Ciprofloxacin/metronidazole versus beta-lactam-based treatment of intra-abdominal infections: a meta-analysis of comparative trials

Int J Antimicrob Agents. 2006 Sep;28(3):159-65. doi: 10.1016/j.ijantimicag.2006.04.005. Epub 2006 Aug 8.


Intra-abdominal infections are polymicrobial and result in substantial morbidity and mortality. The combination of ciprofloxacin/metronidazole as well as several beta-lactam-based regimens are among the commonly used regimens for the treatment of patients with such infections. Thus, we sought to review the evidence from available comparative clinical trials studying ciprofloxacin/metronidazole versus broad-spectrum beta-lactam-based regimens in the treatment of intra-abdominal infections. Studies for the meta-analysis were retrieved from searches of the PubMed database. Five available comparative trials (four randomised controlled trials and one non-randomised comparative trial) including 1431 patients with intra-abdominal infections were included in the meta-analysis. There was a statistically significant difference between the compared arms with regard to cure in favour of the ciprofloxacin/metronidazole combination (odds ratio (OR)=1.69, 95% confidence interval (CI) 1.20-2.39). There was no statistically significant difference between the compared arms with regard to total mortality (OR=1.10, 95% CI 0.71-1.69), mortality attributable to infection (OR=1.42, 95% CI 0.66-3.06) and toxicity (OR=1.25, 95% CI 0.66-2.35). In conclusion, pooled data from the available comparative trials suggest that the ciprofloxacin/metronidazole combination may be superior to beta-lactam-based therapeutic regimens in the treatment of intra-abdominal infections with regard to cure of infections, although no difference in mortality was found.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review

MeSH terms

  • Abdomen*
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / drug therapy*
  • Bacterial Infections / mortality
  • Ciprofloxacin / administration & dosage
  • Ciprofloxacin / adverse effects
  • Ciprofloxacin / therapeutic use*
  • Drug Therapy, Combination
  • Humans
  • Metronidazole / administration & dosage
  • Metronidazole / adverse effects
  • Metronidazole / therapeutic use*
  • PubMed
  • Randomized Controlled Trials as Topic
  • beta-Lactams / administration & dosage
  • beta-Lactams / adverse effects
  • beta-Lactams / therapeutic use*


  • Anti-Bacterial Agents
  • beta-Lactams
  • Metronidazole
  • Ciprofloxacin