• A J Simpson, Y Suputtamongkol, M D Smith, B J Angus, A Rajanuwong, V Wuthiekanun, P A Howe, A L Walsh, W Chaowagul, and N J White.
• Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. fnajs@diamond.mahidol.ac.th
• Clin. Infect. Dis. 1999 Aug 1;29(2):381-7.

AbstractAn open, prospective, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of high-dose intravenous imipenem and ceftazidime for acute severe melioidosis. Adult Thai patients with suspected acute, severe melioidosis were randomized to receive either imipenem, at a dosage of 50 mg/(kg x d), or ceftazidime, at a dosage of 120 mg/(kg x d), for a minimum of 10 days. The main outcome measures were death or treatment failure. Of the 296 patients enrolled, 214 had culture-confirmed melioidosis, and 132 (61.7%) of them had positive blood cultures. Mortality among patients with melioidosis was 36.9% overall. There were no differences in survival overall (P = .96) or after 48 hours (P = .3). Treatment failure after 48 hours was more common among patients treated with ceftazidime (P = .011). Both treatments were well tolerated. Imipenem is a safe and effective treatment for acute severe melioidosis and may be considered an alternative to ceftazidime.

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