Pharmacokinetics of ciprofloxacin in peripheral lymph and skin blisters

Bergan, Tom; Engeset, A; Olszewski, Waldemar L.; Ostby, N; Solberg, Rita

doi:10.1007/bf02075709

Cited by 11 publications

(3 citation statements)

References 8 publications

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“…This discrepancy between in vivo and in vitro findings may be related to differences in the antibiotics’ distribution within the body. Ciprofloxacin is known to distribute extra- and intracellularly (especially within macrophages and polymorphonuclear cells), whereas the aminoglycosides are restricted to the extracellular space [25]–[27]. Although Y. pestis predominantly multiplies during infection as aggregates of extracellular bacteria, it can also replicate within host cells (such as macrophages).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Ciprofloxacin-Gentamicin Combination Therapy in Murine Bubonic Plague

et al. 2012

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Potential benefits of combination antibiotic therapy for the treatment of plague have never been evaluated. We compared the efficacy of a ciprofloxacin (CIN) and gentamicin (GEN) combination therapy with that of each antibiotic administered alone (i) against Yersinia pestis in vitro and (ii) in a mouse model of bubonic plague in which animals were intravenously injected with antibiotics for five days, starting at two different times after infection (44 h and 56 h). In vitro, the CIN+GEN combination was synergistic at 0.5x the individual drugs’ MICs and indifferent at 1x- or 2x MIC. In vivo, the survival rate for mice treated with CIN+GEN was similar to that observed with CIN alone and slightly higher than that observed for GEN alone 100, 100 and 85%, respectively when treatment was started 44 h post challenge. 100% of survivors were recorded in the CIN+GEN group vs 86 and 83% in the CIN and GEN groups, respectively when treatment was delayed to 56 h post-challenge. However, these differences were not statistically significant. Five days after the end of treatment, Y. pestis were observed in lymph nodes draining the inoculation site (but not in the spleen) in surviving mice in each of the three groups. The median lymph node log10 CFU recovered from persistently infected lymph nodes was significantly higher with GEN than with CIN (5.8 vs. 3.2, p = 0.04) or CIN+GEN (5.8 vs. 2.8, p = 0.01). Taken as the whole, our data show that CIN+GEN combination is as effective as CIN alone but, regimens containing CIN are more effective to eradicate Y. pestis from the draining lymph node than the recommended GEN monotherapy. Moreover, draining lymph nodes may serve as a reservoir for the continued release of Y. pestis into the blood – even after five days of intravenous antibiotic treatment.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Ciprofloxacin-Gentamicin Combination Therapy in Murine Bubonic Plague

et al. 2012

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“…This would be a sufficient preoperative interval. Antibacterial agents like temocillin [13], ampicillin, and mecillinam [14] actually appear in peripheral lymph nodes quite soon after administration; this can be assumed to apply to metronidazole as well. Metronidazole has been found at high levels during operation following such a regimen [15].…”

Section: Discussionmentioning

confidence: 99%

Prophylactic regimens in colorectal surgery: Comparisons between metronidazole used alone or with ampicillin for one or three days

et al. 1985

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The purpose of this study was to compare as anti‐infectious prophylaxis in elective colorectal cancer surgery the effect of metronidazole alone and in combination with ampicillin, and the effect of a duration of 1 or 3 days of prophylaxis. The prophylactic regimens designated regimens A‐D given in randomized order were metronidazole 500 mg used alone or with 2.0 g ampicillin administered every 8 hours as separate but simultaneous infusions. All patients studied received preoperative mechanical evacuation of bowel contents. Eight surgical departments participated in the study. Two hundred thirty‐three patients were studied. The distribution of sex, age, and type of operation was similar among the groups of patients receiving each regimen, except that there were more cases of sigmoidectomy, low anterior resection, or rectal amputation in the group receiving regimen D. The duration of the operations was comparable, even for each type of operation considered separately. Samples for bacteriological examination were obtained by abscess punctures when relevant. The pus was taken and transported to the laboratory under anaerobic conditions. Moderate or severe infections were observed in 6 (10.3%) of 58 patients on regimen A, in 2 (3.5%) of 58 patients on regimen B, in 4 (7.0%) of 57 receiving regimen C, and in 2 (3.3%) of 60 given regimen D. The highest incidence of postoperative infections was observed in rectal amputation. The bacteria causing postoperative infections were similar in the regimens A and C receiving only metronidazole for 1 and 3 days, respectively and in regimens B and D in which ampicillin was added. Only one anaerobe, aClostridium perfringens, was recovered from regimen C; twenty‐two strains of anaerobic bacteria were recovered from regimen A. The number of aerobic bacteria was 25 in regimen A and 16 in regimen C. The yield of bacteria was much more sparse when metronidazole was combined with ampicillin. Eleven isolates (2 anaerobes) were recovered from regimen B, only one isolate was recovered from patients on regimen D, an indole positiveProteus. In conclusion, th'is study indicates that a combination of metronidazole and ampicillin is particularly useful in rectal surgery. Metronidazole alone may suffice in colonic surgery, but a combination with an agent against aerobes is recommended in rectal surgery. The difference between 1‐day prophylaxis and 3‐day prophylaxis was insignificant for metronidazole plus ampicillin; a single day of this prophylactic regimen would appear advisable.

