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Ampicillin is used to treat many different types of infections caused by bacteria, such as ear infections, bladder infections, pneumonia, gonorrhea, and E. coli or salmonella infection.

Ampicillin sulbactam doses >12 g/d; and an increased rate of adverse clinical events or mortality.26,27 The findings of current study suggest that higher dosages of ciprofloxacin are associated with both higher treatment failure and rates of treatment-related adverse effects. Our secondary analyses did not detect differences in the results of multivariate logistic regression analyses, indicating that it was the primary outcome in this study and that there were no significant differences in outcome. The results of this investigation are largely consistent with past reports of the association between ciprofloxacin and mortality. The majority of recent reports have looked at the association between daily dose of ciprofloxacin and mortality after treatment of diarrhea by antibiotics.12,28–32 The association of mortality with ciprofloxacin was significant, but not always clinically relevant, in a recent series of patients with advanced kidney cancer.25 In a small community-based study of patients receiving ciprofloxacin at doses up to 1200 mg/d, 6.3% or 5% of patients died.8 The association with mortality may not gentamicin vs ampicillin apply to older patients and receiving high doses of ciprofloxacin because the duration mortality effect has not been fully defined. Furthermore, the associations with disease-related mortality are not always as significant. For example, 2- to 3-fold increases in the incidence of death due to noninfectious disorders in the current series were observed among patients taking 10-mg ciprofloxacin/day.8 This increased risk seems to be similar across doses, including 2–15 mg, as demonstrated in our prior studies of the safety 12-g doses ciprofloxacin.16,17 Although one recent study found that patients on ciprofloxacin with diarrhea showed higher rates of clinical adverse events, the association of events with ciprofloxacin was modest, an increased rate of adverse events at 12- and 24-g doses only.33 Thus, the increased rates of adverse events noted in this study do not seem to represent a substantial increase in morbidity caused by these drugs. One of the most frequently cited sources of potential bias in studies with this association is that not all treated patients die of their diarrhea. However, the difference in overall rate of treatment-related adverse events could be due to a difference in study design, although we did not assess that possibility. Another potential source of bias is lack information on the characteristics (e.g., age, sex, renal failure or prior disease) of our patients and those who underwent treatment (e.g., prior drug use). Unfortunately, we were not able to assess these factors, and the majority of analyses included only the treatment group. An increase in the risk associated with ciprofloxacin diarrhea has been reported in other studies,1,4,28,34 but not our study. In the National Cancer Institute's Treatment of the Gastrointestinal System with Antibiotics Treatment Schedules (TACTICS) trial, a group of patients with severe non-alcoholic steatohepatitis (NASH) was administered oral ciprofloxacin (2.6 g, 3 times/mo) and did not experience a significantly higher rate of treatment-related death or hospitalization.35 This increase seemed to be limited patients with non-alcoholic steatohepatitis-induced cholest.

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