cilastatin--imipenem-drug-combination and Diabetic-Foot

Diabetic foot ulcers and infections are common and incur substantial economic burden for society, patients and families. We performed a comprehensive review, on a number of databases, of health economic evaluations of a variety of different prevention, diagnostic and treatment strategies in the area of diabetic foot ulcers and infections. We included English-language, peer-reviewed, cost-effectiveness, cost-minimization, cost-utility and cost-benefit studies that evaluated a treatment modality against placebo or comparator (i.e. drug, standard of care), regardless of year. Differences were settled through consensus. The search resulted in 1885 potential citations, of which 20 studies were retained for analysis (3 cost minimization, 13 cost effectiveness and 4 cost utility). Quality scores of studies ranged from 70.8% (fair) to 87.5% (good); mean = 78.4% +/- 5.33%.In diagnosing osteomyelitis in patients with diabetic foot infection, magnetic resonance imaging (MRI) showed 82% sensitivity and 80% specificity. MRI cost less than 3-phase bone scanning + Indium (In)-111/Gallium (Ga)-67; however, when compared with prolonged antibacterials, MRI cost $US120 (year 1993 value) more without additional quality-adjusted life-expectancy. Prevention strategies improved life expectancy and QALYs and reduced foot ulcer rates and amputations.Ampicillin/sulbactam and imipenem/cilastatin were both 80% successful in treating diabetic foot infections but the latter cost $US2924 more (year 1994 value). Linezolid cure rates were higher (97.7%) than vancomycin (86.0%) and cost $US873 less (year 2004 value). Ertapenem costs were significantly lower than piperacillin/tazobactam ($US356 vs $US503, respectively; year 2005 values). Becaplermin plus good wound care may be cost effective in specific populations. Bioengineered living-skin equivalents increased ulcer-free months and ulcers healed, but costs varied between countries. Promogran produced more ulcer-free months than wound care alone (3.75 vs 3.41 months, respectively). Treatment with cadexomer iodine resulted in higher rates of healed ulcer (29% vs 11%) and lower weekly treatment costs (Swedish krona [SEK]903 vs SEK1421; year 1993 values) than standard care. Filgrastim decreased hospital stays, time to resolution and costs (36% lower) compared with usual care. Adjunctive hyperbaric oxygen produced an incremental cost per QALY at year 1 of $US27 310 and $US2255 at year 12 (year 2001 values).Overall, preventive strategies were

Topics: Ampicillin; Anti-Bacterial Agents; Cilastatin; Cilastatin, Imipenem Drug Combination; Cost-Benefit Analysis; Diabetes Complications; Diabetic Foot; Drug Combinations; Economics, Pharmaceutical; Humans; Imipenem; Quality-Adjusted Life Years; Sulbactam

In this prospective, randomized, open-label clinical trial, we compared the efficacy and safety of two antibiotic regimens for severe diabetic foot infections (DFI). Sixty-two in-patients with DFI received either piperacillin/tazobactam (Pip-Tazo, n = 30) (4.5 g intravenously every 8h) or imipenem/cilastatin (IMP, n = 32) (0.5 g intravenously every 6h). The mean duration of treatment was 21 days for Pip-Tazo and 24 days for IMP. Twenty-two (73.3%) patients in the Pip-Tazo group and 26 (81.2%) patients in the IMP group had DFI associated with osteomyelitis. Successful clinical response was seen in 14 (46.7%) patients in the Pip-Tazo group and in nine (28.1%) patients in the IMP group [relative risk (RR) 1.6 (95% CI 0.84-3.25), p 0.130]. Two patients in the IMP group and none in the PIP-Tazo group relapsed [RR 2 (0.94-4.24), p 0.058]. Eighty-nine microorganisms were isolated: 38 (43%) Gram-positive and 51(57%) Gram-negative. Among patients with positive culture, 47 (96%) had complete and two (4%) had partial microbiological response. Microbiological response rates were similar in both groups (p 1.000). Amputation was performed in 18 (60%) and 22 (69%) patients in the Pip-Tazo and IMP groups (p 0.739) respectively. Side effects were more common in the Pip-Tazo group (30% vs. 9.4%), but they were generally mild and reversible. In conclusion, although the sample size was small and the results did not reach statistical significance, Pip-Tazo produced a better clinical response rate than IMP in the treatment of severe DFI. There was no significant difference between the treatment groups with respect to microbiological response, relapse and amputation rates.

Topics: Adult; Aged; Aged, 80 and over; Amputation, Surgical; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cilastatin; Cilastatin, Imipenem Drug Combination; Diabetic Foot; Drug Combinations; Female; Hospitals, University; Humans; Imipenem; Male; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prospective Studies; Recurrence; Time Factors; Treatment Outcome

The authors present data of using the selective intraarterial infusion of Thienam and Vasaprostan for treatment of purulent diseases of the foot in 70 patients with diabetes mellitus. The microsurgical method was used. The proposed method is thought to be expedient and highly effective.

Topics: Aged; Alprostadil; Cilastatin; Cilastatin, Imipenem Drug Combination; Diabetic Foot; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Infusions, Intra-Arterial; Male; Middle Aged; Suppuration; Time Factors; Vasodilator Agents

In case of neuropathic forms, infection is the cause of tissue nekros, while - in case of neuroischemic forms, it's critical ischemia. Antibacterial therapy is present in all cases of neuroischemic form, not dependent on the signs of infection, Though, in case of neuropathic forms, a course of antibiotics is prescribed only in case of the attachment of infection. Infected neuroischemic ulcer is characterized of acube development (infection+ischemia), unlike infections neuropathic, ulces. The researches showed that 42 patients (40%) suffered from neuropathic form and 63(60%) - from neuroischemic form. In purulent zones anaerobic flora was revealed in 77.3%, aerobic flora - 17.7%, the rise of microflora was not indicated in 5% of cases. Most often, with 43.6% St. aureus was found out, and from the association of microbes - st. aureus + Str. pyogenes - 8.7%. Was the level of bacterial pollution and varied from 105 to 10(12). The highest sensibility was shown towards Tienam (98.9%). The most acceptable and productive form of treatment turned our to be the following combination phtorchinolyns+aminoglycosides. Out of 105 patients 34 amputations were done + 6 tall, 10 large (more than a half) and 18 small (up to the middle of the foot). In 71 cases we successfully managed to stop infections processes and get rid of amputations.

Topics: Adult; Aged; Anti-Bacterial Agents; Cilastatin; Cilastatin, Imipenem Drug Combination; Diabetic Foot; Drug Combinations; Female; Humans; Imipenem; Ischemia; Male; Middle Aged; Wound Infection

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibiotic Prophylaxis; Cilastatin; Cilastatin, Imipenem Drug Combination; Diabetic Foot; Drug Combinations; Female; Humans; Imipenem; Male; Middle Aged; Pancreatitis, Acute Necrotizing; Peritonitis; Postoperative Care; Protease Inhibitors; Suppuration; Thienamycins

Topics: Abscess; Cilastatin; Cilastatin, Imipenem Drug Combination; Diabetes Complications; Diabetic Foot; Drug Combinations; Drug Therapy, Combination; Humans; Imipenem; Microsurgery; Vasodilator Agents