Comparison of the efficacy of three different treatments with imipenem versus the classical clindamycin plus tobramycin in experimental peritonitis

Abstract

This study compares the efficacy of three different treatment modalities of imipenem/cilastatin and the conventional clindamycin plus tobramycin in an experimental model of intra-abdominal sepsis. 145 Wistar rats were used. 40 served as control and 105 as study groups. A capsule with 0.5 ml of inoculum was surgically implanted in the peritoneal cavity. The inoculum was prepared from human feces of healthy volunteers, with a composition of E. coli 10(6), E. faecalis 10(6), B. fragilis, Clostridium sp 10(5) to 10(6) and anaerobic streptococci 10(5) to 10(6). Eighty animals were treated with imipenem/cilastatin and divided in 3 subgroups: "short pretreatment"--29 animals treated 1 hour prior to surgery and 3 days after; "short"--26 animals starting treatment 2 hours post-surgery and continuing it for 3 days; and "long"--25 animals treated for 10 days, starting 2 hours post-surgery. 25 animals received clindamycin plus tobramycin for 10 days. Mortality and the presence of visceral and peritoneal abscesses were the endpoints of the study. The control group had 100% mortality. There were no statistically significant differences among the treated groups although lower mortality was obtained with "short pretreatment" and "long" treatment with imipenem. The presence of abscesses were statistically significant between the imipenem and the combination group. In the imipenem groups, the "short pretreatment" and the long treatment had fewer abscesses than the short one. We conclude that imipenem may be a good alternative monotherapy to conventional therapy with clindamycin plus tobramycin. The "short pretreatment" seemed as good as the long one and better than the short treatment.