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Sayadi H, Fromage Y, Monchaud C, Languepin J, Masson-Rouchaud A, Labriffe M, Woillard JB. Ciprofloxacin Dosage Optimization in Cystic Fibrosis Through Therapeutic Drug Monitoring. Ther Drug Monit 2025; 47:189-192. [PMID: 39933065 DOI: 10.1097/ftd.0000000000001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 09/03/2024] [Indexed: 02/13/2025]
Abstract
BACKGROUND Ciprofloxacin (CIP) is effective against many Gram-negative pathogens and penetrates well into respiratory secretions and pulmonary tissues, thus making it useful for treating respiratory infections in patients with cystic fibrosis (CF). METHODS A 13-year-old patient with severe CF and an acute respiratory exacerbation from multidrug-resistant Pseudomonas aeruginosa was treated with 700 mg of CIP every 8 hours. Bronchial secretions confirmed that P. aeruginosa was sensitive to high doses of CIP. Pharmacokinetic monitoring using 2 blood samples estimated the AUC24 at 50 hours*mg/L. This led to an increase in CIP dosage to 850 mg three time a day (TID), then to 1000 mg TID, and finally to 1200 mg every 6 hours. RESULTS CIP pharmacokinetics can vary significantly, particularly in patients with CF due to increased clearance, ultimately resulting in shorter half-lives and higher risks of therapeutic failure and resistance. Therapeutic drug monitoring helps when adjusting dosages to maintain effective blood concentrations. CONCLUSIONS This case underscores the role of therapeutic drug monitoring in optimizing CIP dosing for patients with CF and highlights the necessity for close collaboration between clinicians and pharmacologists to ensure effective antibiotic exposure.
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Affiliation(s)
- Hamza Sayadi
- Service of Pharmacology, Toxicology and Pharmacovigilance Department, CHU Dupuytren, Limoges, France
| | - Yeleen Fromage
- Service of Pharmacology, Toxicology and Pharmacovigilance Department, CHU Dupuytren, Limoges, France
| | - Caroline Monchaud
- Service of Pharmacology, Toxicology and Pharmacovigilance Department, CHU Dupuytren, Limoges, France
- Pharmacology & Transplantation, Inserm U1248, Univ. Limoges, CHU Dupuytren, Limoges, France ; and
| | - Jeanne Languepin
- CRCM Mixte Limousin, Department of Medical Pediatrics, CHU Dupuytren, Limoges, France
| | | | - Marc Labriffe
- Service of Pharmacology, Toxicology and Pharmacovigilance Department, CHU Dupuytren, Limoges, France
- Pharmacology & Transplantation, Inserm U1248, Univ. Limoges, CHU Dupuytren, Limoges, France ; and
| | - Jean-Baptiste Woillard
- Service of Pharmacology, Toxicology and Pharmacovigilance Department, CHU Dupuytren, Limoges, France
- Pharmacology & Transplantation, Inserm U1248, Univ. Limoges, CHU Dupuytren, Limoges, France ; and
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2
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Principi N, Esposito S. Appropriate use of fluoroquinolones in children. Int J Antimicrob Agents 2015; 45:341-6. [PMID: 25726705 DOI: 10.1016/j.ijantimicag.2015.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 11/19/2022]
Abstract
With the increasing resistance to antibiotics among common bacterial pathogens, challenges associated with the use of fluoroquinolones (FQs) in paediatrics have emerged. The majority of FQs have favourable pharmacokinetic properties, although these properties can differ in children compared with adults. Moreover, all FQs have broad antimicrobial activity both against Gram-positive and Gram-negative bacteria. However, only some FQs for which adequate studies are available have been approved for use in children in a limited number of clinical situations owing to the supposed risk of development of severe musculoskeletal disorders, as demonstrated in juvenile animals. Recent short- and long-term evaluations appear to indicate that, at least for levofloxacin, this risk, if present at all, is marginal. This marginal risk could lead to more frequent use of FQs in children, even to treat diseases for which several other drugs with documented efficacy, safety and tolerability are considered the first-line antibiotics. However, for most of the FQs, adequate long-term studies of safety are not available. This indicates that the use of FQs should be limited to selected respiratory infections (including tuberculosis), exacerbation of lung disease in cystic fibrosis, central nervous system infections, enteric infections, febrile neutropenia, as well as serious infections attributable to FQ-susceptible pathogen(s) in children with life-threatening allergies to alternative agents. When considering diseases that could benefit from the use of FQs, particular attention must be paid to the choice of drug and its dosage, considering that not all of the FQs have been evaluated in different diseases.
