Ciprofloxacin Group Research Articles

Impact of ciprofloxacin with autophagy on renal tubular injury.

Renal tubular injury caused by oxidative stress and inflammation results in acute kidney injury. Recent research reported that antibiotics may protect renal tubules from progressive deterioration, but the underlying mechanism remains unclear. Therefore, we investigated the efficacy and mechanism of action of antibiotics against renal tubular injury. We screened ciprofloxacin, ceftizoxime, minocycline, and netilmicin and selected ciprofloxacin to examine further because of its low toxicity towards renal tubular cells. We evaluated the effect of ciprofloxacin on cell survival by analyzing apoptosis and autophagy. Terminal deoxynucleotidyl transferase-mediated d-UTP nick end labeling (TUNEL) assay results showed that the ciprofloxacin group had less apoptotic cells than the control group. The ratio of cleaved caspase 3 to caspase 3, the final effector in the apoptosis process, was decreased, but the ratio of B-cell lymphoma 2 (Bcl-2)-associated X protein (Bax) to Bcl-2 located upstream of caspase 3 was not decreased in the ciprofloxacin group. Therefore, apoptosis inhibition does not occur via Bax/Bcl-2. Conversely, the levels of phosphorylated Bcl-2, and Beclin-1, an autophagy marker, were increased, and that of caspase-3 was decreased in the ciprofloxacin group. This indicates that ciprofloxacin enhances autophagy, increasing the amount of free Beclin-1 via phosphorylated Bcl-2, and inhibits caspase activity. Therefore, ciprofloxacin might protect against renal tubular injury through the activation of autophagy in the setting of acute kidney injury.

Ciprofloxacin Accelerates Angiotensin-II-Induced Vascular Smooth Muscle Cells Senescence Through Modulating AMPK/ROS pathway in Aortic Aneurysm and Dissection

Aortic aneurysm and dissection (AAD) is a cardiovascular disease that poses a severe threat to life and has high morbidity and mortality rates. Clinical and animal-based studies have irrefutably shown that fluoroquinolones, a commonly prescribed antibiotic for treating infections, significantly increase the risk of AAD. Despite this, the precise mechanism by which fluoroquinolones cause AAD remains unclear. Therefore, this study aims to investigate the molecular mechanism and role of Ciprofloxacin definitively—a type of fluoroquinolone antibiotic—in the progression of AAD. Aortic transcriptome data were collected from GEO datasets to detect the genes and pathways expressed differently between healthy donors and AAD patients. Human primary Vascular Smooth Muscle Cells (VSMCs) were isolated from the aorta. After 72 h of exposure to 110ug/ml Ciprofloxacin or 100 nmol/L AngII, either or combined, the senescent cells were identified through SA-β-gal staining. MitoTracker staining was used to examine the morphology of mitochondria in each group. Cellular Reactive Oxygen Species (ROS) levels were measured using MitoSox and DCFH-DA staining. Western blot assay was performed to detect the protein expression level. We conducted an analysis of transcriptome data from both healthy donors and patients with AAD and found that there were significant changes in cellular senescence-related signaling pathways in the latter group. We then isolated and identified human primary VSMCs from healthy donors (control-VSMCs) and patients' (AAD-VSMCs) aortic tissue, respectively. We found that VSMCs from patients exhibited senescent phenotype as compared to control-VSMCs. The higher levels of p21 and p16 and elevated SA-β-gal activity demonstrated this. We also found that pretreatment with Ciprofloxacin promoted angiotensin-II-induced cellular senescence in control-VSMCs. This was evidenced by increased SA-β-gal activity, decreased cell proliferation, and elevation of p21 and p16 protein levels. Additionally, we found that Angiotensin-II (AngII) induced VSMC senescence by promoting ROS generation. We used DCFH-DA and mitoSOX staining to identify that Ciprofloxacin and AngII pretreatment further elevated ROS levels than the vehicle or alone group. Furthermore, JC-1 staining showed that mitochondrial membrane potential significantly declined in the Ciprofloxacin and AngII combination group compared to others. Compared to the other three groups, pretreatment of Ciprofloxacin plus AngII could further induce mitochondrial fission, demonstrated by mitoTracker staining and western blotting assay. Mechanistically, we found that Ciprofloxacin impaired the balance of mitochondrial fission and fusion dynamics in VSMCs by suppressing the phosphorylation of AMPK signaling. This caused mitochondrial dysfunction and ROS generation, thereby elevating AngII-induced cellular senescence. However, treatment with the AMPK activator partially alleviated those effects. Our data indicate that Ciprofloxacin may accelerate AngII-induced VSMC senescence through modulating AMPK/ROS signaling and, subsequently, hasten the progression of AAD.

