Amodio-Groton M, Madu A, Madu C N, Briceland L L, Seligman M, McMaster P, Miller M H
Department of Pharmacy, Montefiore Medical Center, Bronx, NY, USA.
Ann Pharmacother. 1996 Jun;30(6):596-602. doi: 10.1177/106002809603000605.
To compare, in patients with gram-negative bacteremia, a course of parenteral antibiotic therapy alone with initial parenteral therapy followed by oral ciprofloxacin in terms of the length of hospitalization, clinical effectiveness, toxicity, and cost.
A prospective, controlled, randomized, open trial in select hospitalized patients.
Large metropolitan teaching hospital.
Fifty hospitalized patients with proven gram-negative bacteremia were randomized to receive either oral ciprofloxacin (group 1) following a 72-hour initial intravenous antibiotic regimen or to continue parenteral therapy alone (group 2). To compare the length of hospitalization, an additional group of 50 hospitalized patients with bacteremia (not enrolled in the study, group 3) were analyzed.
Parenteral antibiotics for 72 hours followed by continuation of a parenteral regimen or oral ciprofloxacin 750 mg bid.
Clinical response, toxicity, and length of hospitalization.
Clinical resolution was comparable in the 24 group 1 patients receiving intravenous antibiotics followed by oral ciprofloxacin (83%), the 26 group 2 patients receiving parenteral therapy alone (77%), and the 50 comparison patients (76%). There was little toxicity noted in any group, and the initial parenteral antibiotic regimens were similar. The mean numbers of hospital days on antibiotics were 9.1, 11.2, and 10.6 days in groups 1,2, and 3, respectively (p < 0.05 for group 1 vs. group 2 or 3), and the lengths of hospitalization were 9.8, 15.7, and 12.1 days, respectively (p < 0.05 for group 1 vs. group 2 or 3). Shortening the length of hospitalization and days of antibiotic therapy was associated with a cost savings of up to $78 000 for group 1 patients.
Parenteral therapy for 72 hours followed by oral ciprofloxacin significantly shortened both the number of hospital days taking antibiotics and the length of stay compared with parenteral therapy alone. Both regimens were equally effective and safe in the therapy of gram-negative bacteremia, and initial parenteral therapy followed by oral ciprofloxacin was cost-effective.
比较单纯肠外抗生素治疗疗程与初始肠外治疗后口服环丙沙星治疗革兰阴性菌血症患者在住院时间、临床疗效、毒性和费用方面的差异。
对部分住院患者进行的一项前瞻性、对照、随机、开放试验。
大型都市教学医院。
50例确诊为革兰阴性菌血症的住院患者被随机分为两组，一组在初始静脉应用抗生素72小时后接受口服环丙沙星治疗（第1组），另一组继续单纯肠外治疗（第2组）。为比较住院时间，分析了另外50例菌血症住院患者（未纳入研究，第3组）。
肠外抗生素治疗72小时后，继续肠外治疗方案或口服环丙沙星750毫克，每日两次。
临床反应、毒性和住院时间。
接受静脉抗生素治疗后口服环丙沙星的24例第1组患者（83%）、单纯接受肠外治疗的26例第2组患者（77%）和50例对照患者（76%）的临床缓解情况相当。各组均未发现明显毒性，初始肠外抗生素治疗方案相似。第1、2、3组患者使用抗生素的平均住院天数分别为9.1天、11.2天和10.6天（第1组与第2组或第3组相比，p<0.05），住院时间分别为9.8天、15.7天和12.1天（第1组与第2组或第3组相比，p<0.05）。第1组患者住院时间和抗生素治疗天数的缩短节省了高达78000美元的费用。
与单纯肠外治疗相比，肠外治疗72小时后口服环丙沙星显著缩短了使用抗生素的住院天数和住院时间。两种治疗方案在革兰阴性菌血症治疗中同样有效且安全，初始肠外治疗后口服环丙沙星具有成本效益。
