Successful treatment of pseudomonas ventriculitis with ciprofloxacin

Isaacs, David; Slack, Mary; Wilkinson, Alex L; Westwood, A.

doi:10.1093/jac/17.4.535

Cited by 57 publications

(26 citation statements)

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“…In humans, a favorable outcome has been reported after therapy with ciprofloxacin for central nervous system infections caused by Pseudomonas spp. (14,20). On the other hand, the activities of the quinolones available for clinical use are insufficient for treating central nervous system infections caused by gram-positive organisms (26).…”

Section: Discussionmentioning

confidence: 99%

Quinolone antibiotics in therapy of experimental pneumococcal meningitis in rabbits

Nau

Schmidt

Kaye

et al. 1995

Antimicrob Agents Chemother

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Using a rabbit model of pneumococcal meningitis, we compared the pharmacokinetics and bactericidal activities in cerebrospinal fluid (CSF) of older (ciprofloxacin, ofloxacin) and newer (levofloxacin, temafloxacin, CP-116,517, and Win 57273) quinolones with those of the ␤-lactam ceftriaxone. All quinolones penetrated into the inflamed CSF better than ceftriaxone, and the speed of entry into CSF was closely related to their degrees of lipophilicity. At a dose of 10 mg/kg ⅐ h, which in the case of the quinolones already in use in clinical practice produced concentrations attainable in the sera and CSF of humans, ciprofloxacin had no antipneumococcal activity (⌬log 10 CFU/ml ⅐ h, ؉0.20 ؎ 0.14). Ofloxacin (⌬log 10 CFU/ml ⅐ h, ؊0.13 ؎ 0.12), temafloxacin (⌬log 10 CFU/ml ⅐ h, ؊0.19 ؎ 0.18), and levofloxacin (⌬log 10 CFU/ml ⅐ h, ؊0.24 ؎ 0.16) showed slow bactericidal activity (not significantly different from each other), while CP-116,517 (⌬log 10 CFU/ml ⅐ h, ؊0.59 ؎ 0.21) and Win 57273 (⌬log 10 CFU/ml ⅐ h, ؊0.72 ؎ 0.20) showed increased bactericidal activities in CSF that was comparable to that of ceftriaxone at 10 mg/kg ⅐ h (⌬log 10 CFU/ml ⅐ h, ؊0.80 ؎ 0.17). These improved in vivo activities of the newer quinolones reflected their increased in vitro activities. All quinolones and ceftriaxone showed positive correlations between bactericidal rates in CSF and concentrations in CSF relative to their MBCs. Only when this ratio exceeded 10 did the antibiotics exhibit rapid bactericidal activities in CSF. In conclusion, in experimental pneumococcal meningitis the activities of new quinolones with improved antipneumococcal activities were comparable to that of ceftriaxone.Pneumococci resistant to several antibiotics are becoming a worldwide challenge. In many areas at least 10% of pneumococcal isolates, including those isolated from cerebrospinal fluid (CSF), show reduced susceptibility to penicillin (15,17,34). Penicillin resistance in pneumococci is often associated with an increase in the MICs of other ␤-lactam antibiotics, and the failure of cefotaxime and ceftriaxone in the treatment of meningitis caused by penicillin-resistant Streptococcus pneumoniae has been observed (1, 7).Quinolones are rapidly bactericidal in vitro and in vivo for susceptible organisms in a highly concentration-dependent way (4, 5). Because of their lipophilicity, quinolones enter the CSF better than other classes of antimicrobial agents (3, 26). However, quinolones have infrequently been used in the past for the therapy of meningitis. They are relatively contraindicated in children, the age group most susceptible to the development of meningitis, and the currently approved quinolones possess only marginal activities against important meningeal pathogens such as S. pneumoniae, other streptococci, and Listeria monocytogenes (26).In recent years, new quinolones with improved activities against gram-positive pathogens, including S. pneumoniae, have been developed (9,11,29,30). These quinolones remain active against ␤-lactam-resistant pneumococci and...

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Section: Discussionmentioning

confidence: 99%

Quinolone antibiotics in therapy of experimental pneumococcal meningitis in rabbits

Nau

Schmidt

Kaye

et al. 1995

Antimicrob Agents Chemother

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“…Clinical data on the efficacy of these agents are limited. There is a single case report in which P. aeruginosa ventriculitis in an infant failed to respond to netilmicin given parenterally and intraventricularly, but was cured after the addition of intravenous ciprofloxacin (382). Intravenous pefloxacin in high doses (800 mg twice daily) was also used successfully to treat a patient with Morganella morganii meningitis associated with a CSF leak following laminectomy (383).…”

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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“…Although combined therapy seems reasonable, the addition of an aminoglycoside does not appear to enhance efficacy, as noted in anecdoctal reports. Ciprofloxacin has been successfully used, as noted in anecdotal reports (37,58,75). However, given the relatively low ratio of cerebrospinal fluid concentrations to MICs for P. aeruginosa (61), ciprofloxacin usage should be confined to situations in which organisms are resistant to beta-lactam agents.…”

Section: Approaches To Specific Infectionsmentioning

confidence: 99%

Antimicrobial agent therapy for Pseudomonas aeruginosa

Korvick

1991

Antimicrob Agents Chemother

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Successful treatment of pseudomonas ventriculitis with ciprofloxacin

Cited by 57 publications

References 0 publications

Quinolone antibiotics in therapy of experimental pneumococcal meningitis in rabbits

Quinolone antibiotics in therapy of experimental pneumococcal meningitis in rabbits

Fluoroquinolone antimicrobial agents

Antimicrobial agent therapy for Pseudomonas aeruginosa

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