Efficacy of empirical Ciprofloxacin or Cefixime plus Metronidazole therapy for the treatment of liver abscess: a randomized control clinical trial.
Cefixime
Ciprofloxacin
Empirical oral antimicrobial
Liver abscess
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
20 05 2024
20 05 2024
Historique:
received:
17
11
2023
accepted:
12
04
2024
medline:
21
5
2024
pubmed:
21
5
2024
entrez:
20
5
2024
Statut:
epublish
Résumé
Liver abscess is a potentially life-threatening medical emergency. Prompt empirical antimicrobial with or without percutaneous aspiration or drainage is therapeutic. The rational for using empirical intravenous broad-spectrum antimicrobials upfront instead of oral Fluoroquinolone or Cephalosporin is contentious. In this double blind randomized control clinical trial 69 participants received Ciprofloxacin (500 mg q 12 hourly) and 71 participants received Cefixime (200 mg q 12 hourly) orally for 2 weeks. Both the group received oral Metronidazole (800 mg q 8 hourly) for 2 weeks and percutaneous drainage or aspiration of the abscess was done as per indication and followed-up for 8 weeks. Out of 140 participants, 89.3% (N = 125) achieved clinical cure, 59 (85.5%) in Ciprofloxacin group and 66 (93%) in Cefixime group (p = 0.154). Mean duration of antimicrobial therapy was 16.2 ± 4.3 days, 15.1 ± 4.5 days in Ciprofloxacin group and 16.0 ± 4.2 days in Cefixime group (p = 0.223). Total 15 (10.7%) participants had treatment failure, 10 (14.5%) in Ciprofloxacin group and 5 (7.0%) in Cefixime group (p = 0.154). The most common reason for treatment failure was need of prolong (> 4 weeks) antimicrobial therapy due to persistent hepatic collection requiring drainage, which was significantly (p = 0.036) higher in Ciprofloxacin (14.5%, N = 10) group, compared to the Cefixime (4.2%, N = 3) group. In conclusion, both, the Ciprofloxacin or Cefixime plus Metronidazole for duration of 2-3 weeks were efficacious as empirical oral antimicrobial regimen along with prompt percutaneous drainage or aspiration for the treatment of uncomplicated liver abscess with similar efficacy. Oral Cefixime was better than Ciprofloxacin in term of lesser chance of treatment failure due to persistent collection which is required to be investigated further in larger clinical trial.Trial registration: clinicaltrials.gov PRS ID: NCT03969758, 31/05/2019.
Identifiants
pubmed: 38769330
doi: 10.1038/s41598-024-59607-1
pii: 10.1038/s41598-024-59607-1
doi:
Banques de données
ClinicalTrials.gov
['NCT03969758']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
11430Informations de copyright
© 2024. The Author(s).
Références
Johannsen, E. C., Sifri, C. D. & Madoff, L. C. Pyogenic liver abscesses. Infect. Dis. Clin. North Am. 14(3), 547–563 (2000).
doi: 10.1016/S0891-5520(05)70120-3
pubmed: 10987109
Cristina, S. et al. Characteristics and management of pyogenic liver abscess: A European experience. Medicine 97(19), e0628. https://doi.org/10.1097/MD.0000000000010628 (2018).
doi: 10.1097/MD.0000000000010628
Sharma, N., Sharma, A., Varma, S., Lal, A. & Singh, V. Amoebic liver abscess in the medical emergency of a North Indian hospital. BMC Res. Notes. 3, 21. https://doi.org/10.1186/1756-0500-3-21 (2010).
doi: 10.1186/1756-0500-3-21
pubmed: 20181006
pmcid: 2830945
Faulkner, R. D., Yacobi, A., Barone, J. S., Kaplan, S. A. & Silber, B. M. Pharmacokinetic profile of cefixime in man. Pediatr. Infect. Dis. J. 6(10), 963–970 (1987).
doi: 10.1097/00006454-198710000-00035
pubmed: 3696837
Mombelli, G. et al. Oral vs intravenous ciprofloxacin in the initial empirical management of severe pyelonephritis or complicated urinary tract infections: A prospective randomized clinical trial. Arch. Intern. Med. 159(1), 53–58 (1999).
doi: 10.1001/archinte.159.1.53
pubmed: 9892331
Rahimian, J., Wilson, T., Oram, V. & Holzman, R. S. Pyogenic liver abscess: Recent trends in etiology and mortality. Clin. Infect. Dis. 39(11), 1654–1659. https://doi.org/10.1086/425616 (2004) (Epub 2004 Nov 9).
doi: 10.1086/425616
pubmed: 15578367
Khan, R. et al. Predictive factors for early aspiration in liver abscess. World J. Gastroenterol. 14(13), 2089–2093. https://doi.org/10.3748/wjg.14.2089 (2008).
doi: 10.3748/wjg.14.2089
pubmed: 18395912
pmcid: 2701532
Jindal, A. et al. Management practices and predictors of outcome of liver abscess in adults: A series of 1630 patients from a liver unit. J. Clin. Exp. Hepatol. 11(3), 312–320. https://doi.org/10.1016/j.jceh.2020.10.002 (2021).
doi: 10.1016/j.jceh.2020.10.002
pubmed: 33994714
Huang, C. J. et al. Pyogenic hepatic abscess. Changing trends over 42 years. Ann. Surg. 223(5), 600–607. https://doi.org/10.1097/00000658-199605000-00016 (1996).
