Efficacy Of Intravenous Ciprofloxacin Research Articles

Relationship between the clinical efficacy and AUC/MIC of intravenous ciprofloxacin in Japanese patients with intraabdominal infections

The efficacy of fluoroquinolones (FQs) correlates with the pharmacokinetic/pharmacodynamic (PK-PD) parameter, AUC/MIC. To our knowledge, however, no prospective studies have reported the relationship between FQ efficacy and PK-PD parameters in intraabdominal infection; therefore, we prospectively investigated the relationship between the efficacy of intravenous ciprofloxacin (CPFX IV) and PK-PD parameters. The study included 16 patients diagnosed with peritonitis between 2006 and 2008: 14 patients infected with a single organism and 2 patients infected with more than one organism. Each patient was treated with CPFX IV (300 mg twice daily). The response rate was 56% (9 responders and 7 non-responders). Non-responders were infected with Escherichia coli, Pseudomonas aeruginosa, and Bacteroides fragilis (6 patients were infected with a single organism and 1 with more than one organism). Plasma drug concentrations were measured 1 h and 2 or 4 h after administration of CPFX IV. AUC for 24 h (AUC(0-24))/MIC values was calculated. The range of AUC(0-24)/MIC values in responders [95.3-3628.4 (geometric mean, 521.6)] was significantly different from that in non-responders [7.0-45.2 (geometric mean, 16.5)] (p = 0.001). The target AUC/MIC value of CPFX IV would be considered to be 45-95 in patients with peritonitis.

Clinical efficacy of intravenous ciprofloxacin in patients with biliary tract infection: a randomized controlled trial with carbapenem as comparator

We conducted a randomized controlled trial (RCT) to evaluate the clinical efficacy of an intravenous fluoroquinolone, ciprofloxacin (CIP), in patients with biliary tract infection requiring biliary drainage using imipenem/cilastatin (IPM/CS) as a control. After the initial collection of bile, patients were randomly assigned to receive CIP at 300 mg twice daily by intravenous drip infusion or IPM/CS at 500 mg twice daily by intravenous drip infusion with the envelope method. The characteristics of the 104 patients evaluated for efficacy were well balanced. The clinical response rates were 100.0% (50/50 patients) in the CIP group and 94.4% (51/54) in the IPM/CS group. The difference in clinical response rate between groups (CIP, IPM/CS) was 5.56% (90% confidence interval: -0.26%, 13.95%), and the non-inferiority of CIP to IPM/CS was confirmed. Adverse events for which causal relationships with the study drugs could not be ruled out developed in 5.4% (3/56) of patients in the CIP group and 5.2% (3/58) of patients in the IPM/CS group, and none of them were serious. The clinical efficacy of CIP in treating biliary tract infection requiring drainage was comparable to that of IPM/CS. These findings suggest that CIP is useful as a new therapeutic option for biliary tract infection.

Intravenous or Sequential Ciprofloxacin Therapy in Hospitalised??Patients with a Broad??Spectrum??of Infections

This study set out to obtain up-to-date information on the efficacy, safety and tolerability of ciprofloxacin as well as the time to improvement and recovery, and to explore data on drug utilisation in hospitalised patients with a special focus on intravenous therapy with ciprofloxacin. METHODS, DESIGN AND PATIENTS: Hospitalised patients with a broad spectrum of infections were included in this non-interventional multicentre study. In order to be included, the patients had to be treated with intravenous ciprofloxacin for a minimum of 2 days. Physicians were advised to pay attention to the contraindications mentioned in the summary of product characteristics. They documented demographic and anamnestic data, the type and severity of the infection, concomitant diseases and medications, the course of clinical and laboratory symptoms, and the treatment. In addition, they rated the overall efficacy of intravenous ciprofloxacin and recorded the time to improvement and recovery. All adverse events were reported. 1012 hospitalised patients with mild to severe clinical infections were included. Their mean age was 61.5 years (SD 16.7), and 57.4% were males. Intravenous ciprofloxacin was given to 28.7% of patients exclusively and 69.6% started with intravenous ciprofloxacin and were switched later to oral treatment. The majority of patients presented with one defined source of infection (77.9%), mainly located in the respiratory tract (40.2%), the abdomen (21.4%), the urinary tract (14.9%) or the kidney (13.4%). Other infections involved the bones and joints (4.5%) or were classified as sepsis (8.0%); 39.6% of infections were classified as severe. Infection symptoms improved in 86.2% of the patients within 5 days. The overall improvement and recovery rates were 91.9% and 85.8%, respectively. Efficacy of ciprofloxacin was judged as 'very good' or 'good' in 86.5% of patients. Tolerability was judged as 'very good' or 'good' in 98.2% of patients. Adverse events occurred rarely and were reported in 2.17% of patients. Seventeen (1.68%) fulfilled the criteria of serious adverse events. In only 0.4% of patients was a relationship between the adverse event and ciprofloxacin treatment suspected. Intravenous ciprofloxacin is an effective and well tolerated antibacterial treatment in hospitalised patients experiencing a broad spectrum of mild to severe infections.

