Titre du document / Document title

Use of ciprofloxacin in the treatment of hospitalized patients with intra-abdominal infections

Auteur(s) / Author(s)

MADAN Atul K. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, ETATS-UNIS

Résumé / Abstract

Background: Numerous combination and single-agent antimicrobial regimens are available for the treatment of intra-abdominal infections. Selection of empiric agents must be directed at providing reliable activity against endotoxin-generating Escherichia coli, other gram-negative facultative bacteria, and anaerobes such as Bacteroides fragile. Safety profiles, pharmacokinetic profiles, and cost-effectiveness must also be considered. Use of fluoroquinolones for the treatment of infra-abdominal infections has recently been advocated. Methods: We review 2 prospective, comparative clinical trials conducted between 1992 and 2002 that evaluated the efficacy and safety of IV ciprofloxacin in patients with intra-abdominal infections. Separate pharmacoeconomic analyses conducted for each study are also reviewed. Results: A total of 4 ciprofloxacin studies (2 clinical, 2 pharmacoeconomic) comprise the database. The combination of ciprofloxacin plus metronidazole was at least as effective as imipenem/cilastatin and clinically more effective than piperacillin/tazobactam therapy, based on clinical success end points. In 1 trial, treatment success for the clinically valid population was reported for 84% (93/111) of patients treated with IV ciprofloxacin/metronidazole, 86% (91/106) of those treated with IV/oral ciprofloxacin/metronidazole, and 81% of those treated with IV imipenem/cilastatin (91/113). The IV/oral ciprofloxacin/metronidazole regimen had a statistically significant lower mean infection-related cost than the IV-only ciprofloxacin/metronidazole plus imipenem groups (difference of ∼$1100; P = 0.029). In the second clinical trial, clinical resolution rates were statistically different for patients receiving IV/oral ciprofloxacin/metronidazole (74%) versus IV piperacillin/ tazobactam therapy (63%; P = 0.047). Ciprofloxacin/metronidazole was more cost-effective compared with piperacillin/tazobactam ($2200-$3600 lower cost-effective ratios per patient) regardless of whether the patient had a diagnosis of appendicitis or whether a switch to an oral drug was permissible. Conclusions: In the studies reviewed herein, the combination of ciprofloxacin plus metronidazole was an effective and safe regimen for the treatment of intra-abdominal infections. This regimen has potential advantages over exclusively IV regimens, including the option of sequential IV/oral therapy, patient convenience, cost savings, and reduced hospital stay.

Revue / Journal Title

Clinical therapeutics   ISSN 0149-2918 

Source / Source

2004, vol. 26, n^o10, pp. 1564-1577 [14 page(s) (article)] (82 ref.)

Langue / Language

Anglais

Editeur / Publisher

Excerpta Medica, Belle Mead, NJ, ETATS-UNIS  (1977) (Revue)

Mots-clés anglais / English Keywords

Imidazole derivatives ; Nitro compound ; Quinolone derivatives ; Antiprotozoal agent ; Antifungal agent ; Parasiticide ; Antibacterial agent ; Metronidazole ; Public health ; Health economy ; Costs ; Oral administration ; Fluoroquinolone derivatives ; Infection ; Human ; Treatment ; Ciprofloxacin ;

Mots-clés français / French Keywords

Imidazole dérivé ; Composé nitro ; Quinolone dérivé ; Antiprotozoaire ; Antifongique ; Antiparasitaire ; Antibactérien ; Métronidazole ; Santé publique ; Economie santé ; Coût ; Voie orale ; Fluoroquinolone dérivé ; Infection ; Homme ; Traitement ; Ciprofloxacine ;

Mots-clés espagnols / Spanish Keywords

Imidazol derivado ; Compuesto nitro ; Quinolone derivado ; Antiprotozoario ; Antifúngico ; Antiparasitario ; Antibacteriano ; Metronidazol ; Salud pública ; Economía salud ; Coste ; Vía oral ; Fluoroquinolone derivado ; Infección ; Hombre ; Tratamiento ; Ciprofloxacino ;

Mots-clés d'auteur / Author Keywords

intra-abdominal infections ; ciprofloxacin ; fluoroquinolones ; IV/oral sequential therapy ; cost benefits ; metronidazole ;

Localisation / Location

INIST-CNRS, Cote INIST : 18353, 35400012267986.0010