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Affiliation(s)
- Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.
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3
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Stockmann C, Sherwin CMT, Zobell JT, Young DC, Waters CD, Spigarelli MG, Ampofo K. Optimization of anti-pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: III. fluoroquinolones. Pediatr Pulmonol 2013; 48:211-20. [PMID: 22949224 DOI: 10.1002/ppul.22667] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/12/2012] [Indexed: 11/07/2022]
Abstract
This review is the third installment in a comprehensive State of the Art series and aims to evaluate the use of fluoroquinolones in the management of P. aeruginosa infection in both children and adults with cystic fibrosis (CF). Oral and intravenous ciprofloxacin have been shown to be well-tolerated in the treatment of acute pulmonary exacerbations (APE) secondary to P. aeruginosa. Older literature supports an oral dosing regimen of 40 mg/kg/day divided every 12 hr, up to 2 g/day, and intravenous (IV) ciprofloxacin 30 mg/kg/day divided every 8 hr, maximum 1.2 g/day in children, and 750 mg administered orally twice a day or 400 mg IV every 8 hr in adults. However, a recent pharmacodynamic (PD) modeling study shows that the literature, U.S. Food and Drug Administration (FDA)-approved, and Cystic Fibrosis Foundation (CFF) guideline dosing regimens may be suboptimal for the treatment of P. aeruginosa in APE. Further study is warranted to determine if higher doses of ciprofloxacin are needed. Limited pharmacokinetic (PK), PK/PD, and efficacy studies involving levofloxacin exist in adult patients with CF. No pediatric data exists for levofloxacin in CF patients. Further study is needed to determine the tolerability and efficacy of levofloxacin in APE. At this time, the routine use of levofloxacin in the treatment of APE in pediatric and adult patients cannot be recommended.
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Affiliation(s)
- Chris Stockmann
- Division of Pediatric Infectious Disease, University of Utah, Salt Lake City, UT 84108, USA.
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4
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Lahiri T. Approaches to the Treatment of Initial Pseudomonas aeruginosa Infection in Children Who Have Cystic Fibrosis. Clin Chest Med 2007; 28:307-18. [PMID: 17467550 DOI: 10.1016/j.ccm.2007.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pseudomonas aeruginosa remains an important cause of pulmonary disease in patients who have cystic fibrosis. The development of antimicrobial therapy directed against this organism has resulted in the preservation of lung function and improved longevity. Efficacy has been demonstrated with agents administered via parenteral, inhaled, and oral routes. The optimal antibiotic regimen remains unclear. There is an active effort to use randomized, controlled clinical trials to rigorously test effective antibiotic for the eradication of P aeruginosa in young children or at least to delay the establishment of chronic infection.
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Affiliation(s)
- Thomas Lahiri
- University of Vermont College of Medicine, Burlington, VT 05401, USA.
