J Infect Chemother. 2005
Feb;11(1):52-4.
Clinical effect of intravenous ciprofloxacin on hospital-acquired
pneumonia.
Okimoto N, Yamato K, Honda Y, Kurihara T, Osaki K, Asaoka N, Fujita
K, Ohba H.
Division of Respiratory Diseases, Department of Medicine, Kawasaki
Medical School Kawasaki Hospital, 2-1-80 Nakasange, Okayama, 700-0821,
Japan.
The effect of intravenous ciprofloxacin (CPFX) on hospital-acquired
pneumonia was examined. The subjects were 32 patients with hospital-acquired
pneumonia classified as being in group I, group II, and group III,
based on The Japanese Respiratory Society Guidelines for management
of hospital-acquired pneumonia. None of the patients had received
antibiotic treatment for the pneumonia. CPFX 300 mg was intravenously
infused twice daily for 3-14 days, and its clinical effect, bacterological
effect, and side effects were examined. Intravenous CPEX was clinically
effective in 21 of the 32 patients, with an efficacy rate of 65.6%.
With regard to bacteriological efficacy, 4 of 5 strains of methicillin-sensitive
Staphylococcus aureus, 2 of 3 strains of Klebsiella pneumoniae,
1 of 2 strains of Streptococcus pneumoniae, 1 of 2 strains of Streptococcus
agalactiae, 1 of 2 strains of Pseudomonas aeruginosa, 1 of 2 strains
of Serratia marcescens, and the 1 strain of Klebsiella oxytoca were
eradicated, with an eradication rate of 42.3% (11 of 26 strains
whose fate was confirmed eradicated). Abnormal laboratory findings
(side effects) were observed in 11 of the 32 patients (34.4%), but
all side effects were mild. Based on the above data, intravenous
CPFX may be the drug which should be recommended as the first choice
for hospital-acquired pneumonia.
J Antimicrob Chemother. 2005 Feb 24; [Epub ahead
of print]
Comparative activity of quinolones (ciprofloxacin, levofloxacin,
moxifloxacin and garenoxacin) against extracellular and intracellular
infection by Listeria monocytogenes and Staphylococcus aureus
in J774 macrophages.
Seral C, Barcia-Macay M, Mingeot-Leclercq MP, Tulkens PM, Van
Bambeke F.
Unite de pharmacologie cellulaire et moleculaire, Universite catholique
de Louvain, Brussels, Belgium.
OBJECTIVES: Quinolones accumulate in eukaryotic cells and show
activity against a large array of intracellular organisms, but
systematic studies aimed at examining their pharmacodynamic profile
against intracellular bacteria are scarce. The present work aims
at comparing intracellular-to-extracellular activities in this
context. METHODS: We assessed the activities of ciprofloxacin,
levofloxacin, moxifloxacin and garenoxacin against the extracellular
(broth) and intracellular (infected J774 macrophages) forms of
Listeria monocytogenes (cytosolic infection) and Staphylococcus
aureus (phagolysosomal infection) using a range of clinically
meaningful extracellular concentrations (0.06-4 mg/L). RESULTS:
All four quinolones displayed concentration-dependent bactericidal
activity against extracellular and intracellular L. monocytogenes
and S. aureus for extracellular concentrations in the range 1-4-fold
their MIC. Compared at equipotent extracellular concentrations,
intracellular activities against L. monocytogenes were roughly
equal to those that were extracellular, but were 50-100 times
lower against S. aureus. Because quinolones accumulate in cells
(ciprofloxacin, approximately 3 times; levofloxacin, approximately
5 times; garenoxacin, approximately 10 times, moxifloxacin, approximately
13 times), these data show that, intracellularly, quinolones are
5-10 times less potent against L. monocytogenes (P=0.065 [ANCOVA]),
and at least 100 times less potent (P < 0.0001) against S.
aureus. Because of their lower MICs and higher accumulation levels,
garenoxacin and moxifloxacin were, however, more active than ciprofloxacin
and levofloxacin when compared at similar extracellular concentrations.
CONCLUSIONS: Quinolone activity is reduced intracellulary. This
suggests that either only a fraction of cell-associated quinolones
exert an antibacterial effect, or that intracellular activity
is defeated by the local environment, or that intracellular bacteria
only poorly respond to the action of quinolones.
J Antimicrob Chemother. 2005 Feb 24; [Epub ahead
of print]
Comparison of gatifloxacin, moxifloxacin and ciprofloxacin for
treatment of experimental Burkholderia pseudomallei infection.
