ABSTRACT
The activity of aztreonam (a beta-lactam antibiotic with specific activity against gram-negative bacteria) was evaluated and compared with that of tobramycin in hospitalized patients with severe intra-abdominal infections due to gram-negative pathogens, either alone or in association with other bacteria. Of a total study population of 156 patients, 76 were assigned to treatment with aztreonam + clindamycin, and the remaining 80 were treated with tobramycin + clindamycin. Patients underwent a variety of surgical procedures involving the peritoneal cavity. The final clinical evaluation revealed similar percentages of satisfactory results: 86.8% for the patients in the aztreonam-treated group and 86.2% for the tobramycin-treated patients. Among the patients who had a poor therapeutic result, gram-negative bacteria, either alone or associated with gram-positive pathogens, were considered responsible for 50% of the infections in the aztreonam group; the percentage increased to 82% among those treated with tobramycin. The incidence of side effects and laboratory alterations was not significant and was similar in both groups. The results of this study suggest that aztreonam may be an effective and safe drug for the treatment of bacterial infections due to gram-negative pathogens.
Subject(s)
Abdomen , Aztreonam/therapeutic use , Bacterial Infections/drug therapy , Clindamycin/therapeutic use , Cross Infection/drug therapy , Tobramycin/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Aztreonam/administration & dosage , Clindamycin/administration & dosage , Clinical Trials as Topic , Drug Therapy, Combination , Female , Gram-Negative Bacteria , Humans , Male , Middle Aged , Random Allocation , Tobramycin/administration & dosageABSTRACT
Sixty-six patients with acute intraabdominal infections due to gram-negative aerobic organisms were treated with aztreonam plus clindamycin or with tobramycin plus clindamycin in a multicenter, comparative, randomized study. The patients had undergone a variety of surgical procedures; most of them had peritonitis. Thirty-three of the 36 patients in the aztreonam group and 26 of the 30 patients in the tobramycin group had satisfactory clinical responses. Only one gram-negative aerobic pathogen, a strain of Pseudomonas aeruginosa, persisted after treatment; the patient involved was in the tobramycin group. The incidences of adverse reactions, superinfections, and abnormal laboratory values were low in each treatment group. The difference between the efficacies of the two regimens was not statistically significant. This study suggests that aztreonam may be a useful alternative to the aminoglycosides in the treatment of gram-negative intraabdominal infections.
