Efficacy of Empirical Ciprofloxacin or Cefixime Plus Metronidazole Therapy for the Treatment of Liver Abscess: A Randomized Control Clinical Trial

Authors

• Lakshmi Priya G
• Deba Prasad Dhibar
• Atul Saroch
• Navneet Sharma
• Vishal Sharma
• Nipun Verma
• Sreedhara Bettadahally Chaluvashetty
• Ajay Prakash
• Harsimran Kaur

Language

English

Publication Date

5-20-2024

Journal

Scientific Reports

DOI

10.1038/s41598-024-59607-1

PMID

38769330

PMCID

PMC11106291

PubMedCentral® Posted Date

5-20-2024

PubMedCentral® Full Text Version

Post-print

Abstract

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.

Keywords

Humans, Ciprofloxacin, Metronidazole, Cefixime, Male, Female, Middle Aged, Adult, Anti-Bacterial Agents, Liver Abscess, Treatment Outcome, Double-Blind Method, Drug Therapy, Combination, Drainage, Aged, Liver abscess, Ciprofloxacin, Cefixime, Empirical oral antimicrobial, Gastrointestinal diseases, Hepatology, Medical research, Antimicrobials

Comments

Trial registration: clinicaltrials.gov PRS ID: NCT03969758, 31/05/2019.

Published Open-Access

yes

Recommended Citation

Priya G, Lakshmi; Dhibar, Deba Prasad; Saroch, Atul; et al., "Efficacy of Empirical Ciprofloxacin or Cefixime Plus Metronidazole Therapy for the Treatment of Liver Abscess: A Randomized Control Clinical Trial" (2024). Faculty, Staff and Students Publications. 8285.
https://digitalcommons.library.tmc.edu/baylor_docs/8285