A randomized clinical trial to compare fleroxacin-rifampicin with flucloxacillin or vancomycin for the treatment of staphylococcal infection.
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.
Schrenzel
Jacques
J
Geneva University Hospitals, Geneva, Switzerland. jacques.schrenzel@hcuge.ch
Harbarth
Stephan
S
Schockmel
Gérard
G
Genné
Daniel
D
Bregenzer
Thomas
T
Flueckiger
Ursula
U
Petignat
Christiane
C
Jacobs
Frédérique
F
Francioli
Patrick
P
Zimmerli
Werner
W
Lew
Daniel P
DP
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*
D005436:Floxacillin; D014640:Vancomycin; D016576:Fleroxacin; D012293:Rifampin