Evaluation of Ciprofloxacin in the Treatment of Pseudomonas aeruginosa Infections

Giamarellou, Helen; Galanakis, Nearchos; Dendrinos, C.; Stefanou, J.; Daphnis, Eugene; Daikos, G. K.

doi:10.1007/978-3-663-01930-5_30

Cited by 14 publications

(35 citation statements)

References 8 publications

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“…Therefore, these mutations are not of clinical importance for E. coli. However, during recent years, members of the family Enterobacteriaceae (2,10,16,28,32) and strains of P. aeruginosa (20) with clinical fluoroquinolone resistance (e.g., MIC of ciprofloxacin, >4 to 256 ,ug/ml) were isolated from patients receiving quinolone therapy. Gyrase proteins were isolated from one strain of E. coli (2) and from Serratia marcescens (16) and characterized biochemically.…”

mentioning

confidence: 99%

Use of a broad-host-range gyrA plasmid for genetic characterization of fluoroquinolone-resistant gram-negative bacteria

Heisig

Wiedemann

1991

Antimicrob Agents Chemother

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Mutations in the target enzyme, gyrase, have been found in both gram-negative (12, 37, 52) and gram-positive (27,44) quinolone-resistant bacteria. Mutations in the gyrB locus were identified in two strains of Escherichia coli K-12 (50) and in one isolate of P. aeruginosa (52). All three mutants have low-level resistance to quinolones with incomplete cross-resistance between fluorinated and unfluorinated compounds.gyrA mutants typically show increased MICs of all quinolone drugs (51). However, examination of E. coli isolates with reduced quinolone susceptibilities by determination of the DNA sequences of the respective gyrA genes revealed single-step mutations to be responsible for quinolone resistance (12,37,51

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confidence: 99%

Use of a broad-host-range gyrA plasmid for genetic characterization of fluoroquinolone-resistant gram-negative bacteria

Heisig

Wiedemann

1991

Antimicrob Agents Chemother

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“…Imipenem enhanced killing by ciprofloxacin in tests with 11 strains, whereas amikacin enhanced killing in tests with only 4 strains.Among the newer quinolones, ciprofloxacin has been proved the most effective against members of the family Enterobacteriaceae, with major antipseudomonal properties (1,5,7,9,10,17). However, in certain clinical situations it may be necessary for ciprofloxacin to be administered in combination with other antimicrobial agents, with the aim of expanding its antimicrobial spectrum, preventing the emergence of resistant mutants during therapy, and obtaining synergistic results.…”

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confidence: 99%

Ciprofloxacin interactions with imipenem and amikacin against multiresistant Pseudomonas aeruginosa

Giamarellou¹,

Petrikkos²

1987

Antimicrob Agents Chemother

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In vitro interactions of ciprofloxacin with imipenem and amikacin were evaluated by the killing-curve technique against 26 Pseudomonas aeruginosa strains resistant to amikacin and resistant or moderately susceptible to ciprofloxacin and imipenem. Imipenem enhanced killing by ciprofloxacin in tests with 11 strains, whereas amikacin enhanced killing in tests with only 4 strains.Among the newer quinolones, ciprofloxacin has been proved the most effective against members of the family Enterobacteriaceae, with major antipseudomonal properties (1,5,7,9,10,17). However, in certain clinical situations it may be necessary for ciprofloxacin to be administered in combination with other antimicrobial agents, with the aim of expanding its antimicrobial spectrum, preventing the emergence of resistant mutants during therapy, and obtaining synergistic results.The purpose of this study was to evaluate in vitro the interactions of ciprofloxacin with amikacin and imipenem against multiresistant strains of Pseudomonas aeruginosa. Twenty-six strains, derived from urine (15 strains), sputum (5 strains), pus (4 strains), and blood (2 strains) cultures, were studied. By the disk diffusion method (2), 100% were resistant to ticarcillin, gentamicin, and amikacin, 90 and 70% were resistant to piperacillin and ceftazidime, respectively, 45% were resistant to imipenem, and 70% were resistant to ciprofloxacin. Ciprofloxacin was kindly provided by Bayer AG, Leverkusen, Federal Republic of Germany; amikacin sulfate was provided by Bristol Myers, Syracuse, N.Y.; and imipenem was provided by Merck Sharp & Dohme, Rahway, N.J.MICs and MBCs were determined for ciprofloxacin, amikacin, and impenem by the broth macrodilution technique in volumes of 1 ml. Unsupplemented Mueller-Hinton broth (BBL Microbiology Systems, Cockeysville, Md.) was used, and the inoculum was derived from an overnight culture after adjustment to 5 x 105 CFU/ml. The MIC was defined as the lowest concentration that completely inhibited growth, and the MBC was defined as the lowest concentration which produced .99.9% killing of the inoculum. With susceptibility cutoff points of 2 ,ug/ml for ciprofloxacin and 8 ,g/ml for imipenem and amikacin, 9 strains were moderately susceptible to ciprofloxacin (MIC, 0.5 to 2 ,ug/ml), 12 strains were moderately susceptible to imipenem (MIC, 4 to 8 ,ug/ml), and none was moderately susceptible to amikacin. The ciprofloxacin, imipenem, and amikacin MICs and MBCs for 90% of strains tested were 16 and 128, 32 and 128, and 512 and >512 ,ug/ml, respectively.Interaction studies of ciprofloxacin with imipenem and amikacin were simultaneously performed by time-kill curves (12) with the following modification. The traditional combination of one-quarter the MIC was not applied, because results based on high MICs could not have clinical rele-* Corresponding author.vance. Instead, for strains that were multiresistant or moderately susceptible to ciprofloxacin, killing studies were performed in Mueller-Hinton broth containing concentrations representing the me...