Steward J, Piercy T, Lever MS, Nelson M, Simpson AJ, Brooks TJ.
Biomedical Sciences, Dstl Porton Down, Salisbury SP4 OJQ, UK.
OBJECTIVES: To compare the efficacy of moxifloxacin, gatifloxacin
and ciprofloxacin for the post-exposure prophylaxis and treatment
of experimental Burkholderia pseudomallei infection. The presence
of persistent infection in treated animals and the rate of relapse
following dexamethasone treatment were also investigated. METHODS:
BALB/c mice were inoculated subcutaneously with 1.75 x 10(6) cfu
of B. pseudomallei strain 576. Gatifloxacin, moxifloxacin and
ciprofloxacin (100 mg/kg) were given orally at 12 hourly intervals
for 14 days starting at 6 h, 7 days or 12 days post-challenge.
Control mice did not receive antibiotic therapy. RESULTS: No regimen
gave 100% protection. Prophylaxis was most effective when started
6 h post-challenge, with survival rates at 42 days for ciprofloxacin,
gatifloxacin and moxifloxacin being 58%, 75% and 75%, respectively.
For treatment started at day 7 post-challenge, survival rates
were 17%, 11% and 44%, respectively. When antibiotic treatment
was delayed until day 12 post-challenge, survival rates fell to
21%, 17% and 28%, respectively. Following dexamethasone treatment
of survivors at 42 days post-challenge, relapses occurred in all
treatment groups. CONCLUSIONS: Fluoroquinolones do not provide
good post-exposure protection against infection with B. pseudomallei.
The newer agents moxifloxacin and gatifloxacin are not significantly
better than ciprofloxacin for this purpose.
Harefuah 2002 May;141 Spec No:63-72, 121,
120
Anthrax - an overview at 2002
Mozes YN, Winder A, Tadmor B, Rotman E, Sagi R, Hourvitz A
Childrens Ward A, Schneider Childrens Medical Centre, Israel
BACKGROUND: Bacillus anthracis, the causative agent of anthrax,
is well known in human history as a major cause of disease in domestic
and wild animals and as a rare condition in humans. For the last
seventy years, anthrax was developed and occasionally stored as
an agent of biological weapon arsenal in numerous countries. The
incubation period in humans is 1-6 days and the disease may be present
as three distinct clinical syndromes: cutaneous, inhalational, and
gastrointestinal disease. The major concern in regard of biological
warfare is the inhalational form of anthrax, which starts as a febrile
flu-like disease. The development of malaise, fatigue, cough and
mild chest discomfort is followed by severe respiratory distress
with dyspnea, diaphoresis, stridor, and cyanosis. Shock and death
occur within 24-36 hours after onset of severe symptoms. Physical
findings are non-specific, but a widened mediastinum is usually
seen on chest x-ray. A positive blood culture, immunohistochemical
methods and the use of the polymerase chain reaction method confirm
the diagnosis. Although effectiveness may be limited after severe
symptoms are present, a high dose of antibiotic treatment should
be administered and aggressive supportive therapy may be necessary.
In the situation of an anthrax attack, as was recently seen in the
United States, penicillin is no longer recommended as an acceptable
first line therapy. In this case, ciprofloxacin or doxycycline is
the recommended drug of choice since penicillin-resistant strains
may be used, as well as the possibility of the emergence of an inducible
beta-lactamase positive bacterium. Since a high infecting dose may
exacerbate the clinical course of the disease, a combination antibiotic
regimen should be considered. The disease is not contagious and
standard precautions are sufficient. Pre-exposure prophylaxis is
based on a vaccine administration, while post-exposure prophylaxis
is feasible by the initial use of oral ciprofloxacin or doxycycline.
In this article we reviewed the literature with emphasis on the
recent medical reports from the United States analyzing the eleven
cases of inhalational anthrax as well as the new guidelines for
diagnosis and treatment that resulted from the bioterrorism attack
in October 2001. Although physical findings were non-specific, abnormal
findings on chest x-rays were present in all the eleven cases. A
positive blood culture, immunohistochemical methods and the use
of the polymerase chain reaction method were highly valuable in
revealing and confirming the diagnosis of anthrax. In the case of
an attack with anthrax spores, the likelihood of exposure to a large
infective dose of high quality spores, may require a prolonged period
of treatment as well as prolonged post-exposure therapy.
Nihon Kokyuki Gakkai Zasshi. 2003 Mar;41(3):211-8.
