***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: This r and omised , double-blind , multicentre trial compared piperacillin/tazobactam ( 2 g/0.5 g/q8h ) and imipenem/cilastatin ( 0.5 g/0.5 g/q8h ) as monotherapy in patients with acute pyelonephritis or complicated urinary tract infections . In total , 237 patients were r and omised to receive either piperacillin/tazobactam ( n=161 ) or imipenem/cilastatin ( n=166 ) . At the early follow-up ( = test-of-cure-visit ) 5 - 9 days after antibiotic therapy , clinical success was noted in 122/147 ( 83.0 % ) piperacillin/tazobactam recipients compared with 123/154 ( 79.9 % ) imipenem/cilastatin recipients , thus proving that both treatments were equally effective . On a descriptive level , an advantage of piperacillin/tazobactam was demonstrated . Microbiological success at the early follow-up was 78/135 ( 57.8 % ) for piperacillin/tazobactam and 70/144 ( 48.6 % ) for imipenem/cilastatin . These results were confirmed by equivalent success rates on the last therapy day . Both drugs were generally well tolerated 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 Complicated intra-abdominal infections usually m and ate prompt surgical intervention supplemented by appropriate antimicrobial therapy . The aim of this study was to demonstrate that ertapenem was not inferior to piperacillin-tazobactam for the treatment of community-acquired intra-abdominal infections . A r and omized open-label active-comparator clinical trial was conducted at 48 medical centers on four continents from December 2001 to February 2003 . Adult patients with intra-abdominal infections requiring surgery were r and omized to receive either ertapenem 1 g daily or piperacillin/tazobactam 13.5 g daily in 3–4 divided doses . The primary analysis of efficacy was the clinical response rate in clinical ly and microbiologically evaluable patients at the test-of-cure assessment 2 weeks after completion of therapy . All treated patients were included in the safety analysis . Patient demographics , disease characteristics , and treatment duration in both treatment groups were generally similar . The most commonly isolated pathogens at baseline were E coli ( greater than 50 % of cases in each group ) and B fragilis ( ~9 % ) . Favorable clinical response rates were 107/119 ( 90 % ) for ertapenem recipients and 107/114 ( 94 % ) for piperacillin/tazobactam recipients . The frequencies of drug-related adverse events , most commonly diarrhea and elevated serum alanine aminotransferase levels , were similar in both treatment groups . Six of 180 ertapenem recipients ( 3 % ) and two of 190 piperacillin/tazobactam recipients ( 1 % ) had serious drug-related adverse experiences . In this study , ertapenem and piperacillin/tazobactam were comparably safe and effective treatments for adult patients with complicated intra-abdominal infections We report on 232 patients undergoing autologous haematopoietic stem cell transplantation ( ASCT ) entered into a multicentre , r and omised trial comparing the efficacy and tolerability of meropenem ( MPM ) with that of piperacillin/tazobactam ( P/T ) as empirical antimicrobial first‐line therapy for febrile neutropenia . In 27·6 % of patients in the MPM group and 22·4 % in the P/T group , therapy was initially supplemented with a glycopeptide for venous catheter infection or bacteraemia because of coagulase‐negative staphylococci .  Complete response rate after 72 h was 63·8 % in the MPM group and 49·6 % in the P/T group ( P = 0·034 ) . Overall complete response rate after treatment modification was 94·0 % in the MPM group and 93·1 % in the P/T group . Median time to defervescence was 2 d in the MPM group and 3 d in the P/T group . The most frequently isolated pathogens were Gram‐positive cocci . Treatment was well tolerated in both groups . One patient ( 0·4 % ) died from infection . Empirical first‐line therapy with MPM as well as with P/T  is safe and effective in febrile episodes emerging after ASCT . Higher response rates to primary treatment can be achieved with MPM In order to compare the clinical and microbiological efficacies and safety of piperacillin plus tazobactam with those of imipenem plus cilastatin , 134 patients with intra-abdominal infections ( 73 patients with appendicitis ) participated in an open r and omized comparative multicenter trial . A total of 40 men and 29 women ( mean age , 53 years ; age range , 18 to 92 years ) were enrolled in the piperacillin-tazobactam group and 40 men and 25 women ( mean age , 54 years ; age range , 16 to 91 years ) were enrolled in the imipenem-cilastatin group . The patients received either piperacillin ( 4 g ) and tazobactam ( 500 mg ) every 8 h or imipenem and cilastatin ( 500 mg each ) every 8 h. Both regimens were given by intravenous infusion . A total of 113 patients were clinical ly evaluable . Of 55 patients who received piperacillin-tazobactam , 50 were clinical ly cured , while 40 of 58 patients in the imipenem-cilastatin group were clinical ly cured . The differences were significant ( Wilcoxon test ; P = 0.005 ) . There were 4 failures or relapses in the piperacillin-tazobactam group and 18 failures or relapses in the imipenem-cilastatin group . The microorganisms isolated were eradicated in similar proportions in the two patient groups . Adverse reactions , mainly gastrointestinal disturbances and nausea , were noted in 13 patients who received piperacillin-tazobactam and in 14 patients who received imipenem-cilastatin . Results of the present study show that piperacillin-tazobactam is effective and safe for the treatment of intra-abdominal infections ABSTRACT In a r and omized , evaluator-blind , multicenter trial , we compared cefepime ( 2 g three times a day ) with imipenem-cilastatin ( 500 mg four times a day ) for the treatment of nosocomial pneumonia in 281 intensive care unit patients from 13 centers in six European countries . Of 209 patients eligible for per- protocol analysis of efficacy , favorable clinical responses were achieved in 76 of 108 ( 70 % ) patients treated with cefepime and 75 of 101 ( 74 % ) patients treated with imipenem-cilastatin . The 95 % confidence interval ( CI ) for the difference between these response rates ( −16 to 8 % ) failed to exclude the predefined lower limit for noninferiority of −15 % . In addition , therapy of pneumonia caused by an organism producing an extended-spectrum β-lactamase ( ESBL ) failed in 4 of 13 patients in the cefepime group but in none of 10 patients in the imipenem group . However , the clinical efficacies of both treatments appeared to be similar in a secondary intent-to-treat analysis ( 95 % CI for difference , −9 to 14 % ) and a multivariate analysis ( 95 % CI for odds ratio , 0.47 to 1.75 ) . Furthermore , the all-cause 30-day mortality rates were 28 of 108 ( 26 % ) patients in the cefepime group and 19 of 101 ( 19 % ) patients in the imipenem group ( P = 0.25 ) . Rates of documented or presumed microbiological eradication of the causative organism were similar with cefepime ( 61 % ) and imipenem-cilastatin ( 54 % ) ( 95 % CI , −23 to 8 % ) . Primary or secondary resistance of Pseudomonas aeruginosa was detected in 19 % of the patients treated with cefepime and 44 % of the patients treated with imipenem-cilastatin ( P = 0.05 ) . Adverse events were reported in 71 of 138 ( 51 % ) and 62 of 141 ( 44 % ) patients eligible for safety analysis in the cefepime and imipenem groups , respectively ( P = 0.23 ) . Although the primary end point for this study does not exclude the possibility that cefepime was inferior to imipenem , some secondary analyses showed that the two regimens had comparable clinical and microbiological efficacies . Cefepime appeared to be less active against organisms producing an ESBL , but primary and secondary resistance to imipenem was more common for P. aeruginosa . Selection of a single agent for therapy of nosocomial pneumonia should be guided by local resistance patterns Objective To examine the clinical efficacy and safety of ertapenem , a novel & bgr;-lactam agent with wide activity against common pathogens encountered in intraabdominal infection . Summary Background Data Ertapenem has a pharmacokinetic profile and antimicrobial spectrum that support the potential for use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic infections . Methods This prospect i ve , r and omized , controlled , and double-blind trial was conducted to compare the safety and efficacy of ertapenem with piperacillin/tazobactam as therapy following adequate 
    Output:
    
The use of carbapenems rather than APP could reduce mortality and , by simplifying treatment decisions , reduce the time before patients receive appropriate antibiotic treatment .
The currently available evidence is insufficient for distinguishing between carbapenems and 4GC