The efficacy and toxicity of sequential intravenous and oral
ciprofloxacin therapy was compared with intravenously administered
ceftazidime in a prospective, randomized, controlled, non-blinded trial. Thirty-two patients (16 patients receiving
ciprofloxacin and 16 patients receiving
ceftazidime) with 38
infections caused by susceptible Pseudomonas aeruginosa, enteric gram-negative rods, Salmonella group B, Serratia marcescens, Pseudomonas cepacia, and Xanthomonas maltophilia at various sites were evaluable for determination of efficacy. Length of
therapy varied from seven to 25 days. Concomitant antimicrobials included intravenously administered
beta-lactams for gram-positive organisms, intravenous/oral
metronidazole and
clindamycin for anaerobes, and intravenous/local
amphotericin B for Candida albicans.
Intravenous administration of 200 mg
ciprofloxacin every 12 hours to 11 patients produced peak serum levels between 1.15 and 3.12 micrograms/ml; trough levels ranged between 0.08 and 0.86 micrograms/ml. Overall response rates were similar for patients receiving
ciprofloxacin and
ceftazidime. Emergence of resistance was similar in both groups--one Enterobacter cloacae and two P. aeruginosa became resistant after
ciprofloxacin therapy and two P. aeruginosa became resistant after
ceftazidime therapy. The frequency of
superinfection with a variety of organisms was also similar in both groups. Adverse events related to
ciprofloxacin included transient
pruritus at the infusion site and generalized
rash leading to
drug discontinuation (one patient each), and with
ceftazidime adverse effects included
pain at the site of infusion and the development of allergic
interstitial nephritis (one patient each). Overall, intravenous/oral ciprofloxin
therapy appears to be as safe and effective as intravenous
ceftazidime therapy in the treatment of a variety of
infections due to susceptible aerobic gram-negative organisms.