Concentration of ciprofloxacin in human serum, lung and pleural tissues and fluids during and after lung surgery

Hopf, G; Böcker, R; Estler, C.‐J.; Radtke, Hans-Georg; Floh, W

doi:10.1007/bf01646928

Cited by 23 publications

(5 citation statements)

References 7 publications

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“…20 In particular, ciprofloxacin has been shown to have excellent penetration into saliva, sputum, bronchial secretions and lung tissue. [21][22][23][24][25][26] Other studies have demonstrated high concentrations of ciprofloxacin in skin tissues and structures. 27 As such, the clinical and bacteriological success seen with ciprofloxacin monotherapy in this study may be attributed to its superior tissue to serum ratios when compared with therapy with a β-lactam and/or aminoglycoside regimen.…”

Section: Discussionmentioning

confidence: 99%

Intravenous and oral mono- or combination-therapy in the treatment of severe infections: ciprofloxacin versus standard antibiotic therapy

Krumpe¹,

Cohn

Garreltes

et al. 1999

Journal of Antimicrobial Chemotherapy

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Five hundred and forty patients with severe infection were enrolled in a multicentre, prospective, randomized, non-blinded study to compare the efficacy and safety of i.v. ciprofloxacin with i.v. standard therapy. Five hundred and thirty-one patients received at least one dose of study drug for pneumonia (310), septicaemia (112) or skin and skin structure infection (109). Intravenous ciprofloxacin (400 mg, every 8 h) or i.v. ciprofloxacin (400 mg, every 8 h) plus a beta-lactam were compared with a standard monotherapy (beta-lactam) or combination (aminoglycoside plus a beta-lactam) therapy. Patients were treated parenterally for a minimum of 2 or 3 days, then at the discretion of the investigator could be switched to oral therapy (ciprofloxacin 750 mg, every 12 h or a standard oral therapy). Patients were randomized in the ratio of 2:1 for the ciprofloxacin and standard therapy treatment groups and stratified to monotherapy if the APACHE II score was < or = 20 or to combination therapy if the APACHE II score was 21-29. Three hundred and ninety-five (74%) patients were valid for the efficacy analysis: these comprised 242 pneumonia (167 ciprofloxacin and 75 standard therapy), 70 septicaemia (47 ciprofloxacin and 23 standard therapy), and 83 skin infections (56 ciprofloxacin and 27 standard). The primary efficacy variable was clinical response and the secondary efficacy assessment was bacteriological response at the end of therapy (2 or 3 days after treatment). The mean duration of therapy for patients receiving only i.v. monotherapy or combination therapy was shorter (9-10 days) than for patients receiving sequential i.v./p.o. therapy (14-17 days). At the end of therapy, overall clinical resolution/improvement (success) for monotherapy was 138/166 (83%) for the ciprofloxacin group, compared with 74/87 (85%) for standard-treated patients (95% CI = -11.5% to 7.6%), and for combination therapy the response was 43/51 (84%) for the ciprofloxacin group and 14/20 (70%) for standard-treated patients (95% CI = -6.3% to 34.9%). For pneumonia, the most frequent infection treated, clinical success rates following monotherapy were 85% for ciprofloxacin and 83% for standard-treated patients and 83% for ciprofloxacin compared with 69% for standard-treated patients in the combination therapy group. Bacteriological eradication/presumed eradication following monotherapy was 85/102 (83%) for ciprofloxacin and 31/46 (67%) for standard-treated patients (95% CI = 1.6% to 30.3%), and that for combination therapy was 29/36 (81%) for ciprofloxacin and 7/10 (70%) for standard-treated patients (95% CI = -18.3% to 39.5%). Drug-related adverse events, primarily diarrhoea and nausea, were reported in 22% of ciprofloxacin-treated patients and 20% of standard-treated patients. In summary, ciprofloxacin administered alone or in combination was found to be effective in treating a wide range of severe infections.

