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

Schockmel, Gerard
Bregenzer, Thomas
Flueckiger, Ursula
Petignat, Christiane
Jacobs, Frederique
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Published in Clinical infectious diseases. 2004, vol. 39, no. 9, p. 1285-1292
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, OralAdultAgedBacteremia/drug therapyCatheters, Indwelling/microbiologyDrug Therapy, CombinationFemaleFleroxacin/administration & dosage/adverse effects/ therapeutic useFloxacillin/administration & dosage/adverse effects/ therapeutic useHumansMaleMethicillin Resistance/drug effectsMiddle AgedProspective StudiesRifampin/administration & dosage/adverse effects/ therapeutic useSafetyStaphylococcal Infections/diagnosis/ drug therapy/metabolismStaphylococcus/drug effects/isolation & purificationStaphylococcus aureus/drug effects/isolation & purificationTreatment OutcomeVancomycin/administration & dosage/adverse effects/ therapeutic use
PMID: 15494904
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Research group Epidémiologie et contrôle de la résistance aux antibiotiques (866)
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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 https://archive-ouverte.unige.ch/unige:7578

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Deposited on : 2010-06-21

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