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

Simon Tiberi, Giovanni Sotgiu, L. D'Ambrosio, Rosella Centis, Marcos Abdo Arbex, Edith Alarcon Arrascue, Jan Willem C Alffenaar, Jose A. Caminero, Mina Gaga, Gina Gualano, Alena Skrahina, Ivan Solovic, Giorgia Sulis, Marina Tadolini, Valentina Alarcon Guizado, Saverio De Lorenzo, Aurora Jazmín Roby Arias, Anna Scardigli, Onno W. Akkerman, Alena AleksaJanina Artsukevich, Vera Auchynka, Eduardo Henrique Bonini, Félix Antonio Chong Marín, Lorena Collahuazo López, Gerard De Vries, Simone Dore, H. Kunst, Alberto Matteelli, Charalampos Moschos, Fabrizio Palmieri, Apostolos Papavasileiou, M. C. Payen, A. F. Piana, Antonio Spanevello, Dante Vargas Vasquez, Pietro Viggiani, Veronica White, Alimuddin Zumla, Giovanni Battista Migliori

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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.

Original languageEnglish
Pages (from-to)1758-1766
Number of pages9
JournalEuropean Respiratory Journal
Volume47
Issue number6
DOIs
Publication statusPublished - Jun 1 2016

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ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine

Cite this

Tiberi, S., Sotgiu, G., D'Ambrosio, L., Centis, R., Arbex, M. A., Arrascue, E. A., Alffenaar, J. W. C., Caminero, J. A., Gaga, M., Gualano, G., Skrahina, A., Solovic, I., Sulis, G., Tadolini, M., Guizado, V. A., De Lorenzo, S., Arias, A. J. R., Scardigli, A., Akkerman, O. W., ... Migliori, G. B. (2016). Comparison of effectiveness and safety of imipenem/clavulanate-versus meropenem/clavulanate-containing regimens in the treatment of MDR- and XDR-TB. European Respiratory Journal, 47(6), 1758-1766. https://doi.org/10.1183/13993003.00214-2016