netilmicin appears more effective than cefotaxime

Netilmicin Appears More Effective than Cefotaxime In patients with life-threatening sepsis caused by Enterobacteriaceae and Staphylococci The efficacy and toxicity of netilmicin compared with cefotaxime and a combination of the two antibacterials was assessed in patients with septicaemia thought to be caused by Enterobacteriaceae or staphylococci. 93 patients were randomised to receive netilmicin, mean 2.5 mgjkg tid initially and then adjusted to 1.5-4.5 (mean 2.8) mgjkg for a mean of 6.6 days (n = 32), cefotaxime 1-2g qid initially and then 12-38 (mean 27.5)g for a mean of 74 days (34), or a combination of the two drugs for a mean of 8.7 days (27). 82 patients were evaluable for safety and 74 for clinical efficacy. 92% of patients receiving netilmicin were clinically improved,compared with 62% receiving cefotaxime alone and 91 % receiving combination therapy. Four patients with mixed infections who failed to respond to cefotaxime were improved with netilmicin. 72 organisms were isolated from 63 patients and included Escherichia coli (n = 25) , KlebsiellajEnterobacter (8) , Proteus sp. (6) and staphylococci (12). Bacteriological failures were more prevalent in patients receiving cefotaxime (especially in mixed infections associated with Klebsiella and Enterobacter). In single pathogen infections there was no difference between groups. Superinfection occurred in 9 patients, 6 receiving combination therapy. Nephrotoxicity occurred more frequently in the netilmicin group (in 14% of patients vs 13% for combination therapy and 7% for cefotaxime) but this was not significant. One patient receiving netilmicin developed ototoxicity. Thus, 'this study indicates that netilmicin was more effective but not significantly more toxic (when its use was monitored carefully) than cefotaxime in the treatment of serious infection with susceptible strains of Enterobacteriaceae and staphylococci.' Sage R. Na zar eth B. Noone P Scandina via n Journal of Infectious Diseases 19 331 ·337 . No 3. 1987 156-2703/ 88/ 0116-0007/0$01.00/0 © ADIS Press INPHARMA· 16 January 1988 7

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Page 1: Netilmicin Appears More Effective than Cefotaxime

Netilmicin Appears More Effective than Cefotaxime In patients with life-threatening sepsis caused by Enterobacteriaceae and Staphylococci

The efficacy and toxicity of netilmicin compared with cefotaxime and a combination of the two antibacterials was assessed in patients with septicaemia thought to be caused by Enterobacteriaceae or staphylococci. 93 patients were randomised to receive netilmicin, mean 2.5 mgjkg tid initially and then adjusted to 1.5-4.5 (mean 2.8) mgjkg for a mean of 6.6 days (n = 32), cefotaxime 1-2g qid initially and then 12-38 (mean 27.5)g for a mean of 74 days (34), or a combination of the two drugs for a mean of 8.7 days (27). 82 patients were evaluable for safety and 74 for clinical efficacy.

92% of patients receiving netilmicin were clinically improved,compared with 62% receiving cefotaxime alone and 91 % receiving combination therapy. Four patients with mixed infections who failed to respond to cefotaxime were improved with netilmicin. 72 organisms were isolated from 63 patients and included Escherichia coli (n = 25) , KlebsiellajEnterobacter (8), Proteus sp. (6) and staphylococci (12) . Bacteriological failures were more prevalent in patients receiving cefotaxime (especially in mixed infections associated with Klebsiella and Enterobacter). In single pathogen infections there was no difference between groups. Superinfection occurred in 9 patients, 6 receiving combination therapy .

Nephrotoxicity occurred more frequently in the netilmicin group (in 14% of patients vs 13% for combination therapy and 7% for cefotaxime) but this was not significant . One patient receiving netilmicin developed ototoxicity.

Thus, 'this study indicates that netilmicin was more effective but not significantly more toxic (when its use was monitored carefully) than cefotaxime in the treatment of serious infection with susceptible strains of Enterobacteriaceae and staphylococci.' Sage R. Nazareth B. Noone P Scandinavian Journal of Infec tious Diseases 19 331 ·337 . No 3. 1987

156-2703/ 88/ 0116-0007/0$01.00/0 © ADIS Press INPHARMA· 16 January 1988 7

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