A Randomized Double Blinded Comparison of Ceftazidime and Meropenem in Severe Melioidosis
Status:
Unknown status
Trial end date:
2010-09-01
Target enrollment:
Participant gender:
Summary
Melioidosis, an infection caused by the bacterium Burkholderia pseudomallei, is a major cause
of community-acquired septicaemia in northeast Thailand. Common manifestations include
cavitating pneumonia, hepatic and splenic abscesses, and soft tissue and joint infections.
Despite improvements in diagnostic procedures and treatment, the mortality of severe
melioidosis remains unacceptably high - approximately 35% with currently used antibiotics
(ceftazidime or co-amoxiclav). There is clear evidence that antibiotics can affect mortality;
the use of ceftazidime rather than previous regimens (doxycycline + chloramphenicol +
co-trimoxazole) led to a 50% reduction in mortality from 80% to 35%. However, the mortality
in the first 48 hours has not been altered by any treatment regimen. A key question is
whether alternative antibiotics could improve early outcome. The hypothesis tested is that
meropenem is superior to ceftazidime in terms of mortality for the treatment of melioidosis.