Oral Ciprofloxacin as good as IV antibiotics in bacteremia
A new study has found oral ciprofloxacin as an effective treatment against gram-negative bacteremia, according to the findings of a study presented at IDWeek 2018 held October 3-7 in San Francisco, California.
Not much evidence has been gathered to guide effective treatment of gram-negative bacteremia. Gregory Cook and his associates conducted a single centered retrospective cohort study to evaluate outcomes in patients who were treated with highly bioavailable oral antibiotics compared with patients treated with intravenous antibiotics.
The study was conducted between January 2015 and December 2017 at Froedtert & the Medical College of Wisconsin in patients requiring hospitalization with one or more positive blood cultures for a gram-negative organism.
The study participants were split into two groups. 98 patients received an intravenous antibiotic and 103 patients received a highly bioavailable oral antibiotic. Treatment failure was defined as a “composite of all-cause mortality and recurrent bacteremia or recurrent primary site infection.” The primary endpoint was 90-day treatment failure and the secondary outcomes consisted of 30-day treatment failure, 30- and 90-day all-cause mortality, and 30- and 90-day recurrent infections.
Patients in the intravenous treatment group were more often found to be immunosuppressed (41% vs 22%). Pitt Bacteremia scores in both groups were similar and source control achievement was also similar. The most common source of bacteremia was found to be urine, and Escherichia coli was the most common pathogen.
Key study findings:
- In the intravenous antibiotic group, 90-day treatment failure occurred in 16 patients and occurred in 2 patients from the highly bioavailable oral antibiotic group (16.8% vs 1.9%).
- Both groups showed similar 30-day mortality (4.5% vs. 0%).
- At 30-days, treatment failure occurred in 0 patients from the highly bioavailable oral antibiotic group and in 6 patients from the intravenous antibiotic patient group (6.3% vs 0%).
- Infection reoccurred after 90-days in 10 patients in the intravenous group and 1 in the oral antibiotic group (10.5% vs 1%).
- Using logistic regression analysis, the researchers adjusted for potential confounders and found that “no characteristics correlated with treatment failure other than [intravenous antibiotic] therapy.
- A potential issue with this study may be its small scope; it drew from a single location's data and included a total of only 201 patients. While all results presented were statistically significant, these findings may warrant a larger scale investigation.
According to the authors, the limitation of the study may be its small scope as the data was drawn from a single location which included a total of only 201 patients.
"While all results presented were statistically significant, these findings may warrant a larger scale investigation,’ write the authors.