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5
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Zeitlinger M, Müller M, Joukhadar C. Lung microdialysis--a powerful tool for the determination of exogenous and endogenous compounds in the lower respiratory tract (mini-review). AAPS JOURNAL 2005; 7:E600-8. [PMID: 16353939 PMCID: PMC2751264 DOI: 10.1208/aapsj070362] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In vivo measurement of concentrations of drugs and endogenous substances at the site of action has become a primary focus of research. In this context the minimal invasive microdialysis (MD) technique has been increasingly employed for the determination of pharmacokinetics in lung. Although lung MD is frequently employed to investigate various drugs and endogenous substances, the majority of lung MD studies were performed to determine the pharmacokinetic profile of antimicrobials that can be related to the importance of respiratory tract infections. For the lower respiratory tract various methods, such as surgical collection of whole lung tissue and bonchoalveolar lavage (BAL), are currently available for the determination of pharmacokinetics of antimicrobials. Head-to-head comparison of pharmacokinetics of antibiotics in lung revealed high differences between MD and conventional methods. MD might be regarded as a more advantageous approach because of its higher anatomical resolution and the ability to obtain dynamic time-vs-concentration profiles within one subject. However, due to ethical objections lung MD is limited to animals or patients undergoing elective thoracic surgery. From these studies it was speculated that the concentrations in healthy lung tissue may be predicted reasonably by the measurement of concentrations in skeletal muscle tissue. However, until now this was only demonstrated for beta-lactam antibiotics and needs to be confirmed for other classes of antimicrobials. In conclusion, the present review shows that MD is a promising method for the determination of antimicrobials in the lung, but might also be applicable for measuring a wide range of other drugs and for the investigation of metabolism in the lower respiratory tract.
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Affiliation(s)
- Markus Zeitlinger
- Department of Clinical Pharmacology, Division of Clinical Pharmacokinetics, Medical University of Vienna, Austria.
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6
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Doherty CP, Saha SK, Cutting WA. Typhoid fever, ciprofloxacin and growth in young children. ANNALS OF TROPICAL PAEDIATRICS 2000; 20:297-303. [PMID: 11219168 DOI: 10.1080/02724936.2000.11748151] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Typhoid fever remains a significant public health problem in Southern Asia, particularly with the emergence of multi-resistant strains of Salmonella typhi in the late 1980s. Use of ciprofloxacin in children, although discouraged, is increasing and we aimed to assess whether its use affects growth or the prevalence of joint symptomology. Children under 6 years of age diagnosed as typhoid fever on the basis of a positive Widal test were recruited in the outpatient department of a paediatric teaching hospital after treatment had been initiated. During 6 months follow-up, prevalences of arthritis/arthralgia and ponderal, linear and knemometric growth were recorded. Seventy-five children were recruited (mean age 32 months, mean weight-for-height Z-score--1.3, mean height-for-age Z-score 1.4) and 29 (39%) of them received ciprofloxacin. No significant adverse effects on ponderal, linear or knemometric growth, or on the incidence of arthritis/arthralgia were found to be associated with the use of ciprofloxacin. Knemometric and ponderal catch-up growth was demonstrable 30 days after diagnosis but linear growth was still declining 3 months after diagnosis with catch-up growth demonstrable only after 6 months. We conclude that ciprofloxacin is commonly used in typhoid fever and has no adverse effects on growth or joint symptomology.
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Affiliation(s)
- C P Doherty
- Department of Child Health, University of Glasgow, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK.
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7
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Hancock REW, Speert DP. Antibiotic resistance in Pseudomonas aeruginosa: mechanisms and impact on treatment. Drug Resist Updat 2000; 3:247-255. [PMID: 11498392 DOI: 10.1054/drup.2000.0152] [Citation(s) in RCA: 311] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pseudomonas aeruginosa continues to be a major cause of infections in Western society, in part because of its high intrinsic resistance to antibiotics. It has been demonstrated that this intrinsic resistance arises from the combination of unusually restricted outer-membrane permeability and secondary resistance mechanisms such as energy-dependent multidrug efflux and chromosomally encoded periplasmic beta-lactamase. Given this high level of natural resistance, mutational resistance to most classes of antibiotics can readily arise. In this review we summarize new insights into the mechanisms of resistance, and describe therapeutic approaches that can be used in the face of this continuing resistance threat, as well as new approaches that are being developed to combat resistance. Copyright 2000 Harcourt Publishers Ltd.
