Efficacy and Tolerability of a Teicoplanin-Ciprofloxacin Combination in Severe Community-Acquired Pneumonia

Abstract

Mortality from community-acquired pneumonia (CAP) is high in the elderly and in patients who have a number of underlying diseases. We evaluated the clinical efficacy of a new unusual combination, teicoplanin-ciprofloxacin, in comparison with ceftriaxone in the treatment of CAP severe enough to require hospital admission. The present multicentre (23 centres) study was an open, comparative, randomised trial using parallel groups, and was carried out according to Good Clinical Practice. All patients required admission to hospital for severe CAP, and all had a follow-up visit that included chest x-ray and a wide biochemical and, in some cases, microbiological profile. 240 patients were enrolled: 158 elderly (over 65 years), 82 with underlying disease (chronic obstructive pulmonary disease, pulmonary primary or metastatic cancer, congestive heart failure, ketoacidotic diabetes), and 71 previously pretreated with other antibiotics with no cure or improvement. 121 patients (mean age 68.4 ± 15.5 years) were randomised to treatment with single-dose teicoplanin 400mg intravenously on the first day followed by 200 (37 patients) or 400 mg/day (84 patients) according to the severity of the disease, plus ciprofloxacin 500mg twice daily orally (TEICO group). 119 patients (mean age 68.9 ± 12.1 years) were randomised to single-dose ceftriaxone 2 g/day intravenously (CEF group). The two groups were homogeneous with regard to gender, pretreatment with other antibiotics, underlying diseases or illness severity at enrolment. Treatment was given for 10.2 ± 3.1 days in the TEICO group and for 9.6 ±3.3 days in the CEP group. Cure or improvement was observed in 85.1% of patients in the TEICO group vs 73.1% in the CEF group, while failures occurred in 5.8% (7 of 121) in the TEICO group, and 23.5% (28 of 119) in the CEF group (the remaining patients were not evaluable for various reasons). Thus, the combination teicoplanin-ciprofloxacin was associated with a failure risk four times lower than ceftriaxone therapy (p < 0.001). Tolerability was good for both treatment regimens.