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

S. M. Cohn; P. A. Lipsett; T. G. Buchman; W. G. Cheadle; J. W. Milsom; S. O'Marro; A. E. Yellin; S. Jungerwirth; E. V. Rochefort; D. C. Haverstock; S. F. Kowalsky; D. Haas; S. Wilson; S. Vogel; F. Chang; J. Van De Water; P. Lipsett; R. Durham; G. Gaber; O. Rotstein; D. Neal; J. Jemsek; W. Cheadle; L. Rumans; M. Salem; J. Milsom; P. Gordon; S. Hamilton; D. Gubler; T. Buchman; C. Terregino; J. Hebert; S. O'Marro; R. Stewart; M. Metzler; M. Malangoni; D. Fry; R. Schwartz; A. Yellin; T. Berne; P. Heseltine; M. Appleman; P. Krumpe; R. Johnston; R. Hall

doi:10.1097/00000658-200008000-00016

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

S. M. Cohn^*, P. A. Lipsett, T. G. Buchman, W. G. Cheadle, J. W. Milsom, S. O'Marro, A. E. Yellin, S. Jungerwirth, E. V. Rochefort, D. C. Haverstock, S. F. Kowalsky, D. Haas, S. Wilson, S. Vogel, F. Chang, J. Van De Water, P. Lipsett, R. Durham, G. Gaber, O. RotsteinD. Neal, J. Jemsek, W. Cheadle, L. Rumans, M. Salem, J. Milsom, P. Gordon, S. Hamilton, D. Gubler, T. Buchman, C. Terregino, J. Hebert, S. O'Marro, R. Stewart, M. Metzler, M. Malangoni, D. Fry, R. Schwartz, A. Yellin, T. Berne, P. Heseltine, M. Appleman, P. Krumpe, R. Johnston, R. Hall

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

91 Scopus citations

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.

Original language	English
Pages (from-to)	254-262
Number of pages	9
Journal	Annals of surgery
Volume	232
Issue number	2
DOIs	https://doi.org/10.1097/00000658-200008000-00016
State	Published - 2000
Externally published	Yes

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Cohn, S. M., Lipsett, P. A., Buchman, T. G., Cheadle, W. G., Milsom, J. W., O'Marro, S., Yellin, A. E., Jungerwirth, S., Rochefort, E. V., Haverstock, D. C., Kowalsky, S. F., Haas, D., Wilson, S., Vogel, S., Chang, F., Van De Water, J., Lipsett, P., Durham, R., Gaber, G., ... Hall, R. (2000). Comparison of intravenous/oral ciprofloxacin plus metronidazole versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections. Annals of surgery, 232(2), 254-262. https://doi.org/10.1097/00000658-200008000-00016

@article{1662ee48f50345fdad0bb255d03b67bd,

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

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.",

author = "Cohn, {S. M.} and Lipsett, {P. A.} and Buchman, {T. G.} and Cheadle, {W. G.} and Milsom, {J. W.} and S. O'Marro and Yellin, {A. E.} and S. Jungerwirth and Rochefort, {E. V.} and Haverstock, {D. C.} and Kowalsky, {S. F.} and D. Haas and S. Wilson and S. Vogel and F. Chang and {Van De Water}, J. and P. Lipsett and R. Durham and G. Gaber and O. Rotstein and D. Neal and J. Jemsek and W. Cheadle and L. Rumans and M. Salem and J. Milsom and P. Gordon and S. Hamilton and D. Gubler and T. Buchman and C. Terregino and J. Hebert and S. O'Marro and R. Stewart and M. Metzler and M. Malangoni and D. Fry and R. Schwartz and A. Yellin and T. Berne and P. Heseltine and M. Appleman and P. Krumpe and R. Johnston and R. Hall",

year = "2000",

doi = "10.1097/00000658-200008000-00016",

language = "English",

volume = "232",

pages = "254--262",

journal = "Annals of surgery",

issn = "0003-4932",

number = "2",

}

Cohn, SM, Lipsett, PA, Buchman, TG, Cheadle, WG, Milsom, JW, O'Marro, S, Yellin, AE, Jungerwirth, S, Rochefort, EV, Haverstock, DC, Kowalsky, SF, Haas, D, Wilson, S, Vogel, S, Chang, F, Van De Water, J, Lipsett, P, Durham, R, Gaber, G, Rotstein, O, Neal, D, Jemsek, J, Cheadle, W, Rumans, L, Salem, M, Milsom, J, Gordon, P, Hamilton, S, Gubler, D, Buchman, T, Terregino, C, Hebert, J, O'Marro, S, Stewart, R, Metzler, M, Malangoni, M, Fry, D, Schwartz, R, Yellin, A, Berne, T, Heseltine, P, Appleman, M, Krumpe, P, Johnston, R & Hall, R 2000, 'Comparison of intravenous/oral ciprofloxacin plus metronidazole versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections', Annals of surgery, vol. 232, no. 2, pp. 254-262. https://doi.org/10.1097/00000658-200008000-00016

TY - JOUR

T1 - Comparison of intravenous/oral ciprofloxacin plus metronidazole versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections

AU - Cohn, S. M.

AU - Lipsett, P. A.

AU - Buchman, T. G.

AU - Cheadle, W. G.

AU - Milsom, J. W.

AU - O'Marro, S.

AU - Yellin, A. E.

AU - Jungerwirth, S.

AU - Rochefort, E. V.

AU - Haverstock, D. C.

AU - Kowalsky, S. F.

AU - Haas, D.

AU - Wilson, S.

AU - Vogel, S.

AU - Chang, F.

AU - Van De Water, J.

AU - Lipsett, P.

AU - Durham, R.

AU - Gaber, G.

AU - Rotstein, O.

AU - Neal, D.

AU - Jemsek, J.

AU - Cheadle, W.

AU - Rumans, L.

AU - Salem, M.

AU - Milsom, J.

AU - Gordon, P.

AU - Hamilton, S.

AU - Gubler, D.

AU - Buchman, T.

AU - Terregino, C.

AU - Hebert, J.

AU - O'Marro, S.

AU - Stewart, R.

AU - Metzler, M.

AU - Malangoni, M.

AU - Fry, D.

AU - Schwartz, R.

AU - Yellin, A.

AU - Berne, T.

AU - Heseltine, P.

AU - Appleman, M.

AU - Krumpe, P.

AU - Johnston, R.

AU - Hall, R.

PY - 2000

Y1 - 2000

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0033863149&partnerID=8YFLogxK

U2 - 10.1097/00000658-200008000-00016

DO - 10.1097/00000658-200008000-00016

M3 - Article

C2 - 10903605

AN - SCOPUS:0033863149

SN - 0003-4932

VL - 232

SP - 254

EP - 262

JO - Annals of surgery

JF - Annals of surgery

IS - 2

ER -

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

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