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


BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Cohn
S M
SM
Department of Surgery, University of Miami School of Medicine, Miami, Florida 33101, USA. stephen.cohn@miami.edu
Lipsett
P A
PA
Buchman
T G
TG
Cheadle
W G
WG
Milsom
J W
JW
O'Marro
S
S
Yellin
A E
AE
Jungerwirth
S
S
Rochefort
E V
EV
Haverstock
D C
DC
Kowalsky
S F
SF
D000005:Abdomen; D018784:Abdominal Abscess / Q000209:etiology; D000284:Administration, Oral; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001064:Appendicitis / Q000188:drug therapy / Q000382:microbiology; D001424:Bacterial Infections / Q000188:drug therapy*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies
D000890:Anti-Infective Agents; D008795:Metronidazole; D000077725:Piperacillin, Tazobactam Drug Combination; D002939:Ciprofloxacin; D010397:Penicillanic Acid; D010878:Piperacillin