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Scientific article
English

A randomized clinical trial to compare fleroxacin-rifampicin with flucloxacillin or vancomycin for the treatment of staphylococcal infection

Published inClinical infectious diseases, vol. 39, no. 9, p. 1285-1292
Publication date2004
Abstract

BACKGROUND: Oral combination therapy with fluoroquinolones plus rifampicin is a promising alternative to standard parenteral therapy for staphylococcal infections. METHODS: In a multicenter, randomized trial, we compared the efficacy, safety, and length of hospital stay for patients with staphylococcal infections treated either with an oral combination of a fluoroquinolone (fleroxacin) plus rifampicin or with standard parenteral treatment (flucloxacillin or vancomycin). Patients were included if cultures showed the presence of bacteremia or deep-seated infections with Staphylococcus aureus (104 patients) or catheter-related bacteremia due to drug-susceptible, coagulase-negative staphylococci (23 patients). RESULTS: The cure rate in the intention-to-treat analysis was 78% for the fleroxacin-rifampicin group (68 patients) and 75% for the standard therapy group (59 patients; 47 received flucloxacillin, and 12 received vancomycin); in the population of clinically evaluable patients (n=119), the cure rate was 82% and 80%, respectively; and in the population of microbiologically evaluable patients (n=103), the cure rate was 86% and 84%, respectively. Clinical and bacteriological failures after S. aureus infections were documented in similar proportions of patients. The median length of hospital stay after study entry was 12 days in the fleroxacin-rifampicin group, compared with 23 days in the standard treatment group (P=.006). More adverse events probably related to the study drug were reported in the fleroxacin-rifampicin group than in the standard therapy group (15 of 68 vs. 5 of 59 patients; P=.05). CONCLUSIONS: This study suggests that an oral regimen containing a fluoroquinolone plus rifampicin may be effective for treating staphylococcal infections, allowing earlier discharge from the hospital.

Keywords
  • Administration, Oral
  • Adult
  • Aged
  • Bacteremia/drug therapy
  • Catheters, Indwelling/microbiology
  • Drug Therapy, Combination
  • Female
  • Fleroxacin/administration & dosage/adverse effects/ therapeutic use
  • Floxacillin/administration & dosage/adverse effects/ therapeutic use
  • Humans
  • Male
  • Methicillin Resistance/drug effects
  • Middle Aged
  • Prospective Studies
  • Rifampin/administration & dosage/adverse effects/ therapeutic use
  • Safety
  • Staphylococcal Infections/diagnosis/ drug therapy/metabolism
  • Staphylococcus/drug effects/isolation & purification
  • Staphylococcus aureus/drug effects/isolation & purification
  • Treatment Outcome
  • Vancomycin/administration & dosage/adverse effects/ therapeutic use
Citation (ISO format)
SCHRENZEL, Jacques et al. A randomized clinical trial to compare fleroxacin-rifampicin with flucloxacillin or vancomycin for the treatment of staphylococcal infection. In: Clinical infectious diseases, 2004, vol. 39, n° 9, p. 1285–1292. doi: 10.1086/424506
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ISSN of the journal1058-4838
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