title: Intravenous ciprofloxacin as treatment for patients with acute suppurative cholangitis: a randomized, controlled clinical trial.
abstract: One hundred consecutive patients with acute suppurative cholangitis were randomized in a prospective, controlled clinical trial to receive either ciprofloxacin (200 mg bd iv) or triple therapy comprising ceftazidime (1 g bd iv), ampicillin (500 mg qds iv) and metronidazole (500 mg tds iv); 46 and 44 patients in the ciprofloxacin and triple therapy groups respectively were suitable for inclusion in the analysis of efficacy. In two-thirds of the patients biliary obstruction was caused by ductal calculi and in one-third by malignant or benign strictures of the biliary tract. Bacteraemia was documented in 38% of patients in the ciprofloxacin group and in 34% of patients in the triple therapy group, while bile cultures were positive in 87% and 92% of patients in the ciprofloxacin and triple therapy groups respectively. Escherichia coli, Klebsiella spp. and Enterococcus spp. were the most common biliary isolates. Eighty-five per cent of evaluable patients in the ciprofloxacin group and 77% of those in the triple therapy group responded to therapy. The mean durations of fever, septicaemic shock and hospitalization were also similar in the two treatment groups. Six (13%) patients in the ciprofloxacin group and seven (16%) in the triple therapy group required urgent endoscopy or surgery for uncontrolled infection. Recurrence of fever after an initial response was documented in one (2%) patient receiving ciprofloxacin and in three (7%) patients receiving triple therapy. The incidences of mortality were 4% in the ciprofloxacin group and 2% in the triple therapy group. The results of this study suggest that ciprofloxacin alone is adequate empirical therapy for patients with cholangitis.
authors.affiliation: Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong.
authors.forename: J J
authors.initials: JJ
authors.lastname: Sung
authors.forename: D J
authors.initials: DJ
authors.lastname: Lyon
authors.forename: R
authors.initials: R
authors.lastname: Suen
authors.forename: S C
authors.initials: SC
authors.lastname: Chung
authors.forename: A L
authors.initials: AL
authors.lastname: Co
authors.forename: A F
authors.initials: AF
authors.lastname: Cheng
authors.forename: J W
authors.initials: JW
authors.lastname: Leung
authors.forename: A K
authors.initials: AK
authors.lastname: Li
mesh_terms: D000208:Acute Disease; D000368:Aged; D001419:Bacteria / Q000187:drug effects; D001646:Bile / Q000382:microbiology; D001659:Biliary Tract / Q000502:physiology; D002761:Cholangitis / Q000188:drug therapy* / Q000382:microbiology; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004322:Drainage; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies
chemical_list: D002939:Ciprofloxacin