Absorption of ciprofloxacin administered through a nasogastric or a nasoduodenal tube in volunteers and patients receiving enteral nutrition

Yuk, Jae H.; Nightingale, Charles H.; Quintiliani, Richard; Yeston, Neil S.; Orlando, Rocco; Dobkin, Eric D.; Kambe, Joseph C.; Sweeney, Kevin; Buonpane, Elizabeth A.

doi:10.1016/0732-8893(90)90092-a

Cited by 29 publications

(14 citation statements)

References 14 publications

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“…This procedure was used to mimic the usual preparation and administration of a dose by nursing staff for a patient receiving enteral nutrition through a feeding tube. This simulation adequately duplicates the clinical situation, because previous investigations into fluoroquinolone administration via feeding tubes have not suggested that these antibiotics bind to the tubing (5,24,47).…”

Section: Resultsmentioning

confidence: 98%

“…Yuk et al (48) reported no difference in the oral bioavailability of ciprofloxacin when it was given with water and when it was given as a crushed tablet administered with an enteral feed (Osmolite) via a nasogastric tube in six healthy volunteers. In a follow-up study (47) those same investigators administered ciprofloxacin to ICU patients receiving enteral feedings. They noted that ciprofloxacin absorption was impaired when the drug was administered via a nasogastric or gastric tube in comparison with that when it was administered via a nasoduodenal tube.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Effect of enteral feeding with ensure on oral bioavailabilities of ofloxacin and ciprofloxacin

Mueller

Brierton

Abel

et al. 1994

Antimicrob Agents Chemother

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The relative oral bioavailabilities of ciprofloxacin and ofloxacin when they were coadministered with water or an enteral feeding product (Ensure) were assessed in 13 healthy volunteers. The area under the concentration time curve from time zero to infinity and the maximum concentration of drug in serum for both drugs were reduced by Ensure in comparison with those by water (P < 0.01). However, Ensure reduced the percent relative bioavailability of ciprofloxacin (72% ± 14%; range, 52 to 96%) significantly more than ofloxacin (90% ± 8.3%; range, 74 to 105%) (P < 0.005). Coadministration of Ensure significantly diminished ciprofloxacin and ofloxacin absorption, but ciprofloxacin absorption was reduced significantly more than ofloxacin absorption.Fluoroquinolone antibiotics represent an important therapeutic advance in the treatment of bacterial infections. The beneficial characteristics of these agents include unique spectra of antimicrobial activity, favorable side effect profiles, and the advantages of both oral and parenteral routes of administration. Many serious infections which previously could be treated only with parenteral drugs can now be treated with an oral fluoroquinolone. The availability of oral fluoroquinolones has allowed more patients to be treated as outpatients and has expanded the use of oral antibiotics to the nursing home and critical care setting (49) to reduce drug costs (12,31,37).The oral bioavailabilities of fluoroquinolone antibiotics may be affected adversely by interactions with divalent cations (1,22,35,39,41). Divalent cations contribute to the clinically important interactions of fluoroquinolone antibiotics with food (9,15,16,18,19,27,42,43,45), vitamins with iron (4, 17, 36), antacids (8,14,21,28,40,41), and sucralfate (10,32,44). Of the two most studied fluoroquinolones, ciprofloxacin absorption appears to be affected more than ofloxacin absorption (6,15,26).The reduced bioavailabilities of oral fluoroquinolone antibiotics because of drug interactions may be important, particularly in the critical care setting, because therapeutic failures have been reported (30,38). The practice of using the enteral rather than the parenteral route to provide nutrition is becoming more common in intensive care units (ICUs) Because of the increasingly common practices of using oral fluoroquinolones and enteral feedings in ICU and nursing home settings, many patients may receive both of these therapies concurrently (23). We conducted a study to assess the influence that concomitant enteral feeding with an enteral feeding product (Ensure) has on the absorption of oral ciprofloxacin and ofloxacin. MATERIALS AND METHODSProtocol. Thirteen healthy adults gave informed consent and were enrolled in the study. Subjects were excluded if they were pregnant or were intending to become pregnant within 30 days of the conclusion of the study. Other exclusion criteria included breastfeeding at the time of the study and use of any medications during the 24 h prior to the study periods. Any known allergies to t...

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Effect of enteral feeding with ensure on oral bioavailabilities of ofloxacin and ciprofloxacin

Mueller

Brierton

Abel

et al. 1994

Antimicrob Agents Chemother

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“…Absorption of ciprofloxacin may be more favourable in the duodenum, which may affect the AUC. 7 However, it has also been reported that ciprofloxacin is absorbed well in the upper gastrointestinal tract, with greater absorption in the stomach and duodenum than in the jejunum; as such, as long as the enteral tube is not placed beyond the jejunum, placement may not be clinically important.…”

Section: Discussionmentioning

confidence: 99%

“…The remaining 8 studies were subjected to a full-text review because the abstracts did not provide sufficient information to assess whether they met the inclusion criteria. One additional trial, by Yuk and others, 7 was identified by handsearching the reference list in the report by Mimoz and others. 5 After review, 7 of the 8 studies were excluded.…”

Section: Resultsmentioning

confidence: 99%

Clinical Equivalency of Ciprofloxacin 750 mg Enterally and 400 mg Intravenously for Patients Receiving Enteral Feeding: Systematic Review

Chui

Cheng

Tejani

2009

CJHP

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Background: Concomitant enteral administration of ciprofloxacin with products containing magnesium, aluminum, and calcium (e.g., as enteral feeds) decreases the oral bioavailability of this antibiotic. The manufacturer currently recommends holding enteral feeds for a total of 8 h after ciprofloxacin is given, but this is not feasible for patients who are receiving continuous enteral feeding. A previous study demonstrated that a higher dose of oral ciprofloxacin (750 mg BID) may compensate for the reduced bioavailability associated with this drug-food interaction, allowing adequate concentrations for effective bactericidal activity.

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“…An example of this is seen wi th ci pro fl o xacin where healthy volunteers absorb up to 40% of an oral do se in the duodenum ( 44 ). Administration of ciprofloxacin into the duodenum results in better absorption than delivery into the stomach in both healthy volunteers and patients in intensive care units ( 45 ). Jejunal administration results in lower serum concentrations than those found after oral administration ( 46,47).…”

Section: The Absorptive Environmentmentioning

confidence: 99%

Drug-Nutrient Interactions in Patients Receiving Enteral Nutrition

Rollins¹

2004

Handbook of Drug-Nutrient Interactions

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Absorption of ciprofloxacin administered through a nasogastric or a nasoduodenal tube in volunteers and patients receiving enteral nutrition

Cited by 29 publications

References 14 publications

Effect of enteral feeding with ensure on oral bioavailabilities of ofloxacin and ciprofloxacin

Effect of enteral feeding with ensure on oral bioavailabilities of ofloxacin and ciprofloxacin

Clinical Equivalency of Ciprofloxacin 750 mg Enterally and 400 mg Intravenously for Patients Receiving Enteral Feeding: Systematic Review

Drug-Nutrient Interactions in Patients Receiving Enteral Nutrition

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