The efficacy of ciprofloxacin plus metronidazole was compared with that of cefotaxime plus gentamicin plus metronidazole in 79 patients with proven intra-abdominal infections. Patients were classified with the Peritonitis Index Altona-II (PIA-II) score for severity of disease, underlying conditions, prognosis and type of infection. Local peritonitis was diagnosed in 21 patients, generalized peritonitis in 25, intra-abdominal abscesses in 33; 35 patients had polymicrobial infections. Cure and improvement rates were: ciprofloxacin 77%, cefotaxime combination 56% (p < 0.02). Failures were significantly associated with a low initial PIA-II score, the presence of generalized peritonitis or abscesses, persistence of pathogens and superinfection. Superinfection was observed in 49% of the cases under cefotaxime and in 30% under ciprofloxacin. Concentrations of ciprofloxacin in pus ranged 2.0-5.2 mg/l with simultaneous serum concentrations of 1.2-3.1 mg/l.
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