Two cases of Legionella pneumophila pneumonia improved by parenteral
ciprofloxacin administration.
Sasaki E, Kaida H, Izumikawa K, Izumikawa K, Hara K, Hirakata
Y, Tomono K, Kohno S.
Department of Internal Medicine, Izumikawa Hospital.
We report here two cases of Legionella pneumophila pneumonia that
were markedly improved by parenteral ciprofloxacin administration.
A 69-year-old man who had previously visited a hot spring was
admitted to our hospital with severe pneumonia and a 48-year-old
man with dilated cardiomyopathy as an underlying disease was also
hospitalized because of heart failure and pneumonia. In both cases
a urinary antigen test for L. pneumophila was negative at the
incipient stage, and the initial treatment with a beta-lactam
agent was ineffective. However, the high titer of L. pneumophila
serogroup 6 antigen in the serum at the convalescent stage revealed
that these two pneumonia cases were caused by L. pneumophila,
and the following intravenous administration of ciprofloxacin
was highly effective. We concluded that intravenous treatment
with ciprofloxacin could be effective against L. pneumophila pneumonia,
which is sometimes hard to diagnose in the acute phase.
Intern Med. 2003 Apr;42(4):318-21.
Metronidazole plus ciprofloxacin therapy for active Crohn's disease.
Ishikawa T, Okamura S, Oshimoto H, Kobayashi R, Mori M.
First Department of Internal Medicine, Gunma University, Maebashi.
OBJECTIVE: The aim of this study was to investigate the efficacy
of metronidazole plus ciprofloxacin for the treatment of Japanese
patients with active Crohn's disease. METHODS AND PATIENTS: Seven
patients (counting one patient twice with 2 enrollments at a 5-month
interval) with a flare-up of Crohn's disease were enrolled. While
continuing the baseline treatment under which the patients relapsed,
they received metronidazole 250 mg twice (4 patients) or three
times (3 patients) daily plus ciprofloxacin 200 mg three times
daily for 4 weeks. The efficacy was evaluated by the changes in
the assessment score of IOIBD, the International Organization
for the Study of Inflammatory Bowel Disease, and the inflammation
markers: C-reactive protein (CRP), erythrocyte sedimentation rate
(ESR), and white blood cell count. RESULTS: Metronidazole plus
ciprofloxacin decreased the CRP in seven patients and the IOIBD
score in six patients. Significant differences were detected in
these parameters at weeks 2 and 4 compared with baseline. Five
of the patients achieved normalization of CRP and a reduction
of the IOIBD score to zero or one. Although one patient complained
of taste disturbance, no other adverse events occurred and all
patients completed the 4 weeks of study medication. CONCLUSION:
The addition of metronidazole plus ciprofloxacin could be a useful
intervention for the treatment of Japanese patients with active
Crohn's disease.
Scand J Infect Dis. 2003;35(1):34-9.
Ciprofloxacin for 2 or 4 weeks in the treatment of febrile urinary
tract infection in men: a randomized trial with a 1 year follow-up.
Ulleryd P, Sandberg T.
Department of Infectious Diseases, Sahlgrenska University Hospital,
Goteborg, Sweden.
In an open, prospective, single-centre study, 114 men with a presumptive
diagnosis of febrile urinary tract infection (UTI) were randomized
to oral treatment with ciprofloxacin 500 mg twice daily for 2
or 4 weeks. 72 patients were assessable for efficacy according
to the protocol, 65 of whom had prostatic involvement by the infection,
as measured by transient increases in serum prostate-specific
antigen and prostate volume. All patients responded successfully
with resolution of fever and symptoms during treatment. There
were no significant differences in short-term bacteriological
and clinical cure rates between the 2 treatment regimens [89 vs
97%, 95%, confidence interval (95% CI) for difference in proportions
-3 to 19%; and 92 vs 97%, 95% CI -5 to 15%, respectively]. The
lower cure rates among those allocated to the 2 week regimen may
be explained by a higher frequency of urinary tract abnormalities
requiring surgical intervention. After 1 y, 21 patients had experienced
recurrences, which comprised asymptomatic bacteriuria (n = 10),
symptomatic lower UTI (n = 5) and another episode of febrile UTI
(n = 6). The results suggest that a 2 week course of ciprofloxacin
may be adequate for febrile UTI in men.
Antibiot Khimioter. 2002;47(10):3-7.
Ciprofloxacin in the treatment of patients with brucellosis.
