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

Abstract

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...

Absolute Bioavailability and Pharmacokinetics of Linezolid in Hospitalized Patients Given Enteral Feedings

“…The sample size was estimated to provide 80% power to detect a 35% difference in bioavailability of oral linezolid between patients receiving continuous EF and controls (␣ ϭ 0.05; two-tailed), assuming 100% bioavailability in the control subjects with a coefficient of variation of 20% (18). The percent difference in bioavailability of 35% was deemed clinically significant and is similar in magnitude to the difference observed with other antibiotics when administered with continuous enteral feedings in hospitalized patients (4,10).…”

Quinolones

“…Concurrent administration of Ensure ® enteral feeding significantly reduced single-dose ciprofloxacin and ofloxacin bioavailability as assessed using C max (mean −47 and −36%, respectively) and AUC (mean −27 and −10%, respectively) data. However, the extent of the interaction was significantly greater for ciprofloxacin than for ofloxacin [109].…”

The bioavailability of bromazepam, omeprazole and paracetamol given by nasogastric feeding tube

“…Antibacterial quinolones, such as ciprofloxacine and ofloxacine, are well absorbed orally, a fact suggesting a similar behaviour following administration by nasogastric tube. Yet a decreased absorption following administration by the latter route was demonstrated for ciprofloxacine and ofloxacine [18]. Another study also found significant losses for ciprofloxacine, ofloxacine and levofloxacine when these were mixed with an enteral feeding formulation [19], suggesting that the phenomenon was a characteristic of this whole class of drugs.…”