Ceftazidime-avibactam plus metronidazole vs. meropenem in complicated intra-abdominal infections: Indian subset from RECLAIM.

Prithi Rodgers,Shweta Kamat,Charles Adhav

doi:10.3855/jidc.14912

Prithi Rodgers, Shweta Kamat + Show 1 more

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https://doi.org/10.3855/jidc.14912

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Abstract

This study analyzes the safety and efficacy results of the Indian population subset from the RECLAIM trial investigating the non-inferiority of Ceftazidime-Avibactam (CAZ-AVI) plus metronidazole to meropenem and interprets its relevance. The study design, subjects inclusion criteria, dosage, safety and efficacy evaluations in Indian patients have been followed as per the RECLAIM trial protocol. A total of 142 Indian patients with complicated intra-abdominal infection were enrolled across eight centers in India, 125 of them were randomized to either CAZ-AVI + metronidazole (n = 62) or meropenem (n = 63) group. the clinical cure rates in modified intention-to-treat (MITT; all randomized patients who met minimum disease requirements and received any amount of study drug) and clinically evaluable (CE , patients who had an evaluable assessment and no protocol deviations) analysis sets, was numerically comparable to the results of overall population for CAZ-AVI + metronidazole [MITT: 82.5% (Overall, n = 429/520) versus 89.3% (Indian, n = 50/56); CE: 91.7% (Overall, n = 376/410) versus 97.8% (Indian, n = 45/46)] and meropenem [MITT: 84.9% (Overall, n = 444/523) versus 84.7% (Indian, n = 50/59); CE: 92.5% (Overall, n = 385/416) versus 95.5% (Indian, n = 42/44)]. No new safety findings were reported in the Indian population. CAZ-AVI + metronidazole proved to be an effective option for critical patients with complicated intra-abdominal infection and can be considered as an alternative to carbapenems in the ICU setting for the treatment of resistant pathogens.

Highlights

This study analyzes the safety and efficacy results of the Indian population subset from the RECLAIM trial investigating the noninferiority of Ceftazidime-Avibactam (CAZ-AVI) plus metronidazole to meropenem and interprets its relevance
Complicated intra-abdominal infections are local or systemic infections that occur as a result of a perforation in the gastrointestinal tract or by a necrotic gut wall spilling bacteria into the peritoneal space, leading to abscess formation and/or generalized peritonitis
A total of 142 Indian patients with Complicated intra-abdominal infections (cIAIs) were enrolled across eight centers in India, of these 125 were randomized to one of the two study treatment arms: to CAZ-AVI + metronidazole group and to Meropenem group (Please refer to Figure 1 for patient disposition)

Summary

Introduction

This study analyzes the safety and efficacy results of the Indian population subset from the RECLAIM trial investigating the noninferiority of Ceftazidime-Avibactam (CAZ-AVI) plus metronidazole to meropenem and interprets its relevance. Results: A total of 142 Indian patients with complicated intra-abdominal infection were enrolled across eight centers in India, 125 of them were randomized to either CAZ-AVI + metronidazole (n = 62) or meropenem (n = 63) group. Complicated intra-abdominal infections (cIAIs) are local or systemic infections that occur as a result of a perforation in the gastrointestinal tract or by a necrotic gut wall spilling bacteria into the peritoneal space, leading to abscess formation and/or generalized peritonitis. These infections require operative intervention or percutaneous drainage in conjunction with antibacterial therapy [1]. About 10 – 15% of OXA-48 producers were reported to co-produce New Delhi metallo-beta-lactamase (NDM) [4-7]

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