***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ABSTRACT Nosocomial pneumonia and acute peritonitis may be caused by a wide array of pathogens , and combination therapy is often recommended . We have previously shown that imipenem-cilastatin monotherapy was as efficacious as the combination of imipenem-cilastatin plus netilmicin in these two setting s. The efficacy of imipenem-cilastatin is now compared to that of piperacillin-tazobactam as monotherapy in patients with nosocomial pneumonia or acute peritonitis . Three hundred seventy one patients with nosocomial pneumonia or peritonitis were r and omly assigned to receive either imipenem-cilastatin ( 0.5 g four times a day ) or piperacillin-tazobactam ( 4.5 g three times a day ) . Three hundred thirteen were assessable ( 154 with nosocomial pneumonia and 159 with peritonitis ) . For nosocomial pneumonia , clinical -failure rates in the piperacillin-tazobactam group ( 13 of 75 [ 17 % ] ) and in the imipenem-cilastatin group ( 23 of 79 [ 29 % ] ) were similar ( P = 0.09 ) , as were the numbers of deaths due to infection ( 6 in the imipenem-cilastatin group [ 8 % ] , 7 in the piperacillin-tazobactam group [ 9 % ] ) ( P = 0.78 ) . For acute peritonitis , clinical success rates were comparable ( piperacillin-tazobactam , 72 of 76 [ 95 % ] ; imipenem-cilastatin , 77 of 83 [ 93 % ] ) . For infections due to Pseudomonas aeruginosa , 45 patients had nosocomial pneumonia ( 21 in the piperacillin-tazobactam group and 24 in the imipenem-cilastatin group ) and 10 had peritonitis ( 5 in each group ) . In the patients with nosocomial pneumonia , clinical failure was less frequent in the piperacillin-tazobactam group ( 2 of 21 [ 10 % ] ) than in the piperacillin-cilastatin group ( 12 of 24 [ 50 % ] ) ( P = 0.004 ) . Bacterial resistance to allocated regimen was the main cause of clinical failure ( 1 in the piperacillin-tazobactam group and 12 in the imipenem-cilastatin group ) . For the patients with peritonitis , no difference in clinical outcome was observed ( five of five cured in each group ) . The overall frequencies of adverse events related to treatment in the two groups were similar ( 24 in the piperacillin-tazobactam group , 22 in the imipenem-cilastatin group ) . Diarrhea was significantly more frequent in the piperacillin-tazobactam group ( 10 of 24 ) than in the imipenem-cilastatin group ( 2 of 22 ) . This study suggests that piperacillin-tazobactam monotherapy is at least as effective and safe as imipenem-cilastatin monotherapy in the treatment of nosocomial pneumonia or peritonitis . In P. aeruginosapneumonia , piperacillin-tazobactam achieved a better clinical efficacy than imipenem-cilastatin , due to reduced development of microbiological resistance . Tolerance was comparable , with the exception of diarrhea , which was more frequent with piperacillin-tazobactam We conducted a retrospective pharmacoeconomic analysis of a prospect i ve , multicenter , double-blind , r and omized , controlled trial comparing the  beta-lactamase inhibitor combination ampicillin-sulbactam ( 96 patients ) and the cephalosporin cefoxitin ( 101 ) in the treatment of intraabdominal infections . An institutional perspective was adopted for the analysis . The primary outcomes of interest were cure and failure rates , development of new infection , and antibiotic-related adverse events . Epidemiologic data pertaining to outcomes was retrieved primarily from the trial , although results of other published studies were taken into consideration through extensive sensitivity analyses . Data pertaining to potential re source use and economic impact were retrieved mainly from the University Health Consortium and hospital-specific sources . When considering only costs associated with drug acquisition through cost-minimization analysis , a potential savings of $ 37.24/patient may be realized with ampicillin-sulbactam relative to cefoxitin based on an average 7-day regimen . Outcome data collected for the entire hospitalization during the trial revealed an approximately 9 % greater frequency of failure with cefoxitin relative to ampicillin-sulbactam . When considering all outcomes of interest in the initial base-case analysis , a potential cost savings of approximately $ 890/patient may be realized with ampicillin-sulbactam relative to cefoxitin . In assessing the impact of the significant variability in probability and cost estimates , Monte Carlo analysis revealed a savings of $ 425/patient for ampicillin-sulbactam over cefoxitin ( 95 % CI -$618 to $ 1516 [ corrected ] ) . Given the model assumptions , our analysis suggests a 78 % certainty level that savings will be experienced when ampicillin-sulbactam is chosen over cefoxitin A multicenter , open-label r and omized trial was conducted to evaluate the efficacy and tolerability of monotherapy with imipenem-cilastatin ( I-C ) compared with combination therapy with clindamycin and an aminoglycoside ( C+A ) for treatment of 117 patients with serious intra-abdominal infections . Fifty-three patients ( 45 % ) received I-C and 64 patients ( 55 % ) received C+A. The overall clinical success rate was 96.2 % for the I-C patients and 92.2 % for the C+A patients . Clinical failure rates were 3.8 % and 7.8 % , respectively ( P = NS ) . Eradication or suppression of pathogens was observed in 81.8 % and 82.2 % of patients , respectively . Uniform bacteriologic response was observed among all infection subgroups . Fourteen of 145 patients experienced adverse symptoms , including six of 66 ( 9.1 % ) monotherapy patients and eight of 79 ( 10.1 % ) combination-therapy patients ( P = NS ) . The results of this study demonstrate that I-C monotherapy was as effective as C+A combination therapy for the treatment of serious intra-abdominal infections , regardless of the site or severity of infection or the clinical status of the patient . Both regimens also were found to be comparable in tolerability This multicentric , r and omized , double-blind trial compared the efficacy and safety of netilmicin , 4.5 mg/kg od and 1.5 mg/kg tid , in patients with intra-abdominal infections . Of 114 patients enrolled , 57 patients ( mean age 40.3 years ) in the od group and 55 ( mean age 36.8 years ) in the tid group were evaluated for efficacy ;  58 and 56 patients in corresponding groups were evaluated for safety . Among those evaluated for efficacy were 12 od-treated and 11 tid-treated patients with documented septicaemia , and 32 and 30 patients of respective groups with polymicrobial infections . Initially , 86 and 81 netilmicin-susceptible causative microorganisms were isolated in corresponding groups . Of these pathogens , 55 % in the od group and 62 % in the tid group were Escherichia coli . Daily dosage of netilmicin ranged from 3.70 to 4.71 mg/kg ( mean 4.50 ) for the od group and from 3.06 to 4.76 mg/kg ( mean 4.46 ) for the tid group . Duration of netilmicin therapy ranged from six to 13 days ( mean 8.7 days ) for od-treated patients and from seven to 16 days ( mean 8.8 days ) for tid-treated patients . Concomitant metronidazole was administered to 41 patients of the od group and 34 of the tid group ; one patient in the tid group received clindamycin .  Clinical and bacteriological responses were assessed , and peak and trough serum netilmicin levels were measured periodically , during therapy . Laboratory tests , including determinations of serum creatinine and blood urea nitrogen values , were performed throughout the trial . A clinical cure was achieved in 57/57 od-treated patients and 54/55 tid-treated patients ; treatment failed in one tid-treated patient ( 1/55 ) . In od and tid groups , 86/86 and 80/81 netilmicin-susceptible pathogens initially isolated were considered to be eliminated , respectively ; one isolate ( Esch . coli ) persisted in the tid group . Mean peak serum netilmicin concentration in the od group was approximately two-fold greater than that in the tid group ; mean trough serum netilmicin concentrations were similar for the two groups . Adverse reactions were limited to mild pain at the site of netilmicin administration in several patients in each treatment group . Netilmicin od and tid ( alone or in combination with metronidazole ) were similarly