[Ceftazidime Versus Cefotaxime in the Therapy of Severe Infections in Intensive Care Patients]

In a randomized controlled, clinical study the efficacy of ceftazidime at a dosage of 2 g b. i. d. was compared to that of cefotaxime at a dosage of 2 g t. i. d. or more in the treatment of pneumonia or peritonitis in intensive care patients. 61 of 67 assessable cases were evaluable. In the ceftazidime group ten out of 11 patients with pneumonia and 17 out of 20 with peritonitis showed a clinical success. In the cefotaxime group 15 out of 19 patients with pneumonia and eight out of 11 with peritonitis were clinically cured or improved. With ceftazidime an overall success was achieved in 87% of the patients (27 out of 31) and with cefotaxime in 77% of the patients (23 out of 30). Two patients in the cefotaxime group developed a reinfection. Five of the patients treated with cefotaxime and four of those treated with ceftazidime were therapeutical failures. Escherichia coli, Pseudomonas, Klebsiella, Enterobacter and Proteus species as well as Staphylococcus aureus and enterococci were the most frequent organisms isolated prior to therapy. Following ceftazidime therapy 30 of the 32 gram-negative species were eliminated, whereas in the cefotaxime group the number of gram-negative species isolated was reduced from 28 to ten. Gram-positive species isolated in ten cases prior to therapy, were still present in seven cases after ceftazidime therapy and the number of gram-positive organisms was reduced from 19 to ten following treatment with cefotaxime. In one patient therapy with ceftazidime was stopped due to urticaria. Reversible leukopenia was observed in a patient treated with ceftazidime and a cholestatic reaction in a patient treated with cefotaxime. In both groups a slight elevation of transaminases was seen.