Duisenova AK, Kurmanova KB, Kurmanova GM.
Scientific Center of Hygiene and Epidemiology, Almaty State Institute
of Prolonged Education, Republik of Kazakhstan, Almaty.
With the aim to estimate the clinical and immunological efficiency
of the ciprofloxacin (cifloxinal) 105 patients with acute (51),
subacute (19) and chronic (35) brucellosis were studied. Control
group (17 patients with acute and 30 patients with chronic brucellosis)
have been treated with combination of two antibiotics: doxycycline
and rifampicin. Ciprofloxacin in a dose 500 mg bid within 14 days
in acute stage and 20 days in chronic stage of disease essentially
reduced duration of local inflammatory processes of brucellosis
with simultaneous treatment of the chronic infection focus, provides
good proximate and distant outcomes of treatment. Ciprofloxacin
can be considered as an alternative drug for the treatment of
brucellosis, more effective (clinically and immunologically) than
a combination of two antibiotics: doxycycline and rifampicin.
Int J Oncol. 2003 Apr;22(4):787-94.
Suppression of human prostate cancer cell growth by ciprofloxacin
is associated with cell cycle arrest and apoptosis.
Aranha O, Grignon R, Fernandes N, McDonnell TJ, Wood DP Jr, Sarkar
FH.
Department of Pathology, Karmanos Cancer Institute, Wayne State
University School of Medicine, Detroit, MI, USA.
For hormone resistant prostate cancer (HRPC), chemotherapy is
used but the mortality is 100% with a mean survival time of 7-8
months. Our previous studies have shown the chemotherapeutic effect
of ciprofloxacin in bladder cancer. At doses 50-400 micro g/ml
ciprofloxacin, the concentrations that are normally achieved at
doses currently used for the treatment of anti-bacterial infections,
inhibited bladder cancer cell growth and induced S/G2M arrest
with modulation of key cell cycle regulatory genes and ultimately
activated apoptotic processes. In this study, we investigated
the effect of ciprofloxacin on androgen independent prostate carcinoma,
PC3 cells and compared our results with non-tumorigenic prostate
epithelial cells. The main advantage of this fluroquinolone antibiotic
is its relative non-toxicity as compared to current chemotherapy,
which is not very effective, for the treatment of advanced hormone
resistant prostate cancer. PC3 cells as well as normal prostate
epithelial cells (MLC8891) were treated with 25-400 micro g/ml
ciprofloxacin, and cell counting was done during 3 days of treatment.
The cell death was determined using DAPI staining of cell nuclei,
7AAD-staining followed by flow cytometric analysis as well as
by activation of caspase-3, a member of the ICE family of enzymes
involved in the apoptotic cascade. The cell lysates were analyzed
by immunoblotting techniques for the expression of key genes targeted
by ciprofloxacin (p21WAF1, Bax and Bcl-2). Translocation of bax
was visualized using a fluorescence staining procedure followed
by laser confocal microscopic imaging. Treatment of prostate cancer
cells with ciprofloxacin resulted in a dose- and time-dependent
inhibition of cell growth (70-100% with 50-400 micro g/ml of the
drug). There was a concomitant induction of cell cycle arrest
at the S and G2/M phases of the cell cycle as well as induction
of apoptosis. The CDK inhibitor p21WAF1 was down-regulated as
early as 12 h following ciprofloxacin treatment (100-200 micro
g/ml for 12-24 h). There was a significant increase in the Bax/Bcl-2
ratio with translocation of Bax, a pro-apoptotic protein, to mitochondria
with concomitant activation of caspase 3. These results suggest
the potential usefulness of the fluroquinolone, ciprofloxacin
as a chemotherapeutic agent for advanced prostate cancer. The
fluroquinolone ciprofloxacin showed anti-proliferative and apoptosis
inducing activity on prostate cancer cells but not on non-tumorigenic
prostate epithelial cells. These effects of ciprofloxacin were
mediated by cell cycle arrest at S-G2/M phase of the cell cycle,
Bax translocation to mitochondrial membrane and by increasing
the Bax/Bcl-2 ratio in PC3 prostate cancer cells. Based on our
in vitro results, further in-depth in vivo animal or human investigations
are warranted.
Clin Infect Dis. 2003 Feb 15;36(4):521-3. Epub
2003 Jan 29.
A case of plague successfully treated with ciprofloxacin and sympathetic
blockade for treatment of gangrene.
Kuberski T, Robinson L, Schurgin A.