Efficacy of intravenous ciprofloxacin in patients with febrile neutropenia refractory to initial therapy

We previously reported that monotherapy with carbapenem or cefepime exhibited efficacy equivalent to cefepime plus an aminoglycoside as initial therapy for febrile neutropenia (FN), achieving an adequate response in two-thirds of the patients. However, only one-third of the remaining poor responders to monotherapy became afebrile after an aminoglycoside was added to the initial carbapenem or cefepime. The present study was designed to evaluate the benefit of intravenous ciprofloxacin for neutropenic patients with fever who were refractory to initial therapy given for the first 3 days. Patients with FN—as defined by an axillary temperature ≥37.5°C and a neutrophil count <1,000/μL—who had no response to initial therapy with carbapenem or cefepime for 72 hours were to receive additional ciprofloxacin 600 mg/day. They were otherwise managed according to the Japanese guidelines for FN. An adequate response was defined as a decline of temperature to <37.5°C within 7 days after initiation of ciprofloxacin treatment. Thirty-one patients with FN (seventeen male and fourteen female; mean age 53.1 ± 14.8 years) were entered in the study. The initial antibiotics were cefepime (2 – 4 g/day) in twenty and carbapenem (1 – 2 g/day) in eleven. Three patients were excluded from analysis, leaving 28 patients for evaluation of efficacy. The response rate was 16/31 patients (51.6%),with four patients judged non-assessable due to adverse effects, protocol violation or early change to other agents. Adverse events occurred in seventeen patients, but all were mild and reversible. Only three patients had adverse events (skin rash, hepatic dysfunction and elevation of alkaline phosphatase in one patient, respectively) considered related to ciprofloxacin. These findings indicate that addition of intravenous ciprofloxacin is effective against FN refractory to initial antibiotic therapy and has acceptable toxicity.

Antibiotic prophylaxis in vaginal hysterectomy

The prophylactic efficacy of three intravenous doses of cefuroxime 1,500 mg plus metronidazole 500 mg in vaginal hysterectomy was compared with placebo in a prospective double-blind randomized study. Febrile morbidity occurred in 13 of 26 patients in the placebo group and 0 of 27 patients in the study group. In a second prospective randomized study, the efficacy of intravenous ciprofloxacin (200 mg single dose) was compared with the cefuroxime plus metronidazole regimen. Febrile morbidity was found in 3 of 54 patients in the ciprofloxacin group, but in none of the 58 patients in the cefuroxime plus metronidazole group.

Brief report: Safety and efficacy of intravenous ciprofloxacin in the treatment of selected infections

A prospective study of the efficacy and safety of intravenous ciprofloxacin in the treatment of selected infections was conducted at the Ochsner Medical Institutions from October 1986 through March 1987. Thirty-three patients were treated with intravenous ciprofloxacin at dosages of either 200 mg or 300 mg every 12 hours. The mean duration of therapy was 12 days. Various infection sites were treated and included urinary tract, respiratory tract, skin and skin structure, bone, intra-abdominal, blood, and heart. Clinical improvement was noted in 20 of the 26 evaluable patients (77 percent). Fifty-two bacterial pathogens were isolated with eradication of 37 (71 percent). There was bacteriologic persistence in seven patients (13 percent). Superinfection occurred in one patient; however, no recurring or reinfecting organisms were isolated. Adverse events related to ciprofloxacin occurred in six patients and were primarily mild. Overall, ciprofloxacin was useful in the treatment of a variety of infections, and adverse events were minimal.

Comparison of the safety and efficacy of intravenous ciprofloxacin and intravenous ceftazidime in the treatment of selected infections

A study was conducted to determine the comparative safety and efficacy of intravenous ciprofloxacin with that of intravenous ceftazidime in the treatment of selected infections. Male and female inpatients 18 years or older had bacterial infections of the blood, skin or skin/structure, intraabdominal region, lower respiratory tract, of urinary tract (considered complicated) caused by organisms susceptible to both ciprofloxacin and ceftazidime. Patients were randomly assigned to receive either ciprofloxacin 200 mg intravenously every 12 hours or ceftazidime 0.5 to 2 g intravenously every eight to 12 hours. Clinical evaluations were performed daily during therapy and within five to nine days after therapy was complete. From patients with urinary tract infection, urine for culture was obtained during (Day 3 or 4) and after (five to nine days and three to five weeks) therapy. A total of 86 patients were enrolled into the study. Forty-three received ciprofloxacin and 43 received ceftazidime. There were 22 evaluable patients in the ciprofloxacin group with 24 infection sites: skin/skin structure (eight), respiratory tract (nine), blood (two), urinary tract (five). In the ceftazidime group, there were 26 evaluable patients with 29 infection sites: skin/skin structure (15), respiratory tract (nine), blood (three), and urinary tract (two). The mean duration of therapy with ciprofloxacin and ceftazidime was 7.5 days (range, four to 28 days) and 8.4 days (range, three to 25 days), respectively. Bacteriologic eradication of the causative organisms occurred at 17 infection sites (70.8 percent) in the ciprofloxacin-treated patients and 21 infection sites (72.4 percent) in the ceftazidime group. Clinically, resolution or improvement in signs/symptoms was demonstrated in 22 patients (91.7 percent) in the ciprofloxacin group and 26 patients (89.7 percent) in the ceftazidime group. Bacteriologic response (by organism) and overall response were comparable in both groups. All enrolled patients were evaluated for determination of safety. Adverse events considered possibly or probably related to the study drugs were reported in 16 of 43 patients (37.2 percent) in the ciprofloxacin group and four of 43 patients (9.3 percent) in the ceftazidime group. Ciprofloxacin and ceftazidime were equally efficacious in the treatment of selected infections, but ciprofloxacin were associated with a higher incidence of adverse reactions probably or possibly related to drug administration. Further studies with larger sample sizes in selected patients populations will be required to identify differences in efficacy among the two antibiotics.