Empirical Treatment of Severe Acute Community-Acquired Gastroenteritis with Ciprofloxacin

• Published in: Clinical infectious diseases Vol. 22; no. 6; pp. 1019 - 1025
• Main Authors: DRYDEN, M. S, GABB, R. J. E, WRIGHT, S. K
• Format: Journal Article
• Language: English
• Published: Chicago, IL University of Chicago Press 01.06.1996
• Subjects: Adult; Age Factors; Aged; Anti-Infective Agents; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Campylobacter; Campylobacter Infections - drug therapy; Ciprofloxacin - therapeutic use; Clinical Articles; Community-Acquired Infections - drug therapy; Community-Acquired Infections - microbiology; Diarrhea; Diarrhea - drug therapy; Diseases; Dysentery, Bacillary - drug therapy; Feces - microbiology; Female; Gastroenteritis; Gastroenteritis - drug therapy; Gastroenteritis - microbiology; Humans; Infections; Male; Medical sciences; Middle Aged; Pathogens; Pharmacology. Drug treatments; Placebos; Quinolones; Salmonella; Salmonella Infections - drug therapy; Sex Factors; Shigella; Time Factors; Treatment Outcome; Human; Epidemic; Quinolone derivative; Fluoroquinolone derivative; Treatment efficiency; Gastroenteritis; Empirical method; Chemotherapy; Treatment; Digestive diseases; Intestinal disease; Adult; Clinical trial; Antibacterial agent; Gastric disease
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clinids/22.6.1019

We conducted a randomized controlled trial to determine whether empirical treatment of severe acute community-acquired gastroenteritis (four fluid stools per day for >3 days) with ciprofloxacin reduces the duration of diarrhea and other symptoms and to determine what effect ciprofloxacin has on the duration of long-term fecal carriage of gastrointestinal pathogens. A total of 173 patients were recruited for the study and received either ciprofloxacin (500 mg b.i.d.) or placebo for 5 days, during which time they recorded the duration of diarrhea and other symptoms (fever, abdominal pain, vomiting, and myalgia). Fecal samples were collected before treatment and regularly after treatment to determine the duration of carriage of gastrointestinal pathogens. Antibiotic susceptibility tests were performed, and the minimum inhibitory concentrations (MICs) of ciprofloxacin were determined. A significant reduction in the duration of diarrhea and other symptoms was observed after treatment, regardless of whether a pathogen was detected (P = .0001). Treatment failure occurred in 3 of 81 patients in the ciprofloxacin group and 17 of 81 patients in the placebo group. Significant pathogens were detected in 87% of patients, 85.5% of whom had cleared the pathogen at the end of treatment with ciprofloxacin, as compared with 34% who received placebo. Six weeks after treatment, there was no difference between the two groups in terms of the pathogen carriage rate (12%). Treatment with ciprofloxacin did not prolong carriage. High-level resistance to ciprofloxacin (MIC, >32 mg/L) was detected in three strains (4%) of Campylobacter species.