Intravenous ciprofloxacin or ceftazidime in selected infections. A prospective, randomized, controlled study

Abstract

In a prospective, randomized, controlled study, the effectiveness and safety of intravenous ciprofloxacin was compared with those of ceftazidime in the treatment of tissue infections. A total of 52 patients received intravenous ciprofloxacin 200 mg twice daily (26 patients) or ceftazidime 1 to 2 g every eight to 12 hours (26 patients). This was followed, respectively, by oral ciprofloxacin or another suitable drug when improvement was seen. Informed consent was obtained from all patients. Cultures and laboratory determinations were performed initially and repeated periodically as indicated. Both groups were comparable in age, sex, number of infected sites, and instance of nosocomial infections (27 total). Severe infections occurred in six ciprofloxacin and 12 ceftazidime patients (p = 0.056). There were 13 patients in the ciprofloxacin group and six in the ceftazidime group with accompanying diseases (p = 0.032). Patients were treated with ciprofloxacin or ceftazidime for infections of the urinary tract (eight and two patients, respectively), skin or soft tissues (15 and 17 patients), pelvis (one and zero patients), lower respiratory tract (one and one patients), intra-abdominal (zero and three patients), and bacteremia (three and five patients). Two patients in each group had two sites of infection. Causative organisms were as follows: 15 gram-positive cocci (90 percent minimal inhibitory concentration: ciprofloxacin, 0.5; ceftazidime, 16.0 micrograms/ml) and 55 gram-negative rods (44 Enterobacteriaceae, nine Pseudomonas aeruginosa; 90 percent minimal inhibitory concentration: ciprofloxacin, 0.25; ceftazidime, 8.0 micrograms/ml). Resistance emerged in one patient treated with ciprofloxacin (Acinetobacter sp.) and 12 treated with ceftazidime (four Enterococcus, two Staphylococcus aureus, six other). Intravenous treatment was longer with ceftazidime (11.5 days versus 5.6 days for the ciprofloxacin group, p less than 0.0005), but the total duration of therapy was similar (12.9 versus 14.1 days, p value not significant). Resolution or improvement occurred in 23 ciprofloxacin and 26 ceftazidime sites of infection (p value not significant). Death occurred in two ceftazidime-treated patients (due to bacterial infection) and one ciprofloxacin-treated patient (at the induction of anesthesia). Adverse experiences were more common in the ceftazidime group as compared with the ciprofloxacin group (22 versus 15 patients, p = 0.026). Ciprofloxacin eradicated 25 of 31 causative organisms, whereas ceftazidime eradicated 30 of 41 (p value not significant). Intravenous ciprofloxacin was at least as effective as ceftazidime. Patients treated with ciprofloxacin may need added coverage for anaerobes, but the drug's excellent activity against nosocomial pathogens and its availability in oral form allow for an early change to oral therapy without compromising effectiveness coupled with added savings and convenience.