Ertapenem versus piperacillin-tazobactam for treatment of mixed anaerobic complicated intra-abdominal, complicated skin and skin structure, and acute pelvic infections.

Abstract

BACKGROUND:

Anaerobes are an important component of many serious, deep tissue infections, especially complicated intra-abdominal (IAI), complicated skin and skin structure (SSSI), and acute pelvic (PI) infections. This study compares the efficacy of ertapenem, 1 g once a day, in the treatment of adults with anaerobic IAI, SSSI, and PI to piperacillin-tazobactam, 3.375 g every 6 hours.

METHODS:

Three randomized, double-blind trials comparing ertapenem to piperacillin-tazobactam for treatment of IAI, SSSI, and PI were conducted. This subgroup analysis included 623 patients, whose baseline culture grew one or more anaerobic pathogens, from these three studies.

RESULTS:

Anaerobes most commonly isolated were Bacteroides fragilis group (IAI) and peptostreptococci (SSSI and PI). The median duration of ertapenem and piperacillin-tazobactam therapy, respectively, in these subgroups was 6 and 7 days for IAI, 7 and 8 days for SSSI, and 4 and 5 days for PI. Cure rates for all evaluable patients with anaerobic infection were 89.3% (242/271) for ertapenem and 85.9% (220/256) for piperacillin-tazobactam (95% CI for the difference, adjusting for infection, -2.6% to 9.3%), indicating that the two treatments were equivalent. Cure rates by infection, for ertapenem and piperacillin-tazobactam, respectively, were as follows: IAI, 86.4% (133/154) and 82.4% (117/142); SSSI, 84.4% (27/32) and 82.4% (28/34); PI, 96.5% (82/85) and 93.8% (75/80). The frequency and severity of drug-related adverse experiences were comparable in both treatment groups.

CONCLUSION:

In this subgroup analysis, ertapenem was as effective as piperacillin-tazobactam for treatment of adults with moderate to severe anaerobic IAI, SSSI, and PI, was generally well tolerated, and had a similar safety profile.

• Authors: Jose Tellado, Gail L Woods, Richard Gesser, Kathleen McCarroll, Hedy Teppler
• Journal: Surgical infections (Surg Infect (Larchmt)) Vol. 3 Issue 4 Pg. 303-14 ( 2002) ISSN: 1096-2964 [Print] United States
• PMID: 12697078 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Lactams
• beta-Lactams
• Piperacillin, Tazobactam Drug Combination
• Penicillanic Acid
• Ertapenem
• Piperacillin

Topics

• Abdomen (microbiology)
• Adult
• Aged
• Anti-Bacterial Agents (administration & dosage, adverse effects, therapeutic use)
• Bacteria, Anaerobic (isolation & purification)
• Bacterial Infections (drug therapy, microbiology)
• Double-Blind Method
• Drug Administration Schedule
• Drug Therapy, Combination (administration & dosage, adverse effects, therapeutic use)
• Ertapenem
• Female
• Humans
• Lactams
• Male
• Middle Aged
• Pelvic Infection (drug therapy, microbiology)
• Penicillanic Acid (administration & dosage, adverse effects, analogs & derivatives, therapeutic use)
• Piperacillin (administration & dosage, adverse effects, therapeutic use)
• Piperacillin, Tazobactam Drug Combination
• Prospective Studies
• Skin Diseases, Bacterial (drug therapy, microbiology)
• Surgical Wound Infection (drug therapy, microbiology)
• beta-Lactams