Imipenem monotherapy versus combination therapy in the management of mixed bacterial infection: a critical appraisal.

There has been a great deal of interest in the use of imipenem monotherapy rather than combinations of antimicrobials for mixed bacterial infections. A review of the published comparative studies of imipenem versus combinations in serious mixed bacterial infections indicated that, overall, imipenem is at least as effective as, and maybe less expensive than, the combinations tested. Several studies suggest that clinical response to imipenem is more rapid than to the comparison regimens; however, other factors may have influenced these values, and the numbers of patients in these reports were small. Imipenem is devoid of the adverse effects associated with aminoglycosides. Other adverse effects, including superinfection and central nervous system toxicity, were similar for imipenem and the comparison regimens. Meta-analysis of the published reports and abstracts revealed that imipenem is as effective as combination regimens for the treatment of serious mixed bacterial infection.