Evaluation of imipenem/cilastatin for treatment of infection in an elderly population

Evaluation of panipenem/betamipron (PAPM/BP) in pneumonia in elderly patients

The present multicenter study evaluated the clinical and bacteriological efficacy and safety of panipenem/betamipron (PAPM/BP) for treating pneumonia in elderly patients. Forty-three episodes of pneumonia in 43 patients were treated with PAPM/BP as the sole antibiotic agent. All patients were 65 years of age or older, and were given PAPM/BP at a total daily dosage range of 0.5-2.0 g. The clinical efficacy rate, expressed as a percentage of the total number of excellent and good responses, was 56.4%. Of the 43 patients, 13 were evaluated bacteriologically. In these 13 patients, the eradication rate, expressed as a percentage of the total number of "eradicated" and "replaced" efficacies, was 30.8%. Adverse effects and abnormal laboratory findings occurred in 2 patients, which was 4.6% of the total number of patients evaluated. No serious adverse effects were observed. We concluded that PAPM/BP was well tolerated overall, and was effective and safe for most of the elderly patients.

Meropenem in elderly and renally impaired patients

The safety profile of meropenem in the elderly (aged > 65 years, n=843) and/or renally impaired (creatinine clearance < 51 ml/min, n=436) was assessed by evaluating data from 26 phase III studies which compared the use of meropenem (0.5 or 1.0 g, i.v. every 8 h) with other antimicrobial agents in patients with bacterial infections. The overall pattern and frequency of adverse events following meropenem therapy in the elderly and/or renally impaired were similar to those in younger and/or non-renally impaired cohorts and to imipenem/cilastatin and injectable third generation cephalosporins. Both dosages of meropenem (0.5 and 1.0 g, i.v. every 8 h) were generally well tolerated. There was no clinically significant mean change in indicators of renal flux between baseline and the end of treatment in any patient sub-group. Importantly, meropenem-related seizures were rare (0.1%), even in patients with renal impairment. In summary, meropenem has an excellent safety profile and is therefore suitable for use in elderly and/or renally impaired patients.

Choosing the right antibacterial agent. Is 'newer' always better?

The newer antibacterials are proving in some situations to be more effective than the older agents, and it is tempting to choose them. In many instances, however, traditional agents remain the treatment of choice. Major drawbacks of using newer antibacterials include their higher cost by weight, compared with older drugs, and the emergence of resistant organisms or superinfection as a result of overuse. The newer drugs are best reserved for use when older agents would be inadequate.

Effects of a restrictive antibiotic policy on clinical efficacy of antibiotics and susceptibility patterns of organisms

To assess the impact of a restrictive antimicrobial policy, the efficacy of therapeutic and prophylactic antibiotic regimens and the susceptibility patterns of infecting bacterial microorganisms were studied during a two-month period in 1986 in inpatients in a general hospital. Twenty-eight percent of patients received antimicrobial agents, 21% as treatment and 7% as prophylaxis. In the 359 evaluable episodes of infection cure was obtained in 88% of cases with the initial therapy and in 7% after a change of drugs, but treatment failed in 5%. Of the 18 cases of failure, improvement was seen in eight although the infection persisted. Ten patients died but in seven of them the infection only partially contributed to this outcome. Ten (8%) of 127 patients receiving antimicrobial prophylaxis developed an infection but in three there was no relation to the condition for which the prophylactic regimen was originally prescribed. No changes were found in the susceptibility patterns of microorganisms.