John C. Lincoln Hospital-Deer Valley, Phoenix, AZ, USA.
A critically ill patient with septicemic plague and peripheral
gangrene was treated successfully with ciprofloxacin. There are
no previous reports of plague being successfully treated with
ciprofloxacin. Peripheral gangrene of this patient's feet was
managed with use of sympathetic blockade; the patient's toes appear
to have been saved by this approach.
Med Pediatr Oncol. 2003 Feb;40(2):93-8.
Ciprofloxacin and amoxicillin as continuation treatment of febrile
neutropenia in pediatric cancer patients.
Park JR, Coughlin J, Hawkins D, Friedman DL, Burns JL, Pendergrass
T.
Pediatric Hematology/Oncology, Children's Hospital and Regional
Medical Center, University of Washington, Seattle, Washington,
USA.
BACKGROUND: The empiric administration of anti-microbial therapy
significantly reduces the morbidity and mortality associated with
febrile neutropenic episodes in oncology patients. Outpatient
empiric antibiotic therapy can be safely administered to a subset
of febrile neutropenic patients at low risk for clinical complications.
PROCEDURE: Pediatric cancer patients presenting with febrile neutropenia
after non-myeloablative chemotherapy and who met institutional
criteria for early hospital discharge following a minimum of 48-hr
inpatient empiric intravenous ceftazidime were eligible for the
study. The feasibility and efficacy of an outpatient continuation
therapy of oral ciprofloxacin (CPR) 25-30 mg/kg/day divided BID
and amoxicillin (AMX) 30-50 mg/kg/day divided TID was assessed.
RESULTS: Thirty febrile neutropenic episodes in 26 patients were
treated with outpatient oral CPR/AMX therapy. Oral CPR/AMX therapy
was feasible in 28 (93%) and efficacious in 26 (87%) of treatment
episodes. CPR/AMX was discontinued due to abdominal pain and diarrhea
(n = 2), recurrent fever (n = 3), or gastrointestinal bleeding
(n = 1). No patient developed new bacteremia or cardiopulmonary
decompensation. Bone/joint pain or gastrointestinal symptoms occurred
in 27% of treatment episodes. Duration of neutropenia, lower absolute
neutrophil count (ANC) (< 100/mm(3)) at start of oral antibiotic
therapy and active malignant disease were associated with failure
of oral antibiotic therapy. CONCLUSIONS: It is feasible to administer
oral CPR/AMX as continuation antibiotic therapy for a selected
subgroup of febrile neutropenic episodes defined after initial
hospitalization and empiric antibiotic therapy. Prospectively
randomized trials will be required to analyze adequately the efficacy
of an oral CPR/AMX outpatient antibiotic regimen for treatment
of febrile neutropenia in pediatric oncology patients.
Pneumologie. 2002 Oct;56(10):599-604.
Ciprofloxacin in the treatment of hospital-acquired pneumonia:
a surveillance study in 676 patients.
Kljucar S, Rost KL, Landen H.
DRK-Kliniken Westend, Zentrale Abteilung fur Anasthesiologie und
Intensivmedizin, Berlin, Germany.
BACKGROUND: Controlled clinical trials have shown efficacy of
high-dose ciprofloxacin for hospital-acquired (HAP) or nosocomial
pneumonia. But it has yet to be demonstrated whether this good
efficacy also holds true for routine intensive-care patients outside
of controlled trials. PATIENTS: In a post-marketing surveillance
study at 87 intensive-care units in Germany we analyzed 676 cases
of nosocomial pneumonia treated with intravenous ciprofloxacin
in a daily dosage of at least 400 mg. RESULTS: 538 (80 %) patients
were evaluable for efficacy. Cure or improvement was reported
in 76 % of the cases. Clinical success rate was higher in previously
untreated patients receiving ciprofloxacin as monotherapy (85.3
%) or in combination with other antibiotics (78.4 %) than in those
who received ciprofloxacin as monotherapy (73.1 %) or as combination
therapy (69.2 %) after an antibiotic pretreatment. In the 66 patients
with Pseudomonas aeruginosa as causal pathogen, clinical success
rate was 86.4 %. 32 adverse events classified as possibly or probably
related to ciprofloxacin occurred in 3.1 % of patients; all of
those were reversible. CONCLUSIONS: Due to the high success rate,
even in cases with failed antimicrobial pretreatment, and the
favourable risk-benefit ratio of high-dose ciprofloxacin, ciprofloxacin
appears to be an attractive choice in the empiric treatment of
hospital-acquired pneumonia.
