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. 2015 Sep 4;2015(9):CD009061. doi: 10.1002/14651858.CD009061.pub2

Lipsky 1997.

Methods Design: randomised controlled trial, multicentre (12 centres), national (USA)
Follow‐up period: not described
Participants N: 180 participants randomised
Age (mean (range)): 61.5 years (31‐90)
Sex (%men): 84%
Inclusion criteria: ≥18 years; diabetes mellitus; foot infection requiring antibiotic therapy; purulent drainage or erythema or swelling
Exclusion criteria: osteomyelitis if all of the infected bone was not to be removed soon; presence of micro‐organisms resistant to the study drugs; underweight; seizures; major psychiatric disorder; pregnancy or lactation; renal replacement therapy; poor prognosis; antibiotic 48 h before study; antibiotic for any other reason; allergy to study drugs
Interventions Intervention (n = 55): ofloxacin 400 mg iv every 12 h. Changed when appropriate to ofloxacin 400 mg po every 12 h
Control (n = 53): ampicillin‐sulbactam 1‐2 g/0.5‐1 g iv every 6 h (initial dose depended on severity). Switched to amoxicillin‐clavulanate 500 mg/125 mg po every 8 h when appropriate
Co‐interventions: wound care; additional antibiotic could be added if participant did not respond: in Intervention Group metronidazole added (n = 5); in Control Group, gentamicin, trimethoprim‐sulfamethoxazole or another (n = 42)
Treatment duration: 14‐28 days
Outcomes
  • Clinical response

  • Microbiological response

  • Adverse events

  • Superinfection

Notes Funding source: Department of Veterans Affairs and the Robert Wood Johnson Pharmaceutical Research Institute
Other: no sample size calculation
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Described as randomised but the sequence generation was not described
Allocation concealment (selection bias) Unclear risk No information reported
Incomplete outcome data (attrition bias) 
 All outcomes High risk 19% of participants excluded with no balanced reasons. No ITT analyses
Selective reporting (reporting bias) Unclear risk No data on superinfection. Author contacted and no data available
Other bias Unclear risk N/A
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Initial dose of ampicillin‐ofloxacin chosen by investigator
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk No information reported