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“…Although a more favourable outcome of combined regimens is still under debate for severe pseudomonal infections such as bacteraemia [7] or pneumonia [7], so far no study could really provide convincing evidence for the benefits of a targeted combined regimen for these infections once the results of the susceptibility testing became available, let alone for osteoarticular infections. Indeed, orthopaedic and infectious diseases studies reporting a dual therapy for P. aeruginosa [13,14] seem to have similar remission incidences than reports with single-agent treatment [15,26]. In one randomised comparative trial, seven cases of biopsy-proven P. aeruginosa osteomyelitis were treated with oral ciprofloxacin, and six patients received a standard parenteral therapy including an aminoglycoside plus an antipseudomonal beta-lactam during six-eight months.…”

Section: Discussionmentioning

confidence: 99%

“…(2) Recurrences of osteomyelitis after several years, if not decades, have been reported [36] and there is no internationally accepted minimal follow-up duration. In the literature, minimal follow-up times range from three [16] to six months [21,25,26] or one [12,22,23] to two years [9,10]. Hence, we consider our individual minimal and median follow-up times of 1.5 and four years as a strong point of our study.…”

Section: Or Longermentioning

confidence: 99%

“…P. aeruginosa accounts for an absolute minority of all osteoarticular pathogens [1], and most reports are either case series involving around 20-30 cases [9][10][11][12][13] or even less [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Moreover, these reports subsume P. aeruginosa under other Gram-negative pathogens [9,12,13,19], including anaerobes [10,28], and lack adjustment for case mix [9,10,19,21].…”

Section: Introductionmentioning

confidence: 99%

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Remission after treatment of osteoarticular infections due to Pseudomonas aeruginosa versus Staphylococcus aureus: a case-controlled study

Seghrouchni

Delden

Dominguez

et al. 2011

International Orthopaedics (SICOT)

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Purpose Osteoarticular infections due to methicillinsusceptible Staphylococcus aureus (MSSA) or its methicillin-resistant variant (MRSA) are feared due to treatment failures. According to clinical experience, Pseudomonas aeruginosa may reveal less long-term remission than S. aureus. Methods A case-controlled study comparing outcomes of osteoarticular infections due to P. aeruginosa vs S. aureus was performed at Geneva University Hospitals. Results A total of 111 S. aureus (including 37 MRSA) and 20 P. aeruginosa osteoarticular infections were analysed in 131 patients: arthroplasties (n=38), fracture fixation devices (n=56), native joint arthritis (n=7) and osteomyelitis without implant (n=30). The median active follow-up time was 4 years. The patients underwent a median number of two surgical interventions for P. aeruginosa infections compared to two for S. aureus (two for MRSA), while the median duration of antibiotic treatment was 87 days for P. aeruginosa and 46 days for S. aureus infections (58 days for MRSA) (all p>0.05). Overall, Pseudomonas-infected patients tended towards a lower remission rate than those infected with S. aureus (12/20 vs 88/111; p=0.06). This was similar when P. aeruginosa was compared with MRSA alone (12/20 vs 30/37; p=0.08). In multivariate logistic regression analyses adjusting for case mix, odds ratios (OR) for remission were as follows: P. aeruginosa vs S. aureus [OR 0.4, 95% confidence interval (CI) 0.1-1.2], number of surgical interventions (OR 0.6, 95% CI 0.5-1.0) and duration of antibiotic treatment (OR 1.0, 95% CI 1.0-1.0). Conclusions Despite a similar number of surgical interventions and longer antibiotic treatment, osteoarticular infections due to P. aeruginosa tended towards a lower remission rate than infections due to S. aureus in general or MRSA in particular.

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Evaluation of Ciprofloxacin in the Treatment of Pseudomonas aeruginosa Infections

Cited by 14 publications

References 8 publications

Use of a broad-host-range gyrA plasmid for genetic characterization of fluoroquinolone-resistant gram-negative bacteria

Use of a broad-host-range gyrA plasmid for genetic characterization of fluoroquinolone-resistant gram-negative bacteria

Ciprofloxacin interactions with imipenem and amikacin against multiresistant Pseudomonas aeruginosa

Remission after treatment of osteoarticular infections due to Pseudomonas aeruginosa versus Staphylococcus aureus: a case-controlled study

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