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Affiliation(s)
- Robert E. W. Hancock
- Departments of Microbiology, Immunology, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Abstract
From low birth weight infants to adolescents, physiologic and developmental differences underlie the marked differences in pharmacokinetics and pharmacodynamics of antibacterial agents. Certain diseases, such as cystic fibrosis, also can alter these parameters. This article describes the principles of pharmacokinetics and pharmacodynamics that are unique to children and that characterize the clinical application of selected antibacterial agents to infectious diseases in children.
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Affiliation(s)
- V H San Joaquin
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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9
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Smith A, Weber A, Pandher R, Williams-Warren J, Cohen ML, Ramsey B. Utilization of salivary concentrations of ciprofloxacin in subjects with cystic fibrosis. Infection 1997; 25:106-8. [PMID: 9108186 DOI: 10.1007/bf02113587] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ciprofloxacin, an orally-absorbed fluoroquinolone is effective against multiply resistant Pseudomonas aeruginosa in cystic fibrosis patients. It is the only practicable agent against extraintestinal salmonellosis and shigellosis in developing countries. However, concern with the risk of arthropathy in young children has restricted its use in pediatrics. Pharmacokinetic studies with ciprofloxacin are limited in the pediatric population. As a result, the dose and frequency of administration are not established in children. In this study the possibility of using salivary concentrations as surrogate measure of serum concentrations was investigated. A pediatric formulation of the drug (125 mg per capsule) was prepared and compared to 250 mg tablets. Relative bioavailability was 105% (tablet/capsule). The time to peak salivary concentration and elimination rate from saliva were significantly different from serum (p < 0.01 and p < 0.05 respectively). The linear regression analysis of post-peak concentrations in serum and saliva yielded a slope of 1.25 and correlation coefficient of 0.83. It was also found that salivary concentrations may be contaminated from drug retained in the oral cavity. The conclusion was drawn that salivary concentrations could not be reliably used as a surrogate measure of serum levels for therapeutic drug monitoring.
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Affiliation(s)
- A Smith
- Dept. of Cystic Fibrosis, Children's Hospital and Medical Center, Seattle, WA 98105, USA
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10
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Bethell DB, Hien TT, Phi LT, Day NP, Vinh H, Duong NM, Len NV, Chuong LV, White NJ. Effects on growth of single short courses of fluoroquinolones. Arch Dis Child 1996; 74:44-6. [PMID: 8660045 PMCID: PMC1511581 DOI: 10.1136/adc.74.1.44] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of the study was to document the effects of short courses of fluoroquinolones given during an outbreak of multidrug resistant typhoid fever in southern Viet Nam on the growth of children over a period of two years. In a prospective cohort study, 326 Vietnamese children aged between 1 and 14 years were followed up for two years after receiving either ciprofloxacin (70 mg/kg given over 7 d) (n = 173) or ofloxacin (45-50 mg/kg given over 3-5 d) (n = 153) for suspected typhoid fever. Growth velocity and weight for height were compared with an age matched control group of children from the same locality (n = 223) who had not contracted typhoid or received any fluoroquinolones. In the ofloxacin and ciprofloxacin treated patients there was no evidence of acute joint toxicity, nor of any joint symptoms attributable to either of the fluoroquinolones. There was no difference in expected weight for height measurements between the three groups of children over the two year period. During the first year, height velocity in ciprofloxacin treated children was greater than in either ofloxacin treated children or untreated controls. Height velocity in the latter two groups was not significantly different. After two years height velocity was similar in the three groups. The results support the use of short course fluoroquinolone treatment in childhood typhoid, especially when caused by strains resistant to other antibiotics.