doi: 10.1097/00000658-199605000-00016
pubmed: 8651751
pmcid: 1235191
Wong, W. M. et al. Pyogenic liver abscess: Retrospective analysis of 80 cases over a 10-year period. J. Gastroenterol. Hepatol. 17(9), 1001–1007. https://doi.org/10.1046/j.1440-1746.2002.02787.x (2002).
doi: 10.1046/j.1440-1746.2002.02787.x
pubmed: 12167122
Wadhera, S., Arora, N. & Dhibar, D. P. Review: Modern management of liver abscess. J. Gastrointest. Infect. 12, 86–93. https://doi.org/10.1055/s-0043-1760740 (2022).
doi: 10.1055/s-0043-1760740
https://www.uptodate.com/contents/pyogenic-liver-abscess (2023).
Sharma, S. & Ahuja, V. Liver abscess: Complications and treatment. Clin Liver Dis. 18, 122–126. https://doi.org/10.1002/cld.1128 (2021).
doi: 10.1002/cld.1128
Singh, S. et al. Treatment of liver abscess: Prospective randomized comparison of catheter drainage and needle aspiration. Ann. Gastroenterol. 26(4), 332–339 (2013).
pubmed: 24714320
pmcid: 3959473
Ghosh, S. et al. Clinical, laboratory, and management profile in patients of liver abscess from northern India. J. Trop. Med. 2014, 142382. https://doi.org/10.1155/2014/142382 (2014) (Epub 2014 Jun 4).
doi: 10.1155/2014/142382
pubmed: 25002869
pmcid: 4066852
Patterson, M., Healy, G. R. & Shabot, J. M. Serologic testing for amoebiasis. Gastroenterology 78(1), 136–141 (1980).
doi: 10.1016/0016-5085(80)90204-8
pubmed: 6765936
Molton, J. S. et al. Oral vs intravenous antibiotics for patients with Klebsiella pneumoniae liver abscess: A randomized controlled noninferiority study. Clin. Infect. Dis. 71(4), 952–959. https://doi.org/10.1093/cid/ciz881 (2020).
doi: 10.1093/cid/ciz881
pubmed: 31641767
Meddings, L. et al. A population-based study of pyogenic liver abscesses in the United States: Incidence, mortality, and temporal trends. Am. J. Gastroenterol. 105(1), 117–124. https://doi.org/10.1038/ajg.2009.614 (2010) (Epub 2009 Nov 3).
doi: 10.1038/ajg.2009.614
pubmed: 19888200
Serraino, C. et al. Characteristics and management of pyogenic liver abscess: A European experience. Med. (Baltim.) 97(19), e0628. https://doi.org/10.1097/MD.0000000000010628 (2018).
doi: 10.1097/MD.0000000000010628
Giangiuli, S. E., Mueller, S. W. & Jeffres, M. N. Transition to oral versus continued intravenous antibiotics for patients with pyogenic liver abscesses: A retrospective analysis. Pharmacotherapy 39(7), 734–740. https://doi.org/10.1002/phar.2296 (2019) (Epub 2019 Jun 20).
doi: 10.1002/phar.2296
pubmed: 31148192
LeBel, M. Ciprofloxacin: Chemistry, mechanism of action, resistance, antimicrobial spectrum, pharmacokinetics, clinical trials, and adverse reactions. Pharmacother. J. Hum. Pharmacol. Drug Therapy. 8(1), 3–30 (1988).
doi: 10.1002/j.1875-9114.1988.tb04058.x
Brogden, R. N. & Campoli-Richards, D. M. Cefixime. Drugs. 38(4), 524–550 (1989).
doi: 10.2165/00003495-198938040-00004
pubmed: 2684593
Brittain, D. C., Scully, B. E., Hirose, T. & Neu, H. C. The pharmacokinetic and bactericidal characteristics of oral cefixime. Clin. Pharmacol. Therapeut. 38(5), 590–594 (1985).
doi: 10.1038/clpt.1985.229
Ali, S. Q., Zehra, A., Naqvi, B. S., Shah, S. & Bushra, R. Resistance pattern of ciprofloxacin against different pathogens. Oman Med. J. 25(4), 294–298. https://doi.org/10.5001/omj.2010.85 (2010).
doi: 10.5001/omj.2010.85
pubmed: 22043361
pmcid: 3191653
Ige, O. M. & Okesola, A. O. Comparative efficacy and safety of cefixime and ciprofloxacin in the management of adults with community-acquired pneumonia in Ibadan, Nigeria. Ann. Ib Postgrad. Med. 13(2), 72–78 (2015).
pubmed: 27162517
pmcid: 4853878
Ji, Y. & Lu, H. Meta-analysis: High-dose vs low-dose metronidazole-containing therapies for Helicobacter pylori eradication treatment. PLoS One. 13(1), e0189888. https://doi.org/10.1371/journal.pone.0189888 (2018).
doi: 10.1371/journal.pone.0189888
pubmed: 29370199
pmcid: 5784897
Bradley, W. G., Karlsson, I. J. & Rassol, C. G. Metronidazole neuropathy. Br. Med. J. 2(6087), 610–611. https://doi.org/10.1136/bmj.2.6087.610 (1977).
doi: 10.1136/bmj.2.6087.610
pubmed: 198056
pmcid: 1631560