Comparison of ciprofloxacin with azlocillin plus tobramycin in the therapy of experimental Pseudomonas aeruginosa endocarditis

Strunk, R W; Gratz, Jean; Maserati, Renato; Scheld, W. Michael

doi:10.1128/aac.28.3.428

Cited by 32 publications

(10 citation statements)

References 21 publications

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“…120, 1984). Additionally, results of studies in animals suggest the efficacy of ciprofloxacin in a variety of infections caused by P. aeruginosa, although it must be noted that it is extremely difficult to duplicate human pharmacokinetics in animal models (7,12,22). The importance of these factors in disease outcome in patients at this time is unclear.…”

Section: Discussionmentioning

confidence: 99%

Bactericidal activity of ciprofloxacin compared with that of cefotaxime in normal volunteers

Standiford¹,

Drusano²,

Forrest³

et al. 1987

Antimicrob Agents Chemother

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We compared ciprofloxacin (200 mg) with cefotaxime (2 g) when each was administered intravenously over a 30-min period to six volunteers in a crossover manner 1 week apart. To integrate the pharmacologic and microbiologic activity, inhibitory and bactericidal activities in serum were obtained for both antibiotics 1 and 6 h after administration against 10 strains of Escherichia coli, 10 strains of Klebsiella pneumoniae, 15 strains of Pseudomonas aeruginosa, and 10 strains each of methicillin-susceptible and -resistant Staphylococcus aureus. Geometric mean bactericidal titers for E. coli 1 h after the infusion were 1:60 for ciprofloxacin and 1:252 for cefotaxime, and for K. pneumoniae they were 1:20 and 1:256, respectively. However, geometric mean titers were poor for both antibiotics against methicillin-susceptible S. aureus (<1:2 for ciprofloxacin versus 1:5 for cefotaxime) and methicillin-resistant S. aureus (<1:2 for both antibiotics), as well as against P. aeruginosa (1:3 for ciprofloxacin versus 1:2 for cefotaxime). These data suggest that ciprofloxacin may be useful for the treatment of serious infections caused by E. coli and K. pneumoniae. However, caution is suggested when this dose of ciprofloxacin is used in situations in which septicemia is caused by P. aeruginosa or S. aureus and originates outside the urinary tract.Ciprofloxacin is a new quinoline carboxylic acid which can be administered orally or intravenously. Results of previous microbiologic studies have shown that this compound has a broad spectrum of activity, encompassing members of the family Enterobacteriaceae, Pseudomonas aeruginosa, and methicillin-susceptible and -resistant Staphylococcus aureus (1,4,5). This suggests that it has the potential for singleagent therapy for serious bacterial infections. Therefore, to test this potential prior to clinical trials, we compared the bactericidal activity of ciprofloxacin in serum with that of a control regimen, cefotaxime, after each was administered intravenously to normal volunteers. Determination of the bactericidal activity in serum is a method used to integrate the microbiologic activity with many of the pharmacologic characteristics of the antibiotic, including the effect of the metabolites, and has been used in previous studies to compare experimental regimens with standards (10, 19-21). Additionally, in some studies it has been shown that there is a correlation between clinical effectiveness and bactericidal activity in serum, as performed by the Stratton-Reller technique, the method that was used in this evaluation (17, 21, 25). MATERIALS AND METHODSVolunteer studies. Six normal male volunteers (age, 21 to 35 years; weight, 74 to 90 kg), who were fully informed before the study, received ciprofloxacin and cefotaxime in a randomized crossover manner, with at least 6 days elapsing between each drug administration. Ciprofloxacin (200 mg) or cefotaxime (2 g) was infused intravenously via a Harvard Pump (Harvard Apparatus, Inc.) over 30 min. Blood was obtained for the serum inhibitory and b...

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Section: Discussionmentioning

confidence: 99%

Bactericidal activity of ciprofloxacin compared with that of cefotaxime in normal volunteers

Standiford¹,

Drusano²,

Forrest³

et al. 1987

Antimicrob Agents Chemother

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“…Ciprofloxacin was, however, significantly less effective than penicillin, alone or in combination with gentamicin, for experimental enterococcal infection (219 (741) or netilmicin (37). In each study, ciprofloxacin was comparable to (741) or better than (37, 38) the comparison agent, although in the study with ceftazidime (38) the bacterial strain used was selected to be ceftazidime resistant.…”

