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Treating diabetic foot infections with sequential intravenous to oral moxifloxacin compared with piperacillin-tazobactam/amoxicillin-clavulanate.
J Antimicrob Chemother. 2007 Aug; 60(2):370-6.JA

Abstract

OBJECTIVES

Complicated skin and skin structure infections (cSSSIs), including diabetic foot infections (DFIs), are often polymicrobial, requiring combination or broad-spectrum therapy. Moxifloxacin, a broad-spectrum fluoroquinolone, is approved for cSSSI and can be administered by either intravenous (iv) or oral routes. To assess the efficacy of moxifloxacin for treating DFIs, we analysed a subset of patients with these infections who were enrolled in a prospective, double-blind study that compared the efficacy of moxifloxacin with piperacillin-tazobactam and amoxicillin-clavulanate.

METHODS

Patients>or=18 years of age with a DFI requiring initial iv therapy were randomized to either moxifloxacin (400 mg/day) or piperacillin-tazobactam (3.0/0.375 g every 6 h) for at least 3 days followed by moxifloxacin (400 mg/day orally) or amoxicillin-clavulanate (800 mg every 12 h orally), if appropriate, for 7-14 days. DFI was usually defined as any foot infection plus a history of diabetes. Our primary efficacy outcome was the clinical response of the infection at test-of-cure (TOC), 10-42 days post-therapy.

RESULTS

Among 617 patients enrolled in the original study, 78 with DFIs were evaluable for treatment efficacy. Clinical cure rates at TOC were similar for moxifloxacin and piperacillin-tazobactam/amoxicillin-clavulanate (68% versus 61%) for patients with investigator-defined infection (P=0.54). Overall pathogen eradication rates in the microbiologically-valid population were 69% versus 66% for moxifloxacin and comparator, respectively (P=1.00).

CONCLUSIONS

Intravenous+/-oral moxifloxacin was as effective as iv piperacillin-tazobactam+/-amoxicillin-clavulanate in treating moderate-to-severe DFIs. Moxifloxacin may have potential as a monotherapy regimen for DFIs.

Authors+Show Affiliations

VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA. benjamin.lipsky@med.va.govNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17553812

Citation

Lipsky, Benjamin A., et al. "Treating Diabetic Foot Infections With Sequential Intravenous to Oral Moxifloxacin Compared With Piperacillin-tazobactam/amoxicillin-clavulanate." The Journal of Antimicrobial Chemotherapy, vol. 60, no. 2, 2007, pp. 370-6.
Lipsky BA, Giordano P, Choudhri S, et al. Treating diabetic foot infections with sequential intravenous to oral moxifloxacin compared with piperacillin-tazobactam/amoxicillin-clavulanate. J Antimicrob Chemother. 2007;60(2):370-6.
Lipsky, B. A., Giordano, P., Choudhri, S., & Song, J. (2007). Treating diabetic foot infections with sequential intravenous to oral moxifloxacin compared with piperacillin-tazobactam/amoxicillin-clavulanate. The Journal of Antimicrobial Chemotherapy, 60(2), 370-6.
Lipsky BA, et al. Treating Diabetic Foot Infections With Sequential Intravenous to Oral Moxifloxacin Compared With Piperacillin-tazobactam/amoxicillin-clavulanate. J Antimicrob Chemother. 2007;60(2):370-6. PubMed PMID: 17553812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treating diabetic foot infections with sequential intravenous to oral moxifloxacin compared with piperacillin-tazobactam/amoxicillin-clavulanate. AU - Lipsky,Benjamin A, AU - Giordano,Philip, AU - Choudhri,Shurjeel, AU - Song,James, Y1 - 2007/06/06/ PY - 2007/6/8/pubmed PY - 2007/12/6/medline PY - 2007/6/8/entrez SP - 370 EP - 6 JF - The Journal of antimicrobial chemotherapy JO - J Antimicrob Chemother VL - 60 IS - 2 N2 - OBJECTIVES: Complicated skin and skin structure infections (cSSSIs), including diabetic foot infections (DFIs), are often polymicrobial, requiring combination or broad-spectrum therapy. Moxifloxacin, a broad-spectrum fluoroquinolone, is approved for cSSSI and can be administered by either intravenous (iv) or oral routes. To assess the efficacy of moxifloxacin for treating DFIs, we analysed a subset of patients with these infections who were enrolled in a prospective, double-blind study that compared the efficacy of moxifloxacin with piperacillin-tazobactam and amoxicillin-clavulanate. METHODS: Patients>or=18 years of age with a DFI requiring initial iv therapy were randomized to either moxifloxacin (400 mg/day) or piperacillin-tazobactam (3.0/0.375 g every 6 h) for at least 3 days followed by moxifloxacin (400 mg/day orally) or amoxicillin-clavulanate (800 mg every 12 h orally), if appropriate, for 7-14 days. DFI was usually defined as any foot infection plus a history of diabetes. Our primary efficacy outcome was the clinical response of the infection at test-of-cure (TOC), 10-42 days post-therapy. RESULTS: Among 617 patients enrolled in the original study, 78 with DFIs were evaluable for treatment efficacy. Clinical cure rates at TOC were similar for moxifloxacin and piperacillin-tazobactam/amoxicillin-clavulanate (68% versus 61%) for patients with investigator-defined infection (P=0.54). Overall pathogen eradication rates in the microbiologically-valid population were 69% versus 66% for moxifloxacin and comparator, respectively (P=1.00). CONCLUSIONS: Intravenous+/-oral moxifloxacin was as effective as iv piperacillin-tazobactam+/-amoxicillin-clavulanate in treating moderate-to-severe DFIs. Moxifloxacin may have potential as a monotherapy regimen for DFIs. SN - 0305-7453 UR - https://www.unboundmedicine.com/medline/citation/17553812/Treating_diabetic_foot_infections_with_sequential_intravenous_to_oral_moxifloxacin_compared_with_piperacillin_tazobactam/amoxicillin_clavulanate_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkm130 DB - PRIME DP - Unbound Medicine ER -