Multicenter trial of imipenem/cilastatin sodium combined with cefotiam hydrochloride in patients with MRSA infections

Kaoru Shimada, Shinichi Oka, Jingoro Shimada, Osamu Sakai, Masaru Yamamoto, Masao Hagiwara, Yosuke Ogura, Jingoro Shimada, Yasuo Idezuki, Toshiro Konishi, Hiroyoshi Kobayashi, Hideo Ikemoto, Hiroshi Isonuma, Takashi Inamatsu, Makiko Fukayama, Yoshishige Masuda, Tomiyoshi Sato, Yushi Uetera, Shigetomi Iwai, Koumei KatoHidekazu Tanaka, Issei Nakayama, Emiko Yamaji, Yozo Akieda, Tersuya Watanabe, Toshiaki Suzuki, Kanji Itokawa, Kota Okinaga, Hiroyuki Kobayashi, Shin Kawai, Masaaki Arakawa, Kouichi Wada, Jiro Yura, Nagao Shinagawa, Syu Ishikawa, Yuji Okada, Hiroshi Mizuno, Keiichi Hori, Susumu Watanabe, Toshiyuki Yamamoto, Kanzo Suzuki, Toshihiko Takeuchi, Yoshimitsu Hayashi, Kazuhide Yamamoto, Ikuji Usami, Kaoru Shimokata, Hidetaka Kawatsu, Kazuyoshi Senda, Hiroshi Amano, Hiroshi Saito, Hiroaki Kinoshita, Ken Morimoto, Shoji Kubo, Katsuji Sakai, Rinzo Soejima, Chikara Nakahama, Kunzo Orita, Eiji Konaga, Sadanori Fuchimoto, Hideyuki Kimura, Akio Hizuta, Yoshiro Sawae, Kaoru Okada, Hisashi Gondo, Masaru Nasu, Toru Yamasaki, Hiroyuki Nagai, Yoichiro Goto, Kohei Hara, Shigeru Kohno, Hironobu Koga, Mitsuo Kaku, Atsushi Saito, Yoshiteru Shigeno, Yuei Irabu, Hiroshi Fukuhara, Nobuchika Kusano, Matsuhisa Inoue

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Sixty-six patients with confirmed or suspected methicillin-resistant Staphylococcus aureus (MRSA) infections were treated with imipenem/cilastatin sodium (IPM/CS) 0.5 g every 12 hours combined with cefotiam hydrochloride (CTM) 2 g every 12 hours. The drugs were administered as either simultaneous or separate (IPM/CS→CTM) drip infusions. The results were as follows: 1) Using the checkerboard agar-dilution method the mean fractional inhibitory concentration (FIC) index of 48 strains of MRSA isolated before concomitant therapy with IPM and CTM was 0.217. 2) Bacteriologically, MRSA was eradicated in 23 patients, decreased in 10 and unchanged in 12. Superinfection occured in 6 patients, and the status of 2 was unknown. The eradication rate was 56.9%. 3) Fifteen (78.9%) of the 19 strains of organisms isolated concomitantly with MRSA were eradicated. More specifically, 7 of 10 strains of Pseudomonas aerginosa were eradicated. 4) Clinical cure was observed in 77.4% of the patients. Treatment was required because of respiratory tract infections in 29 patients including 25 with pneumonia), wound infections in 15, infections secondary to burns in 2, intra-abdominal infections in 2, subcutaneous infections in 2, intrapelvic infection in 1, urinary tract infection in 1 and sepsis in 1. 5) The overall clinical effect was excellent in 11 patients, good in 28 and poor in 12. The efficacy rate was 76.5%. 6) No statistically significant difference in overall clinical efficacy was observed between the simultaneous and separaee infusion protocols. 7) The coagulase type of the MRSA was II in the case of 23 strains, III in 16, IV in 3 and VII in 6. There were no statistically significant differences in efficacy rates among the various coagulase types. 8) Adverse effects observed clinically consisted of nausea in 2 patients, nausea and vomiting in 1 patient and diarrhea in 1 patient. Laboratory abverse events consisted of hepatic enzyme elevation in 8 patients. These abverse events were all mild and transient. In conclusion, IPM/CS combined with CTM is useful in the treatment of MRSA infections.

Original languageEnglish
Pages (from-to)654-672
Number of pages19
JournalCHEMOTHERAPY
Volume40
Issue number5
DOIs
Publication statusPublished - May 1992
Externally publishedYes

Keywords

  • MRSA
  • cefotiam hydrochloride
  • imipenem/cilastatin sodium

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases
  • Pharmacology
  • Drug Discovery
  • Oncology

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  • Cite this

    Shimada, K., Oka, S., Shimada, J., Sakai, O., Yamamoto, M., Hagiwara, M., Ogura, Y., Shimada, J., Idezuki, Y., Konishi, T., Kobayashi, H., Ikemoto, H., Isonuma, H., Inamatsu, T., Fukayama, M., Masuda, Y., Sato, T., Uetera, Y., Iwai, S., ... Inoue, M. (1992). Multicenter trial of imipenem/cilastatin sodium combined with cefotiam hydrochloride in patients with MRSA infections. CHEMOTHERAPY, 40(5), 654-672. https://doi.org/10.11250/chemotherapy1953.40.654