title: Prospective randomized clinical trials of new quinolones versus beta-lactam antibiotics in lower respiratory tract infections.
abstract: In four prospective randomized clinical trials between November 1983 and March 1988, we studied 270 patients with severe bacterial infections, mainly lower respiratory tract ones. We compared ciprofloxacin and imipenem/cilastatin in the first study, ciprofloxacin and ofloxacin in the second study, ciprofloxacin and ticarcillin/clavulanic acid in the third study, and ofloxacin and cefpirome in the fourth study. A total of 90 pneumonias, 139 LRTIs, 22 septicaemias and 19 other bacterial infections were treated; the dominant pathogens were Pseudomonas aeruginosa and enterobacteria. Clinical success rates were high; cure or improvement was registered in 89% of the patients on ciprofloxacin, 89% on ofloxacin and 85% on beta-lactams. Treatment failures occurred mainly in ICU patients with terminal underlying diseases. Bacteriologically, eradication rates were high for enterobacteria and Staphylococcus aureus, but a relatively high persistence rate was seen for P. aeruginosa due to increased resistance and/or specific type and location of the infections. The incidence of side-effects was relatively high (23%-29%) which was related to careful monitoring. Adverse effects were group-specific (CNS reactions with quinolones, diarrhoea with beta-lactam antibiotics).
authors.affiliation: Medical Department of Klinikum Steglitz, Freie Universität Berlin, FRG.
authors.forename: H
authors.initials: H
authors.lastname: Lode
authors.forename: E
authors.initials: E
authors.lastname: Wiley
authors.forename: P
authors.initials: P
authors.lastname: Olschewski
authors.forename: H
authors.initials: H
authors.lastname: Sievers
authors.forename: M
authors.initials: M
authors.lastname: Wintermantel
authors.forename: R
authors.initials: R
authors.lastname: Baetz
authors.forename: K
authors.initials: K
authors.lastname: Lebahn
authors.forename: M
authors.initials: M
authors.lastname: Reinke
authors.forename: J
authors.initials: J
authors.lastname: Wagner
authors.forename: K
authors.initials: K
authors.lastname: Borner
mesh_terms: D015377:Cilastatin / Q000627:therapeutic use*; D000077728:Cilastatin, Imipenem Drug Combination; D002939:Ciprofloxacin / Q000627:therapeutic use*; D002969:Clavulanic Acids / Q000627:therapeutic use*; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D015242:Ofloxacin / Q000627:therapeutic use*; D011014:Pneumonia / Q000188:drug therapy; D011446:Prospective Studies; D012074:Remission Induction; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D018805:Sepsis / Q000188:drug therapy*; D013982:Ticarcillin / Q000627:therapeutic use*
chemical_list: D002969:Clavulanic Acids; D004338:Drug Combinations; D015377:Cilastatin; D002939:Ciprofloxacin; D015378:Imipenem; C043215:ticarcillin-clavulanic acid; D000077728:Cilastatin, Imipenem Drug Combination; D015242:Ofloxacin; D013982:Ticarcillin