J Infect Chemother. 2001 Dec;7(4):255-7.
Efficacy of a 14-day course of oral ciprofloxacin therapy for
acute uncomplicated pyelonephritis.
Takahashi S, Hirose T, Satoh T, Kato R, Hisasue SI, Takagi S,
Shimizu T, Kunishima Y, Matsukawa M, Itoh N, Tsukamoto T.
Department of Urology, Sapporo Medical University School of Medicine,
South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan.
This study aimed to evaluate the efficacy and safety of oral antibacterial
treatment with fluoroquinilone for acute uncomplicated pyelonephritis
Thirteen female patients with acute uncomplicated pyelonephritis
were treated with oral fluoroquinilone (ciprofloxacin; CPFX).
They received 200 mg of the drug three times a day while febrile
(3-5 days). Once they become afebrile, the same dose of the drug,
given twice a day, was given for another 9-11 days. The mean duration
of the course of CPFX was 14 days. Symptoms were evaluated, and
laboratory examinations, including urine culture and measurement
of the minimal inhibitory concentration (MIC) of CPFX were conducted
before treatment, and 3, 7, 14, 21, and/or 28 days after the initiation
of the treatment. Of the 13 patients, only 5 needed to be hospitalized,
and the period of hospitalization was only a few days. On the
14th day after the commencement of treatment, bacteriologic and
clinical cure rates were 100%. Escherichia coli was the most common
uropathogen, being isolated from the urine of 8 patients. No clinical
relapse of the disease was found during a follow-up period of
up to 4 weeks. The patients tolerated the drug well without developing
any serious adverse effects. Oral antimicrobial chemotherapy with
fluoroquinolone, given on an outpatient or short-term hospitalization
basis, achieved satisfactory bacteriological and clinical outcomes
in the treatment of acute uncomplicated pyelonephritis. This treatment
regimen is indicated for patients with this disease who are not
in a serious condition with complications such as shock.
Inflamm Bowel Dis. 2001 Nov;7(4):301-5.
A randomized clinical trial of ciprofloxacin and metronidazole
to treat acute pouchitis.
Shen B, Achkar JP, Lashner BA, Ormsby AH, Remzi FH, Brzezinski
A, Bevins CL, Bambrick ML, Seidner DL, Fazio VW.
Center for Inflammatory Bowel Disease, Department of Gastroenterology,
The Cleveland Clinic Foundation, Ohio 44195, USA.
Metronidazole is effective for the treatment of acute pouchitis
after ileal pouch-anal anastomosis, but it has not been directly
compared with other antibiotics. This randomized clinical trial
was designed to compare the effectiveness and side effects of
ciprofloxacin and metronidazole for treating acute pouchitis.
Acute pouchitis was defined as a score of 7 or higher on the 18-point
Pouchitis Disease Activity Index (PDAI) and symptom duration of
4 weeks or less. Sixteen patients were randomized to a 2-week
course of ciprofloxacin 1,000 mg/d (n = 7) or metronidazole 20
mg/kg/d (n = 9). Clinical symptoms, endoscopic findings, and histologic
features were assessed before and after therapy. Both ciprofloxacin
and metronidazole produced a significant reduction in the total
PDAI score as well as in the symptom, endoscopy, and histology
subscores. Ciprofloxacin lowered the PDAI score from 10.1+/-2.3
to 3.3+/-1.7 (p = 0.0001), whereas metronidazole reduced the PDAI
score from 9.7+/-2.3 to 5.8+/-1.7 (p = 0.0002). There was a significantly
greater reduction in the ciprofloxacin group than in the metronidazole
group in terms of the total PDAI (6.9+/-1.2 versus 3.8+/-1.7;
p = 0.002), symptom score (2.4+/-0.9 versus 1.3+/-0.9; p = 0.03),
and endoscopic score (3.6+/-1.3 versus 1.9+/-1.5; p = 0.03). None
of patients in the ciprofloxacin group experienced adverse effects,
whereas three patients in the metronidazole group (33%) developed
vomiting, dysgeusia, or transient peripheral neuropathy. Both
ciprofloxacin and metronidazole are effective in treating acute
pouchitis with significant reduction of the PDAI scores. Ciprofloxacin
produces a greater reduction in the PDAI and a greater improvement
in symptom and endoscopy scores, and is better tolerated than
metronidazole. Ciprofloxacin should be considered as one of the
first-line therapies for acute pouchitis.
