An open randomised trial was conducted to compare ceftazidime (120 mg/kg/day) with "conventional therapy" (chloramphenicol 100 mg/kg/day, doxycycline 4 mg/kg/day, trimethoprim 10 mg/kg/day, and sulphamethoxazole 50 mg/kg/day) in the treatment of severe melioidosis. A paired restricted sequential trial designed to detect a reduction in mortality from 80 to 40% in culture-positive patients surviving > 48 hours was stopped after 22 months. Of the 161 patients entered into the study, 65 had bacteriologically confirmed melioidosis and 54 of these were septicaemic. Ceftazidime treatment was associated with a 50% (95% CI 19-81%) lower overall mortality than conventional treatment (74% vs 37%; p=0·009) and should now become the treatment of choice for severe melioidosis.
Andrew J. H. Simpson, Yupin Suputtamongkol, Michael D. Smith, Brian Angus, Adul Rajanuwong, Vanaporn Wuthiekanun, Paul A. Howe, Amanda L. Walsh, Wipada Chaowagul, Sir Nicholas White
Yupin Suputtamongkol, A. Rajchanuwong, Wipada Chaowagul, David A. B. Dance, Michelle Smith, Vanaporn Wuthiekanun, Amanda L. Walsh, Sasithon Pukrittayakamee, Sir Nicholas White
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