cilastatin--imipenem-drug-combination and Lung-Neoplasms

Imipenem/cilastatin sodium (IPM/CS) was administered to 102 patients with respiratory tract infections and lung cancer. Patients with other serious diseases were excluded and a total of 73 patients were enrolled. They were divided into 12 patients who underwent surgery (operated group) and 61 who did not (non-operated group); the latter group included 28 patients treated with anticancer agents or radiation therapy (treated group) and 33 untreated patients (untreated group). IPM/CS was effective in 75% of the patients, both with and without surgery. The drug was effective in 81% of the treated group, although many of the patients had Stage III or more advanced cancer, as well as bronchial occlusion. IPM/CS was also effective in 69% of the untreated group, although many of the patients have serious infections and a PS (Performance Status) of 3 or greater. Thus, IPM/CS treatment achieved good results. Bacteriological studies showed that 3 out of 4 strains in the operated group and 16 out of 18 in the non-operated group were eliminated. Safety was evaluated in all patients. Two patients (2%) experienced side effects and two others (2%) showed abnormal clinical findings, but the symptoms were mild and resolved after discontinuation or completion of therapy. In conclusion, IPM/CS was very effective for treating respiratory infections in patients with lung cancer.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Carcinoma, Large Cell; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Infusions, Intravenous; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Opportunistic Infections; Respiratory Tract Infections

We conducted a randomized trial to compare the efficacy of imipenem/cilastatine (IPM/CS) monotherapy with that of a combination of latamoxef (LMOX) and tobramycin (TOB) in the initial management of fever and neutropenia in patients with lung cancer. Leukocytopenic febrile patients (less than 3,000 leukocytes per microliters; temperature greater than 38 degrees C) with lung cancer given induction therapy were randomly assigned to receive intravenous treatment with either 1 g IPM/CS twice daily or 2 g LMOX plus 90 mg TOB twice daily. A total 101 febrile episodes were studied. Fifty-one episodes were treated with IPM/CS and 50 with LMOX+TOB. Fifty-nine of the febrile episodes were bacteriologically confirmed, while an organism could not be isolated despite the presence of obvious clinical infection in the remaining 42. The response rate was 82% with IPM/CS and 80% with combination therapy. This difference was not statistically significant. The response rate regarding gram-negative infections was 10 out of 14 (71%) in the IPM/CS group and seven out of 12 (58%) in the LMOX+TOB group. This difference was also not significant (P = 0.484). The response rate in severely neutropenic patients (neutrophils less than 100/microliters) was low (P = 0.078). Three patients in the IPM/CS group were withdrawn from the study due to skin rash and vomiting. Therapy with IPM/CS monotherapy was as effective as a combination regimen.

Topics: Adult; Aged; Bacterial Infections; Chi-Square Distribution; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Drug Therapy, Combination; Female; Fever; Humans; Imipenem; Logistic Models; Lung Neoplasms; Male; Middle Aged; Moxalactam; Multivariate Analysis; Neutropenia; Random Allocation; Tobramycin; Treatment Outcome

A 78-year-old man underwent a left lower sleeve lobectomy and lymph node dissection for lung cancer. His postoperative course had been uneventful until postoperative day (POD) 3, but severe dyspnea occurred suddenly and the chest X-p showed infiltration shadow on POD 3. Streptococcus pneumonia antigen in the urine was elevated, suggesting pneumonia caused by Streptococcus pneumonia. The patient was treated with double dose of imipenem/cilastatin sodium and supported with a mechanical ventilator in an intensive care unit. Although the patient recovered from penicillin resistant Streptococcus pneumonia, he was suffered from Klebsiella sepsis and expired on the POD 26.

Topics: Aged; Carcinoma, Squamous Cell; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Fatal Outcome; Humans; Imipenem; Klebsiella Infections; Lung Neoplasms; Male; Penicillin Resistance; Pneumonia, Pneumococcal; Postoperative Complications; Sepsis; Streptococcus pneumoniae; Ventilators, Mechanical

A 58-year-old man was admitted to our hospital because of an abnormal shadow found on chest radiography. Chest radiographs and chest CT on admission showed a bulla with a niveau and infiltration in the right upper lobe. Smear of sputum and bronchial lavage were negative for acid-fast bacilli. Despite treatment with meropenem and clindamycin, the infiltrating shadow worsened. Since bronchial lavage and sputum culture were positive for M. fortuitum, these drugs were replaced with minocycline and imipenem. Thereafter, the shadow on the chest radiograph improved. After discharge, outpatient treatment with clarithromycin and levofloxacin was continued. After 4 months, the residual tumor shadow in the right upper lobe gradually grew. When a CT-guided transcutaneous needle lung biopsy was undertaken, malignant cells were found. Right upper lobectomy was performed. Pathological examination of the lesion demonstrated small-cell lung cancer. If a lesion does not change after nontuberculous mycobacteria treatment, the physician should consider other lesions such as lung cancer.

Topics: Anti-Bacterial Agents; Carcinoma, Small Cell; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Humans; Imipenem; Lung Neoplasms; Male; Middle Aged; Minocycline; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Radiography, Thoracic; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

Topics: Adenocarcinoma; Adult; Aged; Anti-Bacterial Agents; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Humans; Imipenem; Injections, Intravenous; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Postoperative Care; Postoperative Complications; Time Factors

The clinical utility of imipenem/cilastatin sodium (IPM/CS, Tienam) was studied in 9 patients with respiratory tract infections from whom Pseudomonas aeruginosa was isolated using transtracheal aspiration. The patients treated were 6 males and 3 females, with ages between 42 and 78 years. The infections diagnosed were chronic bronchitis in 5 patients, diffuse panbronchiolitis in 2 and bronchopneumonia in 2. P. aeruginosa alone was isolated from 6 patients and concomitantly with other organisms from 3. Clinical efficacy was good in 6 patients, fairly good in 1 and poor in 2. No side effects or abnormal laboratory test values were observed, except for a slight elevation of LDH in 1 patient. From these results, it appears that IPM/CS is a clinically useful antibiotic for the treatment of respiratory tract infections caused by P. aeruginosa.

Topics: Adult; Aged; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Female; Humans; Imipenem; Lung Neoplasms; Male; Middle Aged; Pseudomonas aeruginosa; Pseudomonas Infections; Respiratory Tract Infections; Stomach Neoplasms