Evaluation of Intravenous Ciprofloxacin in Patients With Nosocomial Lower Respiratory Tract Infections: Impact of Plasma Concentrations, Organism, Minimum Inhibitory Concentration, and Clinical Condition on Bacterial Eradication

doi:10.1001/archinte.1989.00390100083020

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Vol. 149 No. 10, October 1989

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Evaluation of Intravenous Ciprofloxacin in Patients With Nosocomial Lower Respiratory Tract Infections

Impact of Plasma Concentrations, Organism, Minimum Inhibitory Concentration, and Clinical Condition on Bacterial Eradication

Charles A. Peloquin, PharmD; Thomas J. Cumbo, MD; David E. Nix, PharmD; Mark F. Sands, MD; Jerome J. Schentag, PharmD

Arch Intern Med. 1989;149(10):2269-2273.

Abstract

• Fifty patients with gram-negative lower respiratory tractinfections were treated with intravenous ciprofloxacin to evaluateefficacy and safety. Relationships between individual pharmacokineticsand clinical and bacteriologic outcome were studied. Ciprofloxacinconcentrations in plasma were determined by high-performanceliquid chromatography. Respiratory secretion cultures were obtaineddaily to determine the eradication day of the infecting organism.Susceptibility (minimum inhibitory concentration) to ciprofloxacinand other antimicrobials was determined using standard microdilutiontechniques. The mean age of the patients was 70 years. Theyhad multiple underlying diseases, and two thirds of them wereventilator dependent at entry. Approximately 50% of the patientshad failed previous treatment for the same infections. Patientsinfected with Enterobacteriaceae or Haemophilus influenzae withminimum inhibitory concentrations of less than 0.25 mg/L respondedwell to intravenous ciprofloxacin therapy (200 mg every 12 hours).The organisms were eradicated from sputum cultures usually within1 day after ciprofloxacin therapy was started. Most clinicalfailures occurred in patients who were infected with Pseudomonasaeruginosa and had multiple underlying diseases. Pseudomonasaeruginosa was isolated from 10 patients with pneumonia, 2 patientswith lung abscess, and 1 patient with bronchiectasis. The Pseudomonasisolate acquired resistance during ciprofloxacin treatment in7 patients with pneumonia and in all of the remaining 3 patients.We conclude that ciprofloxacin is safe and effective at a dosageof 200 mg administered intravenously every 12 hours for nosocomiallower respiratory tract infections caused by Enterobacteriaceaeor Haemophilus species. Many patients who had failed previousantibiotic treatment for Enterobacteriaceae infections had goodclinical response to ciprofloxacin therapy. Studies using eitherhigher dosages of ciprofloxacin or combination therapy shouldbe conducted to determine if acquired resistance can be avoidedin Pseudomonas infections.

(Arch Intern Med. 1989;149:2269-2273)

Author Affiliations

From the School of Pharmacy, State University of New York at Buffalo (Drs Peloquin, Nix, and Schentag), and the Department of Medicine (Drs Cumbo and Sands) and the Clinical Pharmacokinetics Laboratory (Drs Peloquin, Nix, and Schentag), Millard Fillmore Hospital, Buffalo, NY.

Footnotes

Accepted for publication March 27, 1989.

Reprints not available.

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