Imperial College London
Portrait Picture

Dr Rachel Phillips

Faculty of Medicine, School of Public Health

Senior Lecturer in Medical Statistics and Clinical Trials
 
 
 
//

Contact

 

+44 (0)20 7594 8802r.phillips

 
 
//

Location

 

Stadium HouseWhite City Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Molton:2020:cid/ciz881,
author = {Molton, JS and Chan, M and Kalimuddin, S and Oon, J and Young, BE and Low, JG and Salada, BMA and Lee, TH and Wijaya, L and Fisher, DA and Izharuddin, E and Koh, TH and Teo, JWP and Krishnan, PU and Tan, BP and Woon, WWL and Ding, Y and Wei, Y and Phillips, R and Moorakonda, R and Yuen, KH and Cher, BP and Yoong, J and Lye, DC and Archuleta, S},
doi = {cid/ciz881},
journal = {Clinical Infectious Diseases},
pages = {952--959},
title = {Oral vs intravenous antibiotics for patients with klebsiella pneumoniae liver abscess: A randomized, controlled noninferiority study},
url = {http://dx.doi.org/10.1093/cid/ciz881},
volume = {71},
year = {2020}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundKlebsiella pneumoniae liver abscess (KLA) is emerging worldwide due to hypermucoviscous strains with a propensity for metastatic infection. Treatment includes drainage and prolonged intravenous antibiotics. We aimed to determine whether oral antibiotics were noninferior to continued intravenous antibiotics for KLA.MethodsThis noninferiority, parallel group, randomized, clinical trial recruited hospitalized adults with liver abscess and K. pneumoniae isolated from blood or abscess fluid who had received ≤7 days of effective antibiotics at 3 sites in Singapore. Patients were randomized 1:1 to oral (ciprofloxacin) or intravenous (ceftriaxone) antibiotics for 28 days. If day 28 clinical response criteria were not met, further oral antibiotics were prescribed until clinical response was met. The primary endpoint was clinical cure assessed at week 12 and included a composite of absence of fever in the preceding week, C-reactive protein <20 mg/L, and reduction in abscess size. A noninferiority margin of 12% was used.ResultsBetween November 2013 and October 2017, 152 patients (mean age, 58.7 years; 25.7% women) were recruited, following a median 5 days of effective intravenous antibiotics. A total of 106 (69.7%) underwent abscess drainage; 71/74 (95.9%) randomized to oral antibiotics met the primary endpoint compared with 72/78 (92.3%) randomized to intravenous antibiotics (risk difference, 3.6%; 2-sided 95% confidence interval, −4.9% to 12.8%). Effects were consistent in the per-protocol population. Nonfatal serious adverse events occurred in 12/72 (16.7%) in the oral group and 13/77 (16.9%) in the intravenous group.ConclusionsOral antibiotics were noninferior to intravenous antibiotics for the early treatment of KLA.
AU  - Molton,JS
AU  - Chan,M
AU  - Kalimuddin,S
AU  - Oon,J
AU  - Young,BE
AU  - Low,JG
AU  - Salada,BMA
AU  - Lee,TH
AU  - Wijaya,L
AU  - Fisher,DA
AU  - Izharuddin,E
AU  - Koh,TH
AU  - Teo,JWP
AU  - Krishnan,PU
AU  - Tan,BP
AU  - Woon,WWL
AU  - Ding,Y
AU  - Wei,Y
AU  - Phillips,R
AU  - Moorakonda,R
AU  - Yuen,KH
AU  - Cher,BP
AU  - Yoong,J
AU  - Lye,DC
AU  - Archuleta,S
DO  - cid/ciz881
EP  - 959
PY  - 2020///
SN  - 1058-4838
SP  - 952
TI  - Oral vs intravenous antibiotics for patients with klebsiella pneumoniae liver abscess: A randomized, controlled noninferiority study
T2  - Clinical Infectious Diseases
UR  - http://dx.doi.org/10.1093/cid/ciz881
UR  - https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciz881/5588353?redirectedFrom=fulltext
UR  - http://hdl.handle.net/10044/1/74979
VL  - 71
ER  -
Download