Ciprofloxacin versus levofloxacin prophylaxis in hematopoietic stem cell transplantation: A randomized trial

ObjectivesWe aimed to assess whether there is a difference between ciprofloxacin and levofloxacin as prophylaxis in hematopoietic stem cell transplant (SCT) recipients. MethodsThis is a prospective, randomized trial in patients receiving SCT at Henry Ford Health in the United States of America. We randomly assigned patients (1:1) to receive ciprofloxacin or levofloxacin. The primary outcome was incidence of bloodstream bacterial infections (BSI) up to day 60 after SCT. ResultsBetween June 4, 2018, and May 23, 2022, we randomly assigned 308 consecutive patients to receive ciprofloxacin (154 patients) or levofloxacin (154 patients). BSI was similar in both the ciprofloxacin and levofloxacin groups (18 [11.7%] vs 18 [11.7%]). Pneumonia was more frequent in the ciprofloxacin group compared to the levofloxacin group (18 [18%] vs 7 [23%]; relative risk 2.57, 95% CI 1.11-5.98; p = 0.028). There were no differences in neutrophil engraftment, fever, Clostridium difficile infection, relapse incidence, overall survival, nonrelapse mortality, length of stay post-SCT, or intensive care unit admission. ConclusionAlthough both prophylaxis regimens demonstrated the same efficacy in SCT recipients, levofloxacin prophylaxis led to less pneumonia in the first 60 days post-SCT. Trial RegistrationThis study is registered on ClinicalTrials.gov, NCT03850379.

IN VIVO STUDY EVALUATES EFFECTIVENESS OF ADDING CIPROFLOXACIN TO CALCIUM HYDROXIDE VERSUS SAUSSUREA COSTUS TO CALCIUM HYDROXIDE MEDICATION AGAINST BACTERIAL BIOFILM IN ROOT CANAL TREATMENT

Background and objectives: Elimination of root canal bacteria is a perquisite for a successful root canal treatment. This research aims to determine the effectiveness of adding ciprofloxacin versus Saussurea costus extract to calcium hydroxide medicament against bacterial biofilm in root canal treatment in vivo study. Materials and methods: In vivo study on 70 single-rooted human teeth at Sana'a University dental clinics used Saussurea costus extract preparation, including washing, drying, crushing, mixing, centrifugation, drying, and homogenization.The intracanal drug concentration was standardized by mixing 1 g of calcium hydroxide powder with 1 ml of ciprofloxacin or 1 ml of Saussurea costus extract in both groups. Three bacteriological samples were taken before root canal treatment, before Medicaments were placed, and 7 days after, and CFU and bacterial isolation were performed using standard methods. Results: An intragroup analysis showed that all drug groups had a significant decrease in the number of intracanal bacterial cells from S1 to S2 and from S2 to S3 (p<0.0001). When comparing quantitative S1 or S2 data, there was no significant difference between the groups; however, at Sample 3, the Saussurea costus extract calcium hydroxide (34.05±21.8) had considerably higher bacterial counts than the calcium hydroxide + Ciprofloxacin group (11.9±29 CFU). The most isolated bacteria in S1 and S2 were Staphylococcus aureus (58.6%, 51.4%), followed by Klebsiella species (27.1%, 18.6%), Escherichia coli (25.7%, 17.1%), Enterococcus faecalis (22.9%, 15.7%) and Pseudomonas aeruginosa (21.4%, 12.9%). Conclusions: The addition of Ciprofloxacin to calcium hydroxide and Saussurea costus- calcium hydroxide provided further antibacterial effectiveness when used as an intracanal medicament in vivo during root canal treatment. Peer Review History: Received 27 March 2024; Revised 5 May 2024; Accepted 28 June; Available online 15 July 2024 Academic Editor: Essam Mohamed Eissa, Beni-Suef University, Egypt, dressamceutics@yahoo.com Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Kingsley C Anukam, University of Benin, Nigeria, kanukam@gmail.com Dr. Liliya Logoyda, Horbachevsky Ternopil State Medical University, Ukraine, logojda@tdmu.edu.ua

In vitro induction and selection of fluoroquinolone-resistant mutants in Elizabethkingia anophelis

For 29 parent strains, recognized by pulsed-field gel electrophoresis, the MICs multiplied significantly in the ciprofloxacin group than levofloxacin group, following the first and third induction cycle. Ser83Arg in GyrA was the most common site of mutations. No mutation in ParC nor ParE was identified in the selected mutants.

