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Merrem plus Cubicin effective against nosocomial spontaneous bacterial peritonitis

Researchers from the University of Padova in Italy found that an antibiotic combination regimen of Merrem and Cubicin was more effective in treating nosocomial spontaneous bacterial peritonitis compared with Glazidim, according to published findings.

Researchers randomly assigned 32 patients with cirrhosis and nosocomial spontaneous bacterial peritonitis (SBP) to receive either 1 g of Merrem (meropenem; AstraZeneca S.p.A., Basiglio, Milan, Italy) every 8 hours plus 6 mg/kg per day of Cubicin (daptomycin; Novartis PharmaGmbH, Germany) or 2 g of Glazidim (ceftazidime; GlaxoSmithKline S.p.A., Verona, Italy) every 8 hours. Of these patients, 31 were included in the final analysis, of which 15 received meropenem plus daptomycin and 16 received ceftazidime. After 48 hours of treatment, the researchers performed a paracentesis.

“The primary outcome was the efficacy of treatment defined by the resolution of SBP after 7 days of treatment,” the researchers wrote.

Overall, more patients who received meropenem plus daptomycin (13/15) experienced resolved infection compared with ceftazidime (4/16; 86.7% vs. 25%; P < .001).

Reasons for treatment failure included bacteria resistance to treatment (four in the ceftazidime group), failure to meet a 25% or greater reduction in PMNC count (seven patients in ceftazidime group, one in meropenem group) and failure to obtain complete treatment response after 7 days (one patient in each group).

The 90-day transplant-free survival (TFS) was not significantly different between the two groups. Independent predictors of 90-day TFS found in the multivariate analysis included a failed response to treatment, the development of acute kidney injury during hospitalization and baseline mean arterial pressure (P = .01 for all).

The rate of occurrence of adverse events (AE) or serious AEs were similar between the two groups. The most common AEs were nausea, diarrhea, developing second infections, encephalopathy and acute kidney injury. None of the AEs led to withdrawal of any of the drugs, according to the research.

“The study shows that [meropenem plus daptomycin] is more effective than [ceftazidime] in the treatment of nosocomial SBP, in centers with a high prevalence of [multi-drug resistant] bacteria,” the researchers concluded. “Thus, in centers with high prevalence of [multi-drug resistant] bacteria, a broad-spectrum antibiotic regimen, such as [meropenem plus daptomycin], should be considered as first-line empirical treatment in patients with cirrhosis and nosocomial SBP.” – by Melinda Stevens

Disclosures: Piano reports no relevant financial disclosures. Please see full study for a list of all other authors’ relevant financial disclosures.