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A Randomized Clinical Trial to Compare Fleroxacin-Rifampicin with Flucloxacillin or Vancomycin for the Treatment of Staphylococcal Infection

Schrenzel, Jacques ; Harbarth, Stephan ; Schockmel, Gérard ; Genné, Daniel ; Bregenzer, Thomas ; Flueckiger, Ursula ; Petignat, Christiane ; Jacobs, Frédérique ; Francioli, Patrick ; Zimmerli, Werner ; Lew, Daniel P.

In: Clinical Infectious Diseases, 2004, vol. 39, no. 9, p. 1285-1292

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    Title
    • A Randomized Clinical Trial to Compare Fleroxacin-Rifampicin with Flucloxacillin or Vancomycin for the Treatment of Staphylococcal Infection
    Author
    • Schrenzel, Jacques. Geneva University Hospitals, Geneva
    • Harbarth, Stephan. Geneva University Hospitals, Geneva
    • Schockmel, Gérard. Geneva University Hospitals, Geneva
    • Genné, Daniel. Geneva University Hospitals, Geneva
    • Bregenzer, Thomas. Kantonsspital, Basel
    • Flueckiger, Ursula. Kantonsspital, Basel
    • Petignat, Christiane. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
    • Jacobs, Frédérique. Hôpital Erasme, Brussels, Belgium
    • Francioli, Patrick. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
    • Zimmerli, Werner. Kantonsspital, Basel
    • Lew, Daniel P.. Geneva University Hospitals, Geneva
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Clinical Infectious Diseases, 2004, vol. 39, no. 9, p. 1285-1292. The University of Chicago Press
    Other Version
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:300840
    Summary
    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