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Affiliation(s)
- D B Bethell
- Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam
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11
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12
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Affiliation(s)
- E Bergogne-Bérézin
- Department of Microbiology, Bichat-Claude Bernard University-Hospital, Paris, France
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13
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Takayama S, Hirohashi M, Kato M, Shimada H. Toxicity of quinolone antimicrobial agents. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH 1995; 45:1-45. [PMID: 7752287 DOI: 10.1080/15287399509531978] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
An approach to minimization of toxicity of a new compound is to elucidate the mechanisms of toxicity of analogous compounds and to clarify their structure-toxicity relationships. A problem with this approach, however, is that such elucidation remains difficult. For quinolones, some improvements in this mechanistic approach have been achieved in the central nervous system (CNS), particularly with regard to their interaction with non-steroidal anti-inflammatory drugs (NSAIDs), and in genotoxicity and phototoxicity studies, particularly in comparison with other toxicities, such as to the cardiovascular, gastrointestinal, bone, reproductive, and developmental systems. This review concentrates on a description of the known effects of quinolones on various organ systems in experimental animals and humans. Given the logarithmic increase in the synthesis of new quinolones, it is questionable whether these drugs share similar safety and efficacy. Nevertheless, this mechanistic approach to the investigation and minimization of toxicity has produced satisfactory results to date and deserves to be continued.
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Affiliation(s)
- S Takayama
- Developmental Research Laboratories, Daiichi Pharmaceutical Co., Ltd., Tokyo, Japan
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14
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Abstract
The fluoroquinolones are characterised by a broad spectrum of antibacterial activity that includes many Mycobacterium, Chlamydia, Legionella, and Mycoplasma species as well as many multiply-resistant bacterial strains, good oral bioavailability, extensive tissue penetration, low protein binding and long elimination half-lives. Numerous clinical trials have shown that these compounds are effective and well tolerated in the treatment of adult patients with various infections, including urinary tract, respiratory tract, skin and soft tissue, bone and joint, and gynaecological infections, sexually transmitted diseases, infectious diarrhoea, infections in immunocompromised patients, and in surgical prophylaxis. Thus, there is increasing pressure to use this class of drugs in paediatric patients. However, concerns regarding adverse effects, particularly cartilage toxicity, have restricted development of the fluoroquinolone compounds for use in this population. Potential indications include Pseudomonas infections (mainly exacerbations of cystic fibrosis), urinary tract, gastrointestinal and central nervous system infections, infections in immunocompromised patients, certain otorhinolaryngological infections and infections caused by multiply-resistant pathogens. To date, clinical experience gained with fluoroquinolones in paediatric infections, which has been mainly on a compassionate-use basis, indicates that well-designed formal studies should be conducted to fully assess the efficacy and tolerability of these agents in specific indications in children.
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Affiliation(s)
- R Dagan
- Pediatric Infectious Disease Unit, Soroka Medical Center, Beer-Sheva, Israel
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15
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Kaminski N, Bogomolski V, Stalnikowicz R. Acute bacterial diarrhoea in the emergency room: therapeutic implications of stool culture results. J Accid Emerg Med 1994; 11:168-71. [PMID: 7804582 PMCID: PMC1342424 DOI: 10.1136/emj.11.3.168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Empiric treatment with ciprofloxacin and norfloxacin has been recommended recently for patients with acute diarrhoeal disease. In a retrospective 6-month study period the results of stool cultures from 209 patients with acute diarrhoea admitted to the emergency room were analysed. Seventy-eight cultures (37%) were positive for one or more bacteria. Shigella was the most commonly isolated pathogen (68%). Shigella sonnei comprised 72% and Shigella flexneri 19% of all the bacterial isolates. While no antimicrobial resistance to ciprofloxacin was found for both Shigella species, only 36 and 26% of the Shigella isolates were sensitive to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ), respectively. These findings point out to the emergence of drug resistance to commonly used antimicrobial drugs. Shigella's high sensitivity to the newer quinolones should make this the treatment of choice for the very sick patient, although physicians should be cautioned to the fact that indiscriminate use of this drug could result in the emergence of resistance similar to that noted with ampicillin and TMP-SMZ.