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“…Ciprofloxacin penetration in inflammatory blister fluid reached 120% of the serum concentration when AUC ratio was used, while for noninflammatory blister fluid and lymph we and others reported 60_70%. 133,134,141,164 Peritoneal fluid penetration approached these latter values as wel1.161, 164 Diffusion of the drug in muscle and fat is poor, according to some investigators,162, 163 but others found levels exceeding serum concentrations.v-186 Conflicting results have also been presented on ciproftoxaclo bone concentrations: 6.9-9.7 J1..g/g after 200 mg intravenously over 15 minutes was reported by one group, 166 while the highest value noted by others was only 1.6 J1..g/g after 1000 mg orally.165 Penetration of infected bone was greater than that of normal bone. 165 Excellent tissue penetration was achieved in kidney and prostate, with drug concentrations several times higher than in serum.…”

Section: Tissue Penetrationmentioning

confidence: 99%

Ciprofloxacin: Chemistry, Mechanism of Action, Resistance, Antimicrobial Spectrum, Pharmacokinetics, Clinical Trials, and Adverse Reactions

1988

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Ciprofloxacin, considered a benchmark when comparing new fluoroquinolones, shares with these agents a common mechanism of action: inhibition of DNA gyrase. While ciprofloxacin demonstrated a fairly good activity against gram-positive bacteria, it is against gram-negative organisms that it proved to be more potent than other fluoroquinolones. It is the most active quinolone against Pseudomonas aeruginosa, with MIC90s on the order of 0.5 micrograms/ml. When given orally, ciprofloxacin exhibited 70% bioavailability and attained peak serum levels ranging between 1.5 and 2.9 micrograms/ml after a single 500-mg dose. Nineteen percent of an oral dose was excreted as metabolites in both urine and feces. In most cases, body fluids and tissue concentrations equaled or exceeded those in concurrent serum samples. In clinical trials, oral and intravenous ciprofloxacin yielded similar clinical and bacteriologic results compared to standard therapy in a wide array of systemic infections, including lower and upper urinary tract infections; gonococcal urethritis; skin, skin structure, and bone infections; and respiratory tract and gastrointestinal tract infections. Major benefits with the oral form of this quinolone are expected in chronic pyelonephritis and bone infections, and in pulmonary exacerbations in patients with cystic fibrosis. Emergence of ciprofloxacin-resistant microorganisms has been noted in clinical practice, primarily Pseudomonas aeruginosa and Staphylococcus aureus. The most frequent side effects are related to the gastrointestinal tract; but attention should be given to adverse central nervous system effects.

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Pharmacokinetics of ciprofloxacin in peripheral lymph and skin blisters

Cited by 11 publications

References 8 publications

Efficacy of Ciprofloxacin-Gentamicin Combination Therapy in Murine Bubonic Plague

Efficacy of Ciprofloxacin-Gentamicin Combination Therapy in Murine Bubonic Plague

Prophylactic regimens in colorectal surgery: Comparisons between metronidazole used alone or with ampicillin for one or three days

Ciprofloxacin: Chemistry, Mechanism of Action, Resistance, Antimicrobial Spectrum, Pharmacokinetics, Clinical Trials, and Adverse Reactions

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