Comparison of intravenous/oral ciprofloxacin plus metronidazole versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections

• Published in: Annals of surgery Vol. 232; no. 2; pp. 254 - 262
• Main Authors: COHN, S. M, LIPSETT, P. A, KOWALSKY, S. F, BUCHMAN, T. G, CHEADLE, W. G, MILSOM, J. W, O'MARRO, S, YELLIN, A. E, JUNGERWIRTH, S, ROCHEFORT, E. V, HAVERSTOCK, D. C
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.08.2000
• Subjects: Abdomen; Abdominal Abscess - etiology; Administration, Oral; Anti-Infective Agents - administration & dosage; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Appendicitis - drug therapy; Appendicitis - microbiology; Bacterial Infections - drug therapy; Biological and medical sciences; Ciprofloxacin - administration & dosage; Double-Blind Method; Drug Therapy, Combination - administration & dosage; Female; Humans; Injections, Intravenous; Male; Medical sciences; Metronidazole - administration & dosage; Middle Aged; Original; Penicillanic Acid - administration & dosage; Penicillanic Acid - analogs & derivatives; Pharmacology. Drug treatments; Piperacillin - administration & dosage; Piperacillin, Tazobactam Drug Combination; Prospective Studies; Human; Nitro compound; Imidazole derivatives; Intravenous administration; β-Lactams; Oral administration; Abdomen; Infection; Penicillin derivatives; Chemotherapy; Fluoroquinolone derivatives; Tazobactam; Abdominal disease; Piperacillin; Combined treatment; Metronidazole; Antibacterial agent; Ciprofloxacin; Comparative study; Quinolone derivatives
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-200008000-00016

To compare the safety and efficacy of intravenous (IV) ciprofloxacin plus IV metronidazole (CIP+MET) with that of IV piperacillin/tazobactam (PIP/TAZO) in adults with complicated intraabdominal infections, and to compare the efficacy of sequential IV-to-oral CIP+MET therapy with that of the IV CIP-only regimen. Treatment of intraabdominal infections remains a challenge, mainly because of their polymicrobial etiology and attendant death and complications. Antimicrobial regimens using sequential IV-to-oral therapy may reduce the length of hospital stay. In this multicenter, randomized, double-blind trial involving 459 patients, clinically improved IV-treated patients were switched to oral therapy after 48 hours. Overall clinical response was the primary efficacy measurement. A total of 282 patients (151 CIP+MET, 131 PIP/TAZO) were valid for efficacy. Of these patients, 64% CIP+MET and 57% PIP/TAZO patients were considered candidates for oral therapy. Patients had a mean APACHE II score of 9.6. The most common diagnoses were appendicitis (33%), other intraabdominal infection (29%), and abscess (25%). Overall clinical resolution rates were statistically superior for CIP+MET (74%) compared with PIP/TAZO (63%). Corresponding rates in the subgroup suitable for oral therapy were 85% for CIP+MET and 70% for PIP/TAZO. Postsurgical wound infection rates were significantly lower in CIP+MET (11%) versus PIP/TAZO patients (19%). Mean length of stay was 14 days for CIP+MET and 17 days for PIP/TAZO patients. CIP+MET, initially administered IV and followed by CIP+MET oral therapy, was clinically more effective than IV PIP/TAZO for the treatment of patients with complicated intraabdominal infections.