CEFTAZIDIME VS AMOXICILLIN/CLAVULANATE IN THE TREATMENT OF SEVERE MELIOIDOSIS

An open, paired, randomized, controlled trial of high-dose parenteral ceftazidime (120 mg/[kg.d]) do vs. amoxicillin/clavulanate (160 mg/[kg d]) for the treatment of severe melioidosis was conducted in Ubon Ratchatani in northeastern Thailand. Of 379 patients enrolled in the study, 212 (56%) had culture-proven melioidosis; 106 patients were in each treatment group. The overall mortality rate (47%) was similar for both treatment groups. However, 4 of 75 surviving patients in the ceftazidime group compared with 16 of 69 surviving patients in the amoxicillin/clavulanate group were switched to the alternate regimen because of an unsatisfactory clinical response after greater than or equal to 72 hours of treatment (P=.004). The overall therapeutic failure rate (i.e., treatment failure or death due to uncontrolled melioidosis) was significantly higher for the amoxicillin/clavulanate group than for the ceftazidime group (P=.02). Clinical and bacteriologic responses for successfully treated patients were similar in both groups, and both treatments were well tolerated. Parenteral amoxicillin/clavuranate is a safe and effective initial treatment, but parenteral ceftazidime remains the treatment of choice for severe melioidosis.