Browsing by Author "Paul A. Howe"

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    Comparison of imipenem and ceftazidime as therapy for severe melioidosis
    (1999-01-01) Andrew J.H. Simpson; Yupin Suputtamongkol; Michael D. Smith; Brian J. Angus; Adul Rajanuwong; Vanaporn Wuthiekanun; Paul A. Howe; Amanda L. Walsh; Wipada Chaowagul; Nicholas J. White; Mahidol University; Sappasitthiprasong Hospital; Centre for Tropical Medicine; John Radcliffe Hospital; Musgrove Park Hospital; Malaria Proj./Wellcome Trust Res. L.
    An open, prospective, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of high-dose intravenous imipenem and ceftazidime for acute severe melioidosis. Adult Thai patients with suspected acute, severe melioidosis were randomized to receive either imipenem, at a dosage of 50 mg/(kg · d), or ceftazidime, at a dosage of 120 mg/(kg · d), for a minimum of 10 days. The main outcome measures were death or treatment failure. Of the 296 patients enrolled, 214 had culture-confirmed melioidosis, and 132 (61.7%) of them had positive blood cultures. Mortality among patients with melioidosis was 36,9% overall. There were no differences in survival overall (P = .96) or after 48 hours (P = .3). Treatment failure after 48 hours was more common among patients treated with ceftazidime (P = .011). Both treatments were well tolerated. Imipenem is a safe and effective treatment for acute severe melioidosis and may be considered an alternative to ceftazidime.