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Affiliation(s)
- N Kaminski
- Department of Internal Medicine, Hadassah University Hospital, Mount-Scopus, Jerusalem, Israel
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16
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Negro F, Baldi M, Mondardini A, Leandro G, Chaneac M, Manzini P, Abate ML, Zahm F, Dastoli G, Ballaré M. Continuous versus intermittent therapy for chronic hepatitis C with recombinant interferon alfa-2a. Gastroenterology 1994; 107:479-85. [PMID: 8039625 DOI: 10.1016/0016-5085(94)90174-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND/AIMS Prolonged interferon administration to patients with chronic hepatitis C, although increasing the sustained response rate, is poorly accepted and may favor drug resistance. A pulse-treatment schedule would be preferred for compliance and costs. METHODS One hundred thirty-five patients with chronic hepatitis C received 6 MU units of interferon alfa-2a, three times weekly, continuously for 9 months (group 1: 66 patients) or for two 3-month cycles, separated by 6 months pause (group 2: 69 patients). RESULTS At the end of therapy, 25 of 54 patients of group 1 (46.3%) and 28 of 60 of group 2 (46.7%) had normal serum aminotransferase levels. Six months after the end of treatment, sustained responders were still similar in the two groups (11 or 16.7% vs. 7 or 10.1%; NS). A loss of response before the end of therapy was seen in 10 patients of group 1 and 6 of group 2; interferon-neutralizing antibodies developed in 1 of 7 and 6 of 6 of such patients, respectively. CONCLUSIONS The intermittent administration of interferon alfa-2a to patients with chronic hepatitis C shows a sustained response rate comparable with that achieved with continuous treatment at the same dosage. Hepatitis breakthroughs during pulse therapy appeared to be limited to interferon neutralizing antibodies, whereas a prolonged, continuous treatment is more likely to induce other forms of interferon resistance.
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Affiliation(s)
- F Negro
- Department of Gastroenterology, Ospedale Molinette, Torino, Italy
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17
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Camp KA, Miyagi SL, Schroeder DJ. Potential quinolone-induced cartilage toxicity in children. Ann Pharmacother 1994; 28:336-8. [PMID: 8193422 DOI: 10.1177/106002809402800309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- K A Camp
- School of Pharmacy, Division of Clinical Pharmacy, University of California, San Francisco 94143
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18
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Dalhoff A. Quinolone resistance in Pseudomonas aeruginosa and Staphylococcus aureus. Development during therapy and clinical significance. Infection 1994; 22 Suppl 2:S111-21. [PMID: 7927829 DOI: 10.1007/bf01793575] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This review focuses on published information on the experimental as well as clinical data on the emergence of quinolone resistant isolates. In the course of clinical use of fluoroquinolones, only a sporadic emergence of quinolone resistance has been noted. The resistant organisms emerged particularly in certain clinical settings where large numbers of organisms frequently causing chronic infections are present and/or in loci where quinolone concentrations may not be optimal. In terms of occurrence in individuals, quinolone resistance has emerged most frequently in hospitalized and nursing-home patients with identifiable risk factors. Epidemiological studies revealed that in nearly all the cases studied one or one predominating quinolone resistant clone was selected that was horizontally transmitted. Thus, the emergence of quinolone resistance is not due to an independent selection of resistant strains in a number of patients, but to the clonal spread of one strain once it has acquired quinolone resistance. Therefore, the rate of quinolone resistance is very likely to be lower than reported.
