Objectives:

The objectives of the study were to do a comparison of the efficacy of parenteral cefepime plus metronidazole and imipenem-cilastatin for the treatment of serious intra-abdominal infections in adult patients. They were also to obtain in-vitro susceptibility data of pathogenic bacteria that cause intra-abdominal infections.

Materials and methods:

This was a prospective, randomised, comparative open study, conducted in a tertiary care hospital.

Patients:

The patients included in the study were adults with a clinically confirmed diagnosis of intra-abdominal infections who received either cefepime 2 g intravenously every 12 h in addition to metronidazole 500 mg every 8 h or imipenem–cilastatin 500 mg intravenously every 6 h.

Outcome:

Complete clinical response was defined as the absence of pretreatment signs and symptoms of infection. Failure was defined as lack of changing or worsening of pretreatment signs and symptoms of infection. Surgical infection management was determined by the patients’ surgeon.

Results:

A total of 122 patients were included in the study and 121 were evaluable (ITT). Sixty patients (33 men) received cefepime plus metronidazole and 52 (87%) of them were cured; while 44 (72%) of 61 (27 men) patients in the imipenem–cilastatin arm were cured (P = 0.015). There were five failures in the cefepime plus metronidazole arm and 16 failures in the imipenem–cilastatin arm. Microbiological eradication was established in similar proportions in both study groups (43 cefepime plus metronidazole and 38 in the imipenem–cilastatin).

Conclusions:

The results of the present study showed that cefepime plus metronidazole was more effective than imipenem–cilastatin in the treatment of intra-abdominal infections.