Cefepima en el tratamiento de la osteomielitis por bacilos gramnegativos

RESUMEN

Llevamos a cabo un estudio prospectivo, aleatorizado y abierto para evaluar la eficacia y la tolerabilidad de cefepima en el tratamiento de la osteomielitis por bacilos gramnegativos. Se incluyeron en el estudio pacientes hospitalizados con diagnóstico de osteomielitis por bacilos gramnegativos sensibles a cefepima. La cefepima se administró por vía intravenosa o intramuscular (2 g cada 8 o 12 horas). Los microorganismos fueron considerados sensibles a la cefepima cuando la CMI era <8 mg/ml. Se incluyeron 45 pacientes con infección osea, 43 con osteomielitis (22 crónicas y 21 agudas) y dos con artritis. En el análisis por protocolo se evaluaron 42 pacientes, de los cuales 30 (71,4%) curaron. Por intención de tratar se evaluaron 45 pacientes y de ellos curaron 33 (73,3%). Nuestro estudio sugiere que la cefepima es tan eficaz como otros modernos betalactámicos parenterales en el tratamiento de la osteomielitis por bacilos gramnegativos.

Palabras clave: Cefepima - Osteomielitis - Bacilos gramnegativos

Cefepime in the treatment of osteomyelitis due to Gram-negative bacilli

SUMMARY

We conducted a prospective, randomized, open-label trial to evaluate the efficacy and tolerability of cefepime in the treatment of osteomyelitis caused by Gram-negative bacilli. Hospitalized patients with diagnosis of osteomyelitis due to Gram-negative bacilli susceptible to cefepime were elegible for enrollment. Cefepime was administered intravenously or intramuscularly (2 g every 8 or 12 hours). Microorganisms were considered susceptible to cefepime when the MIC was <8 mg/l. Forty-five patients with bone infections were enrolled, forty-three with osteomyelitis (22 chronic and 21 acute) and two with arthritis. In the per protocol analysis 42 patients were evaluated: 30 (71.4%) were cured. In the intent to treat analysis 45 patients were evaluated: 33 (73.3%) were cured. Our trial suggests that cefepime is as effective as other modern parenteral beta-lactam antibiotics in the treatment of osteomyelitis due to Gram-negative bacilli.

Key words: Cefepime - Osteomyelitis - Gram-negative bacilli