Treatment of sepsis in patients with neoplastic diseases with intravenous ciprofloxacin

Abstract

Hospitalized patients with sepsis caused by ciprofloxacin-susceptible organisms were treated with intravenous ciprofloxacin 300 mg every 12 hours. Patients were followed closely for side effects and adverse reactions as well as for their response to therapy. Culture specimens and laboratory parameters including serum chemistry profile, complete blood cell count, and urinalysis were obtained before, during (every four to five days), and after ciprofloxacin therapy. Antimicrobial susceptibility of bacterial isolates was determined by the microtiter technique. Patients were considered to have had a successful outcome if satisfactory improvement in signs and symptoms of infection occurred as well as bacteriologic cure, such as eradication of organisms from the blood during and after treatment. Of 30 septic episodes in 30 patients, 27 episodes were considered evaluable. Two septic episodes occurred in patients who were neutropenic (absolute neutrophil count less than 1,000/mm 3). The sources of the 27 septic episodes were intra-abdominal (12 patients), indwelling intravenous access devices (11 patients), urinary tract (three patients), and skin/soft tissue (one patient). Of the 27 evaluable episodes, 24 (88.9 percent) had a completely successful outcome; three (11.1 percent) had a partially successful outcome. Partial successes included the occurrence of a Klebsiella pneumoniae reinfection in one patient, superinfection with Listeria monocytogenes in another patient with the concurrent development of a highly ciprofloxacin-resistant K. pneumoniae, and the recovery of a ciprofloxacin-resistant Pseudomonas aeruginosa during therapy in a third patient who also had superinfection due to Candida albicans. There were minimal ciprofloxacin-related adverse reactions and side effects. Although ciprofloxacin was generally well tolerated with minimal side effects and adverse reactions and was efficacious in the treatment of serious septicemic infections caused by gram-negative aerobic bacilli, the development of a resistant K. pneumoniae and the recovery of a resistant P. aeruginosa during therapy in two cases are of concern and deserve further investigation.