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Affiliation(s)
- A Dalhoff
- Institut für Chemotherapie, Wuppertal, Germany
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19
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Tsang KW, Rutman A, Kanthakumar K, Belcher J, Lund V, Roberts DE, Read RC, Cole PJ, Wilson R. Haemophilus influenzae infection of human respiratory mucosa in low concentrations of antibiotics. THE AMERICAN REVIEW OF RESPIRATORY DISEASE 1993; 148:201-7. [PMID: 8317800 DOI: 10.1164/ajrccm/148.1.201] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We examined the effects of 0.25 and 0.5 minimal inhibitory concentrations (MIC) of amoxicillin, loracarbef, and ciprofloxacin on the interaction of a clinical isolate of nontypable Haemophilus influenzae (NTHi) with human adenoid organ culture. Adenoid tissue was embedded in agar so that only the mucosal surface was exposed. Minimum essential medium containing NTHi with or without antibiotics was added to the organ culture and incubated with 5% CO2 at 37 degrees C for 24 h. The organ cultures (n = 6) were assessed for several parameters by light microscopy (LM) and transmission electron microscopy (TEM). Bacterial viable counts after 24 h were not significantly different in all organ cultures. Compared with uninfected controls at 24 h, infection with NTHi caused significant (p < 0.05) damage to epithelium as assessed by LM: reduced ciliary beat frequency (CBF), disruption of epithelium integrity, and reduced number of ciliated sites. TEM showed extrusion of cells from the epithelial surface, loss of cilia from ciliated cells, cytoplasmic blebbing, and mitochondrial damage. In the presence of 0.25 and 0.5 MIC of all three antibiotics, the mucosal damage was significantly less (p < 0.05). We conclude that in the presence of sub-MIC levels of amoxicillin, loracarbef, and ciprofloxacin, NTHi infection causes less functional (CBF) and structural damage.
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Affiliation(s)
- K W Tsang
- Host Defence Unit, Royal Brompton National Heart and Lung Institute, London, England
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20
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Lindsay CA, Bosso JA. Optimisation of antibiotic therapy in cystic fibrosis patients. Pharmacokinetic considerations. Clin Pharmacokinet 1993; 24:496-506. [PMID: 8513651 DOI: 10.2165/00003088-199324060-00005] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Antibiotic therapy plays a central role in the medical management of patients with cystic fibrosis. While totally convincing efficacy data are lacking, antibiotics probably have a pronounced beneficial effect on both morbidity and mortality. Much has been learned in the past 20 years about antibiotic use in this population. At the same time, new antimicrobial agents with the potential to treat this condition have become available for use. The pharmacokinetics of a number of antibiotic classes, including beta-lactams, aminoglycosides and quinolones, are altered in this patient population. Increased total body clearance is a common occurrence but is not always changed enough to warrant altered dosages. Nonetheless, in light of altered pharmacokinetics in the cystic fibrosis population, appropriate dosage and monitoring parameters for a number of antibiotics have been determined.
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Affiliation(s)
- C A Lindsay
- Pharmacy Department, Texas Children's Hospital, Houston
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Samuelson WM, Pleasants RA, Whitaker MS. Arthropathy secondary to ciprofloxacin in an adult cystic fibrosis patient. Ann Pharmacother 1993; 27:302-3. [PMID: 8453165 DOI: 10.1177/106002809302700308] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To report a case of possible ciprofloxacin-induced arthropathy in an adult patient with cystic fibrosis (CF). CASE SUMMARY A 25-year-old man with CF received three separate courses of ciprofloxacin therapy at usual doses for acute pulmonary exacerbations of his disease. During the second and third courses, the patient experienced bilateral swelling of his knees between two to three weeks after initiation of each course. Both times symptoms markedly decreased after discontinuation of the drug. The patient had no prior history of arthropathy. Furthermore, during the last two acute exacerbations of his CF, he did not receive ciprofloxacin and did not experience any symptoms of arthropathy. DISCUSSION Prior cases of quinolone-induced arthropathy involving pediatric CF patients or adult patients without CF have been reported in the literature. We report the first case of such an arthropathy in an adult patient with CF. The findings are supported by a rechallenge with the drug. CONCLUSIONS It is likely that ciprofloxacin may produce arthropathy in adult as well as pediatric patients with CF. Quinolones should be considered as a possible cause of arthropathy in adult CF patients.
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Affiliation(s)
- W M Samuelson
- Department of Medicine, Duke University Medical Center, Durham, NC
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