Section: Respiratory Tract Infectionsmentioning

confidence: 99%

Fluoroquinolone antimicrobial agents

1989

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The fluoroquinolones, a new class of potent orally absorbed antimicrobial agents, are reviewed, considering structure, mechanisms of action and resistance, spectrum, variables affecting activity in vitro, pharmacokinetic properties, clinical efficacy, emergence of resistance, and tolerability. The primary bacterial target is the enzyme deoxyribonucleic acid gyrase. Bacterial resistance occurs by chromosomal mutations altering deoxyribonucleic acid gyrase and decreasing drug permeation. The drugs are bactericidal and potent in vitro against members of the family Enterobacteriaceae, Haemophilus spp., and Neisseria spp., have good activity against Pseudomonas aeruginosa and staphylococci, and (with several exceptions) are less potent against streptococci and have fair to poor activity against anaerobic species. Potency in vitro decreases in the presence of low pH, magnesium ions, or urine but is little affected by different media, increased inoculum, or serum. The effects of the drugs in combination with a beta-lactam or aminoglycoside are often additive, occasionally synergistic, and rarely antagonistic. The agents are orally absorbed, require at most twice-daily dosing, and achieve high concentrations in urine, feces, and kidney and good concentrations in lung, bone, prostate, and other tissues. The drugs are efficacious in treatment of a variety of bacterial infections, including uncomplicated and complicated urinary tract infections, bacterial gastroenteritis, and gonorrhea, and show promise for therapy of prostatitis, respiratory tract infections, osteomyelitis, and cutaneous infections, particularly when caused by aerobic gram-negative bacilli. Fluoroquinolones have also proved to be efficacious for prophylaxis against travelers' diarrhea and infection with gram-negative bacilli in neutropenic patients. The drugs are effective in eliminating carriage of Neisseria meningitidis. Patient tolerability appears acceptable, with gastrointestinal or central nervous system toxicities occurring most commonly, but only rarely necessitating discontinuance of therapy. In 17 of 18 prospective, randomized, double-blind comparisons with another agent or placebo, fluoroquinolones were tolerated as well as or better than the comparison regimen. Bacterial resistance has been uncommonly documented but occurs, most notably with P. aeruginosa and Staphylococcus aureus and occasionally other species for which the therapeutic ratio is less favorable. Fluoroquinolones offer an efficacious, well-tolerated, and cost-effective alternative to parenteral therapies of selected infections.

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“…In other studies, ciprofloxacin (another new quinolone antimicrobial agent) administered parenterally was effective for the treatment of experimental Pseudomonas aeruginosa endocarditis and chronic osteomyelitis (5,8,9). The unique aspect of the present study was the demonstration that the oral administration of quinolone antimicrobial agents (difloxacin and enoxacin) was effective in reducing bacterial counts of vegetations in E. aerogenes endocarditis in rabbits.…”

mentioning

confidence: 70%

Comparison of difloxacin, enoxacin, and cefoperazone for treatment of experimental Enterobacter aerogenes endocarditis

Boscia¹,

Kobasa²,

Kaye³

1987

Antimicrob Agents Chemother

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This study compared difloxacin administered orally, enoxacin administered orally, and cefoperazone administered intramuscularly for the treatment of experimental Enterobacter aerogenes endocarditis. Difloxacin significantly reduced bacterial counts of vegetations, as compared with enoxacin and cefoperazone. Enoxacin and cefoperazone did not differ significantly. This study demonstrated that difloxacin Was significantly more effective than enoxacin and cefoperazone for the treatment of E. aerogenes endocarditis in rabbits.The development of oral antimicrobial agents with activity against resistant aerobic gram-negative bacilli will represent a major breakthrough in the treatment of deep-seated infections caused by these bacteria. The endocarditis model in rabbits is a severe test of the efficacy of antimicrobial agents for deep-seated infections. The purpose of this study was to compare the therapeutic efficacies of difloxacin administered orally, enoxacin administered orally, and cefoperazone administered intramuscularly for the treatment of experimental Enterobacter aerogenes endocarditis.

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Comparison of ciprofloxacin with azlocillin plus tobramycin in the therapy of experimental Pseudomonas aeruginosa endocarditis

Cited by 32 publications

References 21 publications

Bactericidal activity of ciprofloxacin compared with that of cefotaxime in normal volunteers

Bactericidal activity of ciprofloxacin compared with that of cefotaxime in normal volunteers

Fluoroquinolone antimicrobial agents

Comparison of difloxacin, enoxacin, and cefoperazone for treatment of experimental Enterobacter aerogenes endocarditis

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