efficacious in the treatment of patients with appendicitis and other intra-abdominal infections caused by netilmicin-susceptible pathogens . Both dosage regimens of netilmicin were safe and well tolerated Many antibiotics and antibiotic combinations are used for the treatment of peritonitis because of advanced ( gangrenous or perforated ) appendicitis . An aminoglycoside combined with an antianaerobe antibiotic is one st and ard treatment , but there is concern about the potential nephrotoxicity of the aminoglycoside and the necessity for monitoring aminoglycoside blood levels . Cefepime , a new broad-spectrum cephalosporin with a prolonged serum half-life , has excellent activity against gram-positive and gram-negative bacteria , including Pseudomonas aeruginosa . Its spectrum of activity is similar to the aminoglycosides , but it has less potential for inducing renal injury . A double-blind , r and omized study compared cefepime , 2 grams every 12 hours IVPB plus metronidazole 0.5 grams every eight hours IVPB ( C/M ) with gentamicin 1.5 milligrams per kilograms of IVPB plus clindamycin 0.9 grams q eight hours IVPB ( G/C ) , administered up to 14 days , in 96 surgically treated patients with gangrenous or perforated appendicitis . Fifty patients had advanced appendicitis ( nine gangrenous and 41 perforated ) in the C/M group and 46 patients ( six gangrenous and 40 perforated ) in the G/C group . The mean number of days of postoperative fever ( C/M , 4.4 + /- 2.7 versus G/C , 5.0 + /- 2.2 ) , postoperative hospitalization ( C/M , 2.0 + /- 1.9 versus G/C , 2.0 + /- 2.1 ) and antibiotic therapy ( C/M , 6.3 + /- 1.9 versus G/C , 6.9 + /- 1.9 ) was similar in the two treatment groups . There were 11 treatment failures ( C/M , three ; G/C , eight ; p = 0.13 ) , six of which were probably a result of enterococci . No deaths occurred . Our study results show that the efficacy of cefepime plus metronidazole is equivalent to that of clindamycin plus gentamicin Etappenlavage is defined as a series of planned multiple operative procedures performed at a 24-hour interval . It includes a commitment to reexplore the patient 's abdomen at the initial corrective operation . This is a report of a prospect i ve study of 117 patients treated by etappenlavage for severe advanced suppurative peritonitis in 2 institutions .  Etappenlavage was performed in 15 % of all patients with operations for peritonitis . In these patients , the abdominal infection had progressed to an advanced stage of severe functional impairment . A total of 669 laparotomies  were performed and the abdomen closed temporarily utilizing retention sutures ( n=45 ) , a simple zipper ( n=26 ) , a slide fastener ( n=29 ) , and Velcro ® analogue ( n=17 ) . An average of 6.1 procedures were necessary to control the infection . In 57 % of the patients , additional complications were recognized and repaired after the initial operation . Patients were artificially ventilated for an average of 17 days . The median duration of therapy was 33 ( range , 3–183 ) days . Twenty-eight patients died between days 3 and 71 ( median , 9 ) after initiation of therapy . In 88 % , uncomplicated wound healing was observed after wounds were closed definitely . In the last 17 patients , no complications were attributable to the use of 2 adhesive sheets of polyamide plus nylon or perlon for temporary abdominal closure ( Velcro ® -like artificial burr ) .  APACHE II scoring predicted a median mortality of 47 % . The actual mortality was 25 % . Overall , the mortality of advanced diffuse peritonitis was reduced from a predicted 34–93 % ( APACHE II/SIS scoring ) to 24 % . Velcro ® analogue ( artificial burr ) was the most 
    Output:
    
All antibiotics showed equivocal comparability in terms of clinical success .
Mortality did not differ between the regimens .
Despite the potential high toxicity profile of regimens using aminoglycosides , this was not demonstrated in this review .
No specific recommendations can be made for the first line treatment of secondary peritonitis in adults with antibiotics , as all regimens showed equivocal efficacy .