Oral Ciprofloxacin vs Parenteral Cefotaxime in the Treatment of Difficult Skin and Skin Structure Infections

Gentry, Layne O.; Ramírez-Ronda, C H; Rodríguez-Noriega, E; Thadepalli, Haragopal; Rosal, Pedro Leal Del; Ramírez, Claudio

doi:10.1001/archinte.1989.00390110127028

Cited by 48 publications

(4 citation statements)

References 9 publications

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“…Clinical cure rates were 68.8% for the clinafloxacin group and 65.2% for the piperacillin-tazobactam group. Overall clinical cure rates were somewhat lower than those in previously published reports (9,10,20) and may be a reflection of differences in methodology. The clinical cure rate reported in the present study was determined 6 to 14 days posttherapy rather than the more common endpoint at end-of-therapy.…”

Section: Discussioncontrasting

confidence: 76%

“…During the early 1990s, fluoroquinolones such as ciprofloxacin became widely used in the treatment of SSTIs, with reported cure rates between 70 and 85% (18,19,20). In a randomized trial, i.v.…”

Section: Discussionmentioning

confidence: 99%

“…; and anaerobes such as Bacteroides fragilis are frequently isolated (8,12,13,18,32 Frequently used antimicrobial agents have included expandedspectrum cephalosporins (e.g., cefoxitin, cefotetan, cefmetazole), imipenem-cilastatin, ␤-lactam-␤-lactamase inhibitor combinations (e.g., piperacillin-tazobactam, ticarcillin-clavulanate), and fluoroquinolones (13,14,15,18,20,35). However, emerging resistance, particularly among S. aureus, P. aeruginosa, and enterococci, is making the choice of treatment increasingly more difficult (23).…”

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confidence: 99%

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Clinafloxacin versus Piperacillin-Tazobactam in Treatment of Patients with Severe Skin and Soft Tissue Infections

Siami

Christou

Eiseman³

et al. 2001

Antimicrob Agents Chemother

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Patients (n ‫؍‬ 409) with severe skin and soft tissue infections (SSTIs) were randomized to receive clinafloxacin or piperacillin-tazobactam (plus optional vancomycin for methicillin-resistant cocci), administered intravenously, with the option to switch to oral medication. Most patients had cellulitis, wound infections, or diabetic foot infections. Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa were the most common baseline pathogens. Fewer baseline pathogens were resistant to clinafloxacin (1.8%) than to piperacillin-tazobactam (6.2%) (P ‫؍‬ 0.001). The clinafloxacin and piperacillin-tazobactam groups did not differ significantly in clinical cure rates (68.8 and 65.2%, respectively) or microbiologic eradication rates (61.5 and 57.2%). Clinafloxacin yielded higher eradication rates for all three of the most common pathogenic species, although no differences were statistically significant. Within the power of this study, the overall frequency of adverse events was similar (P ‫؍‬ 0.577) in the two treatment groups. Drug-associated adverse events (P ‫؍‬ 0.050) and treatment discontinuations (P ‫؍‬ 0.052) were marginally more frequent in the clinafloxacin group, primarily due to phototoxicity in outpatients receiving clinafloxacin. Although most cases of phototoxicity were mild to moderate, four cases were reported as severe. In summary, clinafloxacin monotherapy was equivalent in effectiveness to therapy with piperacillin-tazobactam plus optional vancomycin in the treatment of hospitalized patients with severe SSTIs.Skin and soft tissue infections (SSTIs), such as spontaneous lymphangitis or cellulitis, and especially complicated infections, such as wound and surgical infections or diabetic foot ulcers, often require hospitalization and intravenous (i.v.) antibacterial treatment. These infections are caused by a mixture of aerobic and anaerobic organisms and are responsible for increased morbidity, prolonged hospital stay, and increased health care costs (3,13,19).Staphylococcus aureus and streptococci; gram-negative bacteria such as Pseudomonas aeruginosa, Enterobacteriaceae, and Enterococcus spp.; and anaerobes such as Bacteroides fragilis are frequently isolated (8,12,13,18,32 Frequently used antimicrobial agents have included expandedspectrum cephalosporins (e.g., cefoxitin, cefotetan, cefmetazole), imipenem-cilastatin, ␤-lactam-␤-lactamase inhibitor combinations (e.g., piperacillin-tazobactam, ticarcillin-clavulanate), and fluoroquinolones (13,14,15,18,20,35). However, emerging resistance, particularly among S. aureus, P. aeruginosa, and enterococci, is making the choice of treatment increasingly more difficult (23).Clinafloxacin is an extended-spectrum fluoroquinolone antibacterial that is bactericidal against S. aureus, including methicillin-resistant strains, and most strains of ciprofloxacinresistant S. aureus (7,33). Like other fluoroquinolones, clinafloxacin has activity against Pseudomonas spp. and the Enterobacteriaceae; the MICs of clinafloxacin at which 90% of isolates are ...

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinafloxacin versus Piperacillin-Tazobactam in Treatment of Patients with Severe Skin and Soft Tissue Infections

Siami

Christou

Eiseman³

et al. 2001

Antimicrob Agents Chemother

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“…A clinical response rate of approximately 80% was reported for the treatment of this indication with ciprofloxacin or ofloxacin compared to cefotaxime [12,13]. The response rate achieved in the present study was lower (ofloxacin 70%, ciprofloxacin 72%), but was similar in both treatment groups.…”

Section: Discussionsupporting

confidence: 45%

A randomised, multinational study with sequential therapy comparing ciprofloxacin twice daily and ofloxacin once daily

et al. 1995

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In a multinational, open, randomised, controlled clinical study, 474 hospitalised patients with moderate or severe infections were treated with sequential regimens of ofloxacin or ciprofloxacin. Ofloxacin 400 mg once daily or ciprofloxacin 200 mg twice daily were given intravenously for at least 3 days followed by oral treatment with ofloxacin 400 mg once daily or ciprofloxacin 500 mg twice daily. Overall cure rates of 86.8% (85.7%) in the ofloxacin group and 89.6 (89.5%) in the ciprofloxacin group were achieved in the intention-to-treat analysis (per protocol analysis). The overall bacteriological response rate (ofloxacin 89.5%, ciprofloxacin 89.0%) was comparable to the clinical cure rate. Both drugs were well tolerated and adverse events were rarely observed. It is concluded that ofloxacin and ciprofloxacin can be used successfully in the treatment of hospitalised patients with aerobic gram-positive and gram-negative infections. Ofloxacin has the advantage of a once-daily regimen, compared to the twice-daily regimen with ciprofloxacin.

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Interventions for cellulitis and erysipelas

Kilburn

Featherstone

Higgins

et al. 2010

Cochrane Database of Systematic Reviews

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Oral Ciprofloxacin vs Parenteral Cefotaxime in the Treatment of Difficult Skin and Skin Structure Infections

Cited by 48 publications

References 9 publications

Clinafloxacin versus Piperacillin-Tazobactam in Treatment of Patients with Severe Skin and Soft Tissue Infections

Clinafloxacin versus Piperacillin-Tazobactam in Treatment of Patients with Severe Skin and Soft Tissue Infections

A randomised, multinational study with sequential therapy comparing ciprofloxacin twice daily and ofloxacin once daily

Interventions for cellulitis and erysipelas

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