Ciprofloxacin absorption is impaired in patients given enteral feedings orally and via gastrostomy and jejunostomy tubes

Abstract

Twenty-six hospitalized patients participated in a randomized crossover study to evaluate the effect of enteral feedings on ciprofloxacin absorption when given orally or via gastrostomy or jejunostomy tubes. Patients in the oral group received an intact 500-mg ciprofloxacin tablet alone or ciprofloxacin plus three oral doses of Sustacal (240 ml given 8 h before, with, and 4 h after ciprofloxacin administration). Patients with gastrostomy or jejunostomy tubes received 500 mg of crushed ciprofloxacin in 60 ml water via the feeding tube. After a washout period, the patients received ciprofloxacin with a continuous enteral formula (Jevity) given at 60 to 90 ml/h beginning 6 h before drug administration and continuing for 10 h. Serial blood samples were analyzed for ciprofloxacin concentration by high-performance liquid chromatography. The maximum ciprofloxacin concentrations in serum for ciprofloxacin given and for ciprofloxacin plus enteral feeding for the oral, gastrostomy, and jejunostomy groups were (mean +/- standard deviation) 2.59 +/- 1.24 versus 1.43 +/- 0.61 micrograms/ml (P < 0.05), 3.68 +/- 1.36 versus 2.27 +/- 0.67 micrograms/ml (P < 0.05), and 3.78 +/- 1.87 versus 1.45 +/- 0.48 micrograms/ml (P < 0.05), respectively. Corresponding values for area under the concentration-time curve were 13.4 +/- 8.32 versus 9.44 +/- 4.74 micrograms/h/ml (P < 0.05) 15.9 +/- 6.62 versus 7.44 +/- 3.16 (micrograms/h/ml (P < 0.05), and 18.1 +/- 9.37 versus 5.82 +/- 2.63 micrograms.h/ml (P < 0.05). We conclude that enteral feedings given orally or via gastrostomy or jejunostomy tubes resulted in a 27 to 67% reduction in the mean bioavailability of ciprofloxacin in hospitalized patients. The decreased absorption may be clinically important, especially when the enteral feeding is coadministered with ciprofloxacin by the oral and jejunostomy tube routes. Reductions in maximum levels of ciprofloxacin in serum as a result of feedings given via a gastrostomy tube are similar to those following oral administration on an empty stomach, making a clinically important interaction by this route less likely.

Pharmacokinetic Drug Interactions of Antimicrobial Drugs: A Systematic Review on Oxazolidinones, Rifamycines, Macrolides, Fluoroquinolones, and Beta-Lactams

“…Enteral feeding reduced the C max and AUC of CIP, depending on the method of administration, i.e. , orally (by 43% and 27% respectively), through gastrostomy tubes (by 37% and 53% respectively), or through jejunostomy (by 59% and 67% respectively) [239,240]. Both C max and AUC of CIP were reduced by approximately 20% when co-administered with orange juice and by approximately 40% in case of concomitant treatment with calcium-fortified orange juice [241].…”

Impact of direct drug delivery via gastric access devices

“…The binding of cations found in feeds such as magnesium, calcium or iron to drug compounds can impair both their absorption and efficacy. These findings of reduced efficacy have been seen in studies evaluating ciprofloxacin, tetracyclines and phenytoin [48][49][50][51][52]. Warfarin is another important medication that can be influenced by enteral formulas.…”

Roundtable Discussion of Antibiotic Therapy in Surgical Infections

“…There are very strong data for ciprofloxacin admixed with enteral feedings. With ciprofloxacin, the bioavailability drops to about one-half to two-thirds when admixed with a tube feeding (23). You then need a 750-mg dose rather than 500 mg.…”