Oral ciprofloxacin in refractory gram-negative bacillary infections.

The 13 patients included in this series: had chronic Gram-negative bacillary infections that were refractory to prior antibiotic therapy; were unable or unwilling to receive intravenous antibiotics; and had altered host defenses or environmental factors that contributed to persistent infection. Five patients had chronic polymicrobic Gram-negative osteomyelitis, three had urinary tract infections caused by Pseudomonas aeruginosa, two had Pseudomonas skin infections and three had respiratory tract infections with Gram-negative bacilli. The overall bacteriological cure rate for Gram-negative bacilli was four of five osteomyelitis, all three urinary tract infections, both skin infections and one out of three respiratory infections. Secondary infections occurred in two patients with bone infections, one with prostatitis and one with deep seated cellulitis and myonecrosis. Two patients with end-stage lung disease had emergence of resistant strains during therapy. Ciprofloxacin was well tolerated and effective in most of the ambulatory patients with refractory Gram-negative bacillary infection. It appears to be especially promising for Pseudomonas infections of the bone, urinary tract and soft tissue.