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

Ann Surg. 2000 Aug;232(2):254-62. doi: 10.1097/00000658-200008000-00016.

Abstract

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.

Summary background data: 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.

Conclusion: 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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen*
  • Abdominal Abscess / etiology
  • Administration, Oral
  • Anti-Infective Agents / administration & dosage*
  • Appendicitis / drug therapy
  • Appendicitis / microbiology
  • Bacterial Infections / drug therapy*
  • Ciprofloxacin / administration & dosage*
  • Double-Blind Method
  • Drug Therapy, Combination / administration & dosage*
  • Female
  • Humans
  • Injections, Intravenous
  • Male
  • Metronidazole / administration & dosage*
  • Middle Aged
  • Penicillanic Acid / administration & dosage
  • Penicillanic Acid / analogs & derivatives
  • Piperacillin / administration & dosage
  • Piperacillin, Tazobactam Drug Combination
  • Prospective Studies

Substances

  • Anti-Infective Agents
  • Metronidazole
  • Piperacillin, Tazobactam Drug Combination
  • Ciprofloxacin
  • Penicillanic Acid
  • Piperacillin