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Oral Ciprofloxacin vs Parenteral Cefotaxime in the Treatment of Difficult Skin and Skin Structure InfectionsA Multicenter Trial
Layne O. Gentry, MD;
Carlos H. Ramirez-Ronda, MD;
Edward Rodriguez-Noriega, MD;
Haragopal Thadepalli, MD;
Pedro Leal del Rosal, MD;
Claudio Ramirez, MD
Arch Intern Med. 1989;149(11):2579-2583.
Abstract
• A prospective, randomized, double-blind, multicenter study was conducted of hospitalized patients to compare the efficacy and safety of oral ciprofloxacin (dosage, 750 mg every 12 hours) with intravenous cefotaxime (dosage, 2.0 g every 8 hours) as monotherapy for difficult skin and skin structure infections requiring hospitalization. Five hundred seventy patients were assessed for an analysis of safety and 461 patients were assessed for an analysis of efficacy. The most common infections were infected ulcers and abscesses. At the end of therapy, there was a higher incidence of recurrent or persistent organisms in the cefotaxime group compared with ciprofloxacin. Adverse reactions related to either therapy were rare. By pathogens, there were no differences in activity, except the higher rate of recurrent or persistent Pseudomonas aeruginosa infection in the cefotaxime group. By diagnosis, the two drugs had comparable efficacy, except for the higher incidence of bacteriologic failure in patients with polymicrobial infected ulcers in the cefotaxime group. Larger studies are needed to evaluate emergence of resistance to ciprofloxacin. Oral ciprofloxacin therapy is as safe and effective as parenteral cefotaxime in the treatment of difficult infections of the skin and skin structure, and affords the prospect of early discharge from the hospital and significant cost savings.
(Arch Intern Med. 1989;149:2579-2583)
Author Affiliations
From St Luke's Episcopal Hospital, Houston, Tex (Dr Gentry); the Division of Infectious Diseases, University of Puerto Rico School of Medicine, San Juan (Dr Ramirez-Ronda); the Infectious Disease Service, Civil Hospital, Apartado, Jalisco, Mexico (Dr Rodriguez-Noriega); Martin Luther King, Jr, General Hospital, UCLA School of Medicine (Dr Thadepalli); Hospital Clinical Del Parque, Chihuahua, Mexico (Dr del Rosal); and Roosevelt Hospital, Guatemala City, Guatemala (Dr Ramirez).
Footnotes
Accepted for publication June 23, 1989.
Portions of this article are reprinted with permission from the American Journal of Medicine (1987;82[suppl 4a]:220-223,227-229,239-241).
Reprint requests to St Luke's Episcopal Hospital, 6720 Bertner 2-233, Houston, TX 77030 (Dr Gentry).
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