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Section: Discussionmentioning

confidence: 99%

Intravenous and oral mono- or combination-therapy in the treatment of severe infections: ciprofloxacin versus standard antibiotic therapy

Krumpe¹,

Cohn

Garreltes

et al. 1999

Journal of Antimicrobial Chemotherapy

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“…Concentrations in bronchial secretions were 20 to 100% of peak serum concentrations for ciprofloxacin (45, 49), ofloxacin (753), pefloxacin (476), and enoxacin (145,237,835), while concentrations in lung tissue were higher than those in serum, in the 1.6-to 3.5-fold range for ciprofloxacin (368,673), ofloxacin (834), enoxacin (835), and, for bronchial mucosa, fleroxacin (852).…”

Section: Pharmacokinetic Properties In Healthy Personsmentioning

confidence: 98%

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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“…The present study focused on ciprofloxacin penetration into bronchial secretions collected from mechanically ventilated patients in intensive care units with a diagnosis of nosocomially acquired pneumonia. Determination of antibiotic penetration into bronchial secretions is usually based on calculation of the B/S ratio at the time of the maximum concentration of drug in bronchial secretions (4,14). However, this simple method reflects only the quantity of drug present at a given time.…”

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confidence: 99%

Penetration of ciprofloxacin into bronchial secretions from mechanically ventilated patients with nosocomial bronchopneumonia

Saux

Martin

Mallet

et al. 1994

Antimicrob Agents Chemother

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The aim of the study was to evaluate the penetration of ciprofloxacin into bronchial secretions from mechanically ventilated patients with nosocomial bronchopneumonia. For this purpose, in each patient studied, simultaneous serial blood and bronchial secretion samples were obtained over a 12-h period on days 2 and 4. Eight patients were included in the study. Ciprofloxacin was given at a dose of 200 mg over 30 min by using an automatic pump. Ciprofloxacin was measured by high-performance liquid chromatography. Peak levels of drug in serum were 2.95 ± 1 mg/liter on day 2 and 2.43 ± 0.7 mg/liter on day 4. Peak and trough levels in bronchial secretions were 0.95 ± 0.51 and 0.21 ± 0.12 mg/liter, respectively, on day 2 and 0.76 ± 0.17 and 0.18 ± 0.14 mg/liter, respectively, on day 4. The ratios of peak concentrations in bronchial secretions/serum were 0.32 ± 0.11 and 0.33 ± 0.06 on days 2 and 4, respectively. The ratios of the area under the concentration-time curve from 0 to 12 h (AUC1_12) for bronchial secretions/those for serum were 0.66 ± 0.40 and 0.55 ± 0.30 on days 2 and 4, respectively. A significant positive correlation was found on day 4 between the AUCO_12 for serum and the AUCo_12 for bronchial secretions. No significant correlations were found between peak values in serum and bronchial secretions.Ciprofloxacin is a fluoroquinolone with a broad spectrum of activity, including activity against staphylococci and gramnegative bacteria, including most members of the family Enterobacteriaceae and Pseudomonas aeruginosa (1,22). Weaker activity against gram-positive cocci other than staphylococci has also been reported. These bacteriological aspects make this antibiotic of interest for the treatment of nosocomial bronchopneumonia (23). Bronchial tree colonization by pathogens coming from the patient's oropharynx and secondary bronchial tree infection are the main pathogenic mechanisms of nosocomial bronchopneumonia acquired by intubated patients under mechanical ventilation (16,19). Therefore, it is of interest to determine the degree of penetration of ciprofloxacin into bronchial secretions when this drug is used to treat nosocomial pulmonary infections. Penetration of ciprofloxacin has been studied in patients with cystic fibrosis or acute exacerbation of chronic bronchitis (5,6,8,10,12,17,24 following diagnostic criteria: purulent sputum; body temperature, .38.50C; leukocyte count, .12,000/mm3; new or progressive infiltrate on chest X ray; hypoxia which required the use of positive end-expiratory pressure or an increase in fraction inspiratory oxygen concentration; no other site of infection; and growth of a pathogenic bacterium on a protected specimen brush or bronchoalveolar lavage specimens. The pathogens that were isolated were P. aeruginosa (six patients), Enterobacter aerogenes (one patient), and Klebsiella pneumoniae (1 patient). Five patients had a mild impairment of their renal function, with a creatinine clearances of between 60 and 70 ml/min/1.74 M2. The other three patients had creatinine clearance...

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Concentration of ciprofloxacin in human serum, lung and pleural tissues and fluids during and after lung surgery

Cited by 23 publications

References 7 publications

Intravenous and oral mono- or combination-therapy in the treatment of severe infections: ciprofloxacin versus standard antibiotic therapy

Intravenous and oral mono- or combination-therapy in the treatment of severe infections: ciprofloxacin versus standard antibiotic therapy

Fluoroquinolone antimicrobial agents

Penetration of ciprofloxacin into bronchial secretions from mechanically ventilated patients with nosocomial bronchopneumonia

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