anticonvulsant therapy. The patient died 83 days after hospital admission from an epileptic state resistant to therapy., Conclusion: Though nocardiosis is still rare, it should early be included in the differential diagnosis of infections in immunocompromised patients to allow timely diagnosis and therapy.
- Published
- 1996
- Full Text
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13. [Comparative study of the cost-/effectiveness relationship of initial therapy with imipenem/cilastatin in nosocomial pneumonia. Group study].
- Author
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Rodloff AC, Laubenthal HJ, Bastian A, Bestehorn K, Büchele G, and Gaus W
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Cilastatin therapeutic use, Cost-Benefit Analysis, Critical Care economics, Cross Infection drug therapy, Drug Therapy, Combination economics, Drug Therapy, Combination therapeutic use, Female, Humans, Imipenem therapeutic use, Length of Stay economics, Male, Middle Aged, Pneumonia, Bacterial drug therapy, Protease Inhibitors therapeutic use, Thienamycins therapeutic use, Treatment Outcome, Cilastatin economics, Cross Infection economics, Imipenem economics, Pneumonia, Bacterial economics, Protease Inhibitors economics, Thienamycins economics
- Abstract
Aim of the Study: The present study assessed the total cost involved in the therapy of nosocomial pneumonia. Cost for patients receiving Imipenem as initial antibiotic therapy was compared with that for patients treated by selected alternative regimens. Secondary objectives included the evaluation of fever days, days of antibiotic therapy, days at ICU and days of overall hospitalisation required for the treatment of the nosocomial pneumonia for both methods of treatment., Methods: A prospective randomised open study involving multiple study sites was conducted. Total cost, efficacy and safety of an initial therapy with Imipenem were compared to results achieved with selected other antibiotic regimens. Altogether 109 patients were enrolled into the study; 85 patients could be assessed., Results: Both treatment methods showed equal clinical efficacy. Total cost of the therapy of nosocomial pneumonia for all patients was in the range between 1,616 DM and 82,141 DM, the arithmetic mean was calculated to be 11,307 DM and the median was found to be 6,507 DM. Imipenem-treated patients incurred lower cost (median 5,649 DM, mean 10,009 DM) than patients treated with other antibiotics (median 9,334 DM, mean 12,701 DM)., Conclusion: The total cost of treatment of nosocomial pneumonia was lower for Imipenem-treated patients than for patients receiving initially other selected antibiotic regimens. The savings are apparently due to a faster recovery of the patients resulting in reduced duration of therapy. The study shows that assessment of cost of therapy per day might be misleading in the economic analysis of antimicrobial chemotherapy.
- Published
- 1996
- Full Text
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14. [Preventive use of antibiotics in necrotizing pancreatitis?].
- Author
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Layer P and Böcker U
- Subjects
- Acute Disease, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Humans, Imipenem pharmacokinetics, Male, Middle Aged, Necrosis, Bacterial Infections prevention & control, Imipenem therapeutic use, Pancreatitis drug therapy
- Published
- 1994
15. [Imipenem/cilastatin as monotherapy in neutropenic patients with fever].
- Author
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Fridrik MA, Wahl G, Grafinger-Witt E, and Leisch F
- Subjects
- Adult, Aged, Anti-Bacterial Agents adverse effects, Cilastatin adverse effects, Cilastatin therapeutic use, Cilastatin, Imipenem Drug Combination, Drug Combinations adverse effects, Drug Combinations therapeutic use, Female, Humans, Imipenem adverse effects, Imipenem therapeutic use, Male, Middle Aged, Prospective Studies, Agranulocytosis complications, Anti-Bacterial Agents therapeutic use, Bacterial Infections drug therapy, Fever of Unknown Origin drug therapy, Neutropenia complications
- Abstract
We treated 20 febrile episodes in 14 patients with granulocytopenia under 1.0 x 10(9)/L. 6 episodes were pretreated, in 14 Imipenem/Cilastatin was the initial therapy. The age was between 36 and 78 years, mean 57 years. Predominant underlying disease was acute leukemia. 8 out of 20 episodes became afebrile. Counting only proven bacterial infections the response rate was 6 out of 12. There was a statistical difference between not pretreated and pretreated patients. The treatment had no success in the latter. There was also a significant difference between febrile episodes of patients with granulocytes increasing under treatment to those remaining unchanged. 5 of 6 of the first group but none of the 9 episodes of the second group resolved. 7 patients died while on treatment between the 9th and 32nd day after therapy had started. There was no connection between the Imipenem treatment and the deaths. Tolerance of therapy was good. The most common side effect was nausea, which was reversible with reduction of the infusion rate. Most important advantage of imipenem is the easy handling and the low inconvenience to the patient. We had only moderate efficacy in our series.
- Published
- 1988
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