cilastatin--imipenem-drug-combination and Chronic-Disease

To evaluate the feasibility and effects of transcatheter arterial embolization with imipenem/cilastatin sodium (CS) to treat tendinopathy and enthesopathy that are refractory to traditional nonsurgical management.. Transcatheter arterial embolization with imipenem/CS as an embolic agent was performed in seven patients (five men; mean age, 51.7 y) with tendinopathy and enthesopathy (patellar tendinopathy, n = 1; rotator cuff tendinopathy, n = 2; plantar fasciitis, n = 1; lateral epicondylitis, n = 1; iliotibial band syndrome, n = 1; and Achilles insertion tendinopathy, n = 1). All patients had unrelenting pain at the site of tendinopathy and enthesopathy before the procedure. Technical success, adverse events, and changes in visual analog scale (VAS) scores were assessed.. All procedures were technically successful, and no major adverse events developed. Compared with before the procedure, mean VAS scores were significantly decreased at 1 day, 1 week, and 1 and 4 months after the procedure (72.7 mm±9.9 vs 17.4 mm±18.5, 16.0 mm±18.1, 13.7 mm±7.3, and 9.7 mm±6.8, respectively; all P< .001).. Transcatheter arterial embolization with imipenem/CS was feasible and effectively relieved unrelenting pain associated with tendinopathy and enthesopathy.

Topics: Adult; Aged; Anti-Bacterial Agents; Arthralgia; Catheterization, Peripheral; Chronic Disease; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Embolization, Therapeutic; Female; Hemostatics; Humans; Imipenem; Male; Middle Aged; Pain Measurement; Protease Inhibitors; Rheumatic Diseases; Tendinopathy; Treatment Outcome

We conducted a prospective, randomized, open-label trial, comparing oral ofloxacin with intravenous imipenem-cilastatin for the treatment of chronic osteomyelitis in order to evaluate the efficacy and tolerance. Hospitalized patients with diagnosis of chronic osteomyelitis and isolation of susceptible organisms to ofloxacin and imipenem/cilastatin were eligible for enrollment. Ofloxacin was administered orally (400 mg every 12 hours), and imipenem-cilastatin was given intravenously (500 mg every 6 hours). Organisms were considered susceptible to ofloxacin when the minimal inhibitory concentration (MIC) was <2 micrograms/ml, and to imipenem-cilastatin when the MIC was <4 micrograms/ml. Thirty-two patients were enrolled, 16 in each group. In the intent to treat analysis 11 (69%) patients in the ofloxacin group and eight (50%) in the imipenem-cilastatin group were cured (p = 0.473; 95% confidence interval of the difference from -14.7% to 52.2%). In the per protocol analysis 10 (91%) patients in the ofloxacin group and seven (70%) in the imipenem/cilastatin group were cured (p = 0.311; 95% confidence interval of the difference from -12.2% to 54%). Our trial suggests that oral ofloxacin is as effective as parenteral therapy with betalactam antibiotics in the treatment of osteomyelitis, which could allow a reduction of the period of hospitalization and economic costs.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Chronic Disease; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Female; Humans; Imipenem; Injections, Intravenous; Male; Middle Aged; Ofloxacin; Osteomyelitis; Prospective Studies

Mycobacterium fortuitum is a rapidly growing nontuberculous mycobacterium. This microorganism is an uncommon etiological agent of lung lesions; among lung lesions caused by M. fortuitum, thoracic empyema is particularly rare. A 61-year-old man who had been treated for chronic hypercapnic respiratory failure with noninvasive ventilation was admitted because of breathing difficulty and was found to have M. fortuitum thoracic empyema. He improved after the administration of amikacin, imipenem/cilastatin, and clarithromycin following sulfamethoxazole/trimethoprim and clarithromycin. This is the first report of M. fortuitum thoracic empyema in a patient without human immunodeficiency virus infection. The thoracic empyema may have developed via a pulmonary fistula in this case. This case highlights the fact that we must be aware of the possibility of M. fortuitum thoracic empyema, especially in patients with M. fortuitum lung infection and treatment with noninvasive ventilation. Multidrug therapy may be effective and important to the resolution of M. fortuitum thoracic empyema.

Topics: Amikacin; Anti-Bacterial Agents; Chronic Disease; Cilastatin; Cilastatin, Imipenem Drug Combination; Clarithromycin; Drug Combinations; Drug Therapy, Combination; Empyema, Pleural; Humans; Hypercapnia; Imipenem; Male; Middle Aged; Mycobacterium fortuitum; Noninvasive Ventilation; Sulfamethoxazole

Topics: Adult; Anti-Bacterial Agents; Ascitic Fluid; Chronic Disease; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Female; Half-Life; Humans; Imipenem; Liver Diseases; Male; Middle Aged

Topics: Acute Disease; Adult; Aged; Bacterial Infections; Chronic Disease; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Female; Humans; Imipenem; Lung Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Pulmonary Disease, Chronic Obstructive; Safety

Ten patients with cystic fibrosis (CF) and chronic broncho-pulmonary Pseudomonas aeruginosa infection were given imipenem/cilastatin (100 mg/kg/day) in combination with tobramycin (15 mg/kg/day). Forced vital capacity and forced expiratory volume in the first second improved significantly in nine out of ten patients, and most of the patients improved clinically. P. aeruginosa was not eradicated in any patient and resistance against imipenem developed in all patients during treatment. A concomitant increase in MIC of piperacillin and ceftazidime occurred during treatment. In-vitro bactericidal synergy of imipenem and tobramycin was noted in 57% of pretreatment isolates. Seven patients complained of adverse reactions, mainly gastrointestinal, and treatment of three patients was discontinued after 5, 8, and 12 days of therapy, because of rash or nausea and vomiting. The side effects were considered to be due to imipenem/cilastatin. Because of the rapid development of imipenem resistance despite combination therapy, the high proportion of side effects, and the risk of induction of beta-lactam resistance, imipenem/cilastatin cannot be recommended for routine treatment of CF-patients with P. aeruginosa infection.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bronchopneumonia; Child; Chronic Disease; Cilastatin; Cilastatin, Imipenem Drug Combination; Cyclopropanes; Cystic Fibrosis; Drug Combinations; Drug Synergism; Drug Therapy, Combination; Female; Humans; Imipenem; Kinetics; Male; Microbial Sensitivity Tests; Penicillin Resistance; Piperacillin; Pseudomonas aeruginosa; Pseudomonas Infections; Sputum; Thienamycins; Tobramycin