Short and Long Courses of Ofloxacin Therapy of Klebsiella pneumoniae Sepsis Following Irradiation

Abstract

Exposure to whole-body irradiation is associated with fatal gram-negative sepsis. The optimal length of therapy of such infection is not established. The effect of short and long courses of oral therapy with the quinolone ofloxacin for orally acquired Klebsiella pneumoniae infection was tested in B6D2F1 mice exposed to 8.0 Gy of bilateral radiation from 60Co. A dose of 10(8) organisms was given orally 4 days after irradiation, and therapy was started 1 day later. Cultures of the ileum 7 days after irradiation showed the recovery of K. pneumoniae in 7 of 10 untreated mice and in 3 of 20 treated with ofloxacin. However, 14 days after irradiation K. pneumoniae was isolated in 5 of 6 untreated mice, in 7 of 9 that received the short course of therapy, and in one of those that received the long course of therapy (P less than 0.05). At Day 7, K. pneumoniae was isolated from the livers of 6 of 10 untreated mice, and from none of those receiving ofloxacin (P less than 0.05). At 14 days, K. pneumoniae was isolated in 4 of 6 untreated animals, in 4 of 9 that received the short course of therapy, and in none of the mice that received the long course of therapy (P less than 0.05). Only 3 of 20 (15%) untreated mice survived for 30 days as compared to 11 of 20 (55%) mice treated for 7 days with ofloxacin and 18 of 20 (90%) mice treated for 21 days with ofloxacin (P less than 0.05). These survival data illustrate the efficacy of a 21-day course over a 7-day course of ofloxacin therapy for orally acquired K. pneumoniae infection in irradiated hosts.