Efficacy of empirical Ciprofloxacin or Cefixime plus Metronidazole therapy for the treatment of liver abscess: a randomized control clinical trial

Liver abscess is a potentially life-threatening medical emergency. Prompt empirical antimicrobial with or without percutaneous aspiration or drainage is therapeutic. The rational for using empirical intravenous broad-spectrum antimicrobials upfront instead of oral Fluoroquinolone or Cephalosporin is contentious. In this double blind randomized control clinical trial 69 participants received Ciprofloxacin (500 mg q 12 hourly) and 71 participants received Cefixime (200 mg q 12 hourly) orally for 2 weeks. Both the group received oral Metronidazole (800 mg q 8 hourly) for 2 weeks and percutaneous drainage or aspiration of the abscess was done as per indication and followed-up for 8 weeks. Out of 140 participants, 89.3% (N = 125) achieved clinical cure, 59 (85.5%) in Ciprofloxacin group and 66 (93%) in Cefixime group (p = 0.154). Mean duration of antimicrobial therapy was 16.2 ± 4.3 days, 15.1 ± 4.5 days in Ciprofloxacin group and 16.0 ± 4.2 days in Cefixime group (p = 0.223). Total 15 (10.7%) participants had treatment failure, 10 (14.5%) in Ciprofloxacin group and 5 (7.0%) in Cefixime group (p = 0.154). The most common reason for treatment failure was need of prolong (> 4 weeks) antimicrobial therapy due to persistent hepatic collection requiring drainage, which was significantly (p = 0.036) higher in Ciprofloxacin (14.5%, N = 10) group, compared to the Cefixime (4.2%, N = 3) group. In conclusion, both, the Ciprofloxacin or Cefixime plus Metronidazole for duration of 2–3 weeks were efficacious as empirical oral antimicrobial regimen along with prompt percutaneous drainage or aspiration for the treatment of uncomplicated liver abscess with similar efficacy. Oral Cefixime was better than Ciprofloxacin in term of lesser chance of treatment failure due to persistent collection which is required to be investigated further in larger clinical trial.Trial registration: clinicaltrials.gov PRS ID: NCT03969758, 31/05/2019.

Dual-emission ratio fluorescent probe based on carbon dots and copper-silver bimetallic nanoclusters for visual and fluorescent detection of ciprofloxacin

Ciprofloxacin (CIP) plays an important role in many physiological processes. Previously reported methods for CIP detection have many drawbacks and so it is crucial to develop highly sensitive methods to detect CIP. In this study, a dual-emission ratiometric fluorescent probe (SF-CQDs/CuAg NCs) of a nanocomposite of carbon quantum dots (SF-CQDs) and copper-silver bimetallic nanoclusters (CuAg NCs) was developed for sensitive and selective detection of CIP. The fluorescent signal of CuAg NCs was quenched while the fluorescence intensity of SF-CQDs was enhanced in the presence of CIP. The working principle of the fluorescent probe SF-CQDs/CuAg NCs is mainly based on the complexation of CIP with CuAg NCs to free SF-CQDs. The quenching of CuAg NCs by CIP arises from the chelation between the metal and the 1-oxo substituent and the adjacent carboxyl group of CIP. The fluorescence recovery of SF-CQDs is attributing to the release of SF-CQDs from SF-CQDs/CuAg NCs and the hydrogen bonding interaction between SF-CQDs and CIP. The ratiometric fluorescence measurement of SF-CQDs/CuAg NCs has been employed to analyze CIP with good sensitivity and selectivity. The working range of CIP is 5.0–200.0 μM and the detection limit is 3.3 μM. More importantly, the fluorescence of SF-CQDs/CuAg NCs can be detected intuitively via a smartphone which can be applied to determine CIP.

Open-