***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A phase 3 , r and omized , double-blind trial was conducted in subjects with diabetic foot infections without osteomyelitis ( primary study ) or with osteomyelitis ( sub study ) to determine the efficacy and safety of parenteral ( intravenous [ iv ] ) tigecycline ( 150 mg once-daily ) versus 1 g once-daily iv ertapenem ± vancomycin .  Among 944 subjects in the primary study who received ≥1 dose of study drug , > 85 % had type 2 diabetes ; ~90 % had Perfusion , Extent , Depth/tissue loss , Infection , and Sensation infection grade 2 or 3 ; and ~20 % reported prior antibiotic failure . For the clinical ly evaluable population at test-of-cure , 77.5 % of tigecycline- and 82.5 % of ertapenem ± vancomycin-treated subjects were cured . Corresponding rates for the clinical modified intent-to-treat population were 71.4 % and 77.9 % , respectively . Clinical cure rates in the sub study were low ( < 36 % ) for a subset of tigecycline-treated subjects with osteomyelitis . Nausea and vomiting occurred significantly more often after tigecycline treatment ( P = 0.003 and P < 0.001 , respectively ) , result ing in significantly higher discontinuation rates in the primary study ( nausea P = 0.007 , vomiting P < 0.001 ) . In the primary study , tigecycline did not meet criteria for noninferiority compared with ertapenem ± vancomycin in the treatment of subjects with diabetic foot infections Aims /hypothesisThe aim of the present study was to investigate re source utilisation and associated costs in patients with diabetic foot ulcers and to analyse differences in re source utilisation between individuals with or without peripheral arterial disease ( PAD ) and /or infection . Methods Data on re source utilisation were collected prospect ively in a European multicentre study . Data on 1,088 patients were available for the analysis of re source use , and data on 821 patients were included in the costing analysis . Costs were calculated for each patient by multiplying the country-specific direct and indirect unit costs by the number of re sources used from inclusion into the study up to a defined endpoint . Country-specific costs were converted into purchasing power st and ards . Results Re source use and costs varied between outcome groups and between disease severity groups . The highest costs per patient were for hospitalisation , antibiotics , amputations and other surgery . All types of re source utilisation and costs increased with the severity of disease . The total cost per patient was more than four times higher for patients with infection and PAD at inclusion than for patients in the least severe group , who had neither . Conclusions /interpretationImportant differences in re source use and costs were found between different patient groups . The costs are highest for individuals with both peripheral arterial disease and infection , and these are mainly related to substantial costs for hospitalisation . In view of the magnitude of the costs associated with in-hospital stay , reducing the number and duration of hospital admissions seems an attractive option to decrease costs in diabetic foot disease Daptomycin is the first available agent from a new class of antibiotics , the cyclic lipopeptides , that has activity against a broad range of gram-positive pathogens , including organisms that are resistant to methicillin , vancomycin , and other currently available agents . Daptomycin ( 4 mg/kg intravenously [ iv ] every 24 h for 7 - 14 days ) was compared with conventional antibiotics ( penicillinase-resistant penicillins [ 4 - 12 g iv per day ] or vancomycin [ 1 g iv every 12 h ] ) in 2 r and omized , international trials involving 1092 patients with complicated skin and skin-structure infections . Among 902 clinical ly evaluable patients , clinical success rates were 83.4 % and 84.2 % for the daptomycin- and comparator-treated groups , respectively ( 95 % confidence interval , -4.0 to 5.6 ) . Among patients successfully treated with iv daptomycin , 63 % required only 4 - 7 days of therapy , compared with 33 % of comparator-treated patients ( P<.0001 ) . The frequency and distribution of adverse events were similar among both treatment groups . Overall , the safety and efficacy of daptomycin were comparable with conventional therapy BACKGROUND Severe skin and soft-tissue infections ( SSTIs ) , particularly diabetic foot infections , are a source of considerable morbidity and mortality . Inappropriate antimicrobial therapy may contribute to the increasing emergence of bacterial resistance , as well as to increased health care costs . Thus , there is a continuing search for reasonably safe , well-tolerated , and effective antimicrobial agents that are less susceptible to the development of resistance than older agents . OBJECTIVE The Department of Veterans Affairs ( VA ) Medical Center in Nashville , Tennessee , was I site in a multicenter , Phase III , r and omized , investigator-blinded clinical trial comparing the safety and efficacy of clinafloxacin with those of piperacillin/tazobactam in the treatment of adult patients with SSTI . METHODS Over an 18-month period , patients aged > or = 18 years with physical findings of acute bacterial SSTI requiring hospitalization and intravenous antimicrobial therapy were r and omized in a 1:1 ratio to receive either clinafloxacin 200 mg IV every 12 hours or piperacillin/tazobactam 3.375 g IV every 6 hours . After a minimum of 3 days of intravenous therapy , a switch to oral therapy with clinafloxacin 200 mg PO every 12 hours or amoxicillin/clavulanate 500 mg PO every 8 hours could be made in the respective treatment groups . RESULTS The center enrolled 84 patients ( 42 in each group ) , all but I of whom were male , reflecting the typical VA medical center population . The mean age was 60 years ( range , 36 - 80 years ) in the clinafloxacin group and 65 years ( range , 35 - 87 ) in the piperacillin/tazobactam group ; the latter group was significantly older ( P = 0.0482 ) , which could have affected recovery rates . Sixty-six patients were white and 18 were black . The mean ( + /- SD ) duration of treatment was 10.69 + /- 5.34 days in the clinafloxacin group and 12.07 + /- 5.06 days in the piperacillin/tazobactam group ; the mean length of stay was 10.83 + /- 10.28 days and 14.95 + /- 19.20 days , respectively . Fifty-three ( 63 % ) patients were switched to oral therapy ( 21 in the clinafloxacin group , 32 in the piperacillin/tazobactam group ) . The most commonly isolated pathogens were Staphylococcus aureus , Enterococcus faecalis , Pseudomonas aeruginosa , and Enterobacter cloacae . Clinical cure rates and microbiologic eradication rates were similar between the 2 treatments . The piperacillin/ tazobactam arm experienced more all-cause adverse events than the clinafloxacin arm , although the difference was not statistically significant . The clinafloxacin arm experienced significantly more adverse events ( eg , photosensitivity ) that were judged by the investigator to be drug related ( P = 0.034 ) . CONCLUSIONS In this study population of hospitalized adults , clinafloxacin was as effective as piperacillin/tazobactam in the treatment of complicated SSTIs . Appropriate pre caution s must be taken against exposure to sunlight and ultraviolet light in patients receiving clinafloxacin , and adequate monitoring is necessary . Further investigation is necessary into how the phototoxic effects of the flu oroquinolones can be limited This study tested whether levofloxacin , at a new high dose of 750 mg , was effective for the treatment of  complicated skin and skin-structure infections ( SSSIs ) . Patients with complicated SSSIs ( n=399 ) were r and omly assigned in a ratio of 1:1 to 2 treatment arms : levofloxacin ( 750 mg given once per day intravenously [ iv ] , orally , or iv/orally ) or ticarcillin-clavulanate ( TC ; 3.1 g given iv every 4 - 6 hours ) followed , at the investigator 's discretion , by amoxicillin-clavulanate ( AC ; 875 mg given orally every 12 hours ) . In the clinical ly evaluable population , therapeutic equivalence was demonstrated between the levofloxacin and TC/AC regimens ( success rates of 84.1 % and 80.3 % , respectively ) . In the microbiologically evaluable population , the overall rate of eradication was 83.7 % in the levofloxacin treatment group and 71.4 % in the TC/AC treatment group ( 95 % confidence interval , -24.3 to -0.2 ) . Both levofloxacin and TC/AC were well tolerated . These data demonstrate that levofloxacin ( 750 mg once per day ) is safe and at least as effective as TC/AC for complicated SSSIs Objectives The primary aim of the RELIEF study was to evaluate the efficacy and safety of two sequential intravenous (iv)/oral regimens : moxifloxacin iv/oral versus piperacillin/tazobactam ( TZP ) iv followed by oral amoxicillin/clavulanate ( AMC ) . Patients and methods The study had a prospect i ve , r and omized , double-dummy , double-blind , multicentre design . Patients ≥18 years were prospect ively stratified according to complicated skin and skin structure infection ( cSSSI ) subtype/diagnosis ( major abscess , diabetic foot infection , wound infection or infected ischaemic ulcer ) , surgical intervention and severity of illness . Diagnoses and disease severity were based on predetermined criteria , documented by repeated photographs , and confirmed by an independent data review committee . Patients were r and omized to receive either 400 mg of moxifloxacin iv once daily followed by 400 mg of moxifloxacin orally once daily or 4.0/0.5 g of TZP iv thrice daily followed by 875/125 mg of AMC orally twice daily for 7–21 days . The primary efficacy variable was clinical response at test of cure ( TOC ) for the per- protocol ( PP ) population . Clinical efficacy was assessed by the data review committee based on repeated photographs and case descriptions . Clinical trials registry number : NCT 00402727 . Results A total of 813 patients were r and omized . Clinical success rates at TOC were similar for moxifloxacin and TZP – AMC in the PP [ 320/361 ( 88.6 % ) versus 275/307 ( 89.6 % ) , respectively ; P = 0.758 ] and intent-to-treat ( ITT ) [ 350/426 ( 82.2 % ) versus 305/377 ( 80.9 % ) , respectively ; P = 0.632 ] population s. Thus , moxifloxacin was non-inferior to TZP  –  AMC . Bacteriological success rates were high in both treatment arms [ moxifloxacin : 432/497 ( 86.9 % ) versus TZP – AMC : 370/429 ( 86.2 % ) , microbiologically valid ( MBV ) population ] . Moxifloxacin was non-inferior to TZP – AMC at TOC in both the MBV and the ITT population s. Both treatments were well tolerated . Conclusions Once-daily iv/oral moxifloxacin monotherapy was clinical ly and bacteriologically non-inferior to iv TZP thrice daily followed by oral AMC twice daily in patients with cSSSIs Background In the United Kingdom ( UK ) , there is an extensive market for the class ' A ' drug heroin . Many heroin users spend time in prison . People addicted to heroin often require prescribed medication when attempting to cease their drug use . The most commonly used detoxification agents in UK prisons are buprenorphine , dihydrocodeine and methadone . However , national guidelines do not state a detoxification drug of choice . Indeed , there is a paucity of research evaluating the most effective treatment for opiate detoxification in prisons . This study seeks to address the paucity by evaluating routinely used interventions amongst drug using prisoners within UK prisons . Methods / Design The Leeds Evaluation of Efficacy of Detoxification Study ( LEEDS ) Prisons Pilot Study will use r and omised controlled trial methodology to compare the open use of buprenorphine and dihydrocodeine for opiate detoxification , given in the context of routine care , within HMP Leeds . Prisoners who are eligible and give informed consent will be entered into the trial . The primary outcome measure will be abstinence status at five days post detoxification , as determined by a urine test . Secondary outcomes during the detoxification and then at one , three and six months post detoxification will be recorded The management of infectious  diabetic foot ulcers 
    Output:
    
Consequently it is not clear if any one systemic antibiotic treatment is better than others in resolving infection or in terms of safety .