title: A randomized clinical trial to compare fleroxacin-rifampicin with flucloxacillin or vancomycin for the treatment of staphylococcal infection.
abstract: BACKGROUND
  Oral combination therapy with fluoroquinolones plus rifampicin is a promising alternative to standard parenteral therapy for staphylococcal infections.
  
  
  METHODS
  In a multicenter, randomized trial, we compared the efficacy, safety, and length of hospital stay for patients with staphylococcal infections treated either with an oral combination of a fluoroquinolone (fleroxacin) plus rifampicin or with standard parenteral treatment (flucloxacillin or vancomycin). Patients were included if cultures showed the presence of bacteremia or deep-seated infections with Staphylococcus aureus (104 patients) or catheter-related bacteremia due to drug-susceptible, coagulase-negative staphylococci (23 patients).
  
  
  RESULTS
  The cure rate in the intention-to-treat analysis was 78% for the fleroxacin-rifampicin group (68 patients) and 75% for the standard therapy group (59 patients; 47 received flucloxacillin, and 12 received vancomycin); in the population of clinically evaluable patients (n=119), the cure rate was 82% and 80%, respectively; and in the population of microbiologically evaluable patients (n=103), the cure rate was 86% and 84%, respectively. Clinical and bacteriological failures after S. aureus infections were documented in similar proportions of patients. The median length of hospital stay after study entry was 12 days in the fleroxacin-rifampicin group, compared with 23 days in the standard treatment group (P=.006). More adverse events probably related to the study drug were reported in the fleroxacin-rifampicin group than in the standard therapy group (15 of 68 vs. 5 of 59 patients; P=.05).
  
  
  CONCLUSIONS
  This study suggests that an oral regimen containing a fluoroquinolone plus rifampicin may be effective for treating staphylococcal infections, allowing earlier discharge from the hospital.
authors.affiliation: Geneva University Hospitals, Geneva, Switzerland. jacques.schrenzel@hcuge.ch
authors.forename: Jacques
authors.initials: J
authors.lastname: Schrenzel
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.forename: Gérard
authors.initials: G
authors.lastname: Schockmel
authors.forename: Daniel
authors.initials: D
authors.lastname: Genné
authors.forename: Thomas
authors.initials: T
authors.lastname: Bregenzer
authors.forename: Ursula
authors.initials: U
authors.lastname: Flueckiger
authors.forename: Christiane
authors.initials: C
authors.lastname: Petignat
authors.forename: Frédérique
authors.initials: F
authors.lastname: Jacobs
authors.forename: Patrick
authors.initials: P
authors.lastname: Francioli
authors.forename: Werner
authors.initials: W
authors.lastname: Zimmerli
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Lew
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy; D002408:Catheters, Indwelling / Q000382:microbiology; D004359:Drug Therapy, Combination; D005260:Female; D016576:Fleroxacin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005436:Floxacillin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance / Q000187:drug effects; D008875:Middle Aged; D011446:Prospective Studies; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012449:Safety; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D013210:Staphylococcus / Q000187:drug effects / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D005436:Floxacillin; D014640:Vancomycin; D016576:Fleroxacin; D012293:Rifampin