Comparison of effectiveness and safety of imipenem/clavulanate- versus meropenem/clavulanate-containing regimens in the treatment of MDR- and XDR-TB

Eur Respir J. 2016 Jun;47(6):1758-66. doi: 10.1183/13993003.00214-2016. Epub 2016 Apr 13.

Abstract

No large study to date has ever evaluated the effectiveness, safety and tolerability of imipenem/clavulanate versus meropenem/clavulanate to treat multidrug- and extensively drug-resistant tuberculosis (MDR- and XDR-TB). The aim of this observational study was to compare the therapeutic contribution of imipenem/clavulanate versus meropenem/clavulanate added to background regimens to treat MDR- and XDR-TB cases.84 patients treated with imipenem/clavulanate-containing regimens showed a similar median number of antibiotic resistances (8 versus 8) but more fluoroquinolone resistance (79.0% versus 48.9%, p<0.0001) and higher XDR-TB prevalence (67.9% versus 49.0%, p=0.01) in comparison with 96 patients exposed to meropenem/clavulanate-containing regimens. Patients were treated with imipenem/clavulanate- and meropenem/clavulanate-containing regimens for a median (interquartile range) of 187 (60-428) versus 85 (49-156) days, respectively.Statistically significant differences were observed on sputum smear and culture conversion rates (79.7% versus 94.8%, p=0.02 and 71.9% versus 94.8%, p<0.0001, respectively) and on success rates (59.7% versus 77.5%, p=0.03). Adverse events to imipenem/clavulanate and meropenem/clavulanate were reported in 5.4% and 6.5% of cases only.Our study suggests that meropenem/clavulanate is more effective than imipenem/clavulanate in treating MDR/XDR-TB patients.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • Antitubercular Agents / administration & dosage*
  • Clavulanic Acid / administration & dosage*
  • Cohort Studies
  • Comparative Effectiveness Research
  • Drug Resistance, Bacterial
  • Extensively Drug-Resistant Tuberculosis / drug therapy*
  • Female
  • Humans
  • Imipenem / administration & dosage*
  • Male
  • Meropenem
  • Middle Aged
  • Sputum / metabolism
  • Thienamycins / administration & dosage*
  • Time Factors
  • Treatment Outcome
  • Tuberculosis, Multidrug-Resistant / drug therapy*

Substances

  • Antitubercular Agents
  • Thienamycins
  • Clavulanic Acid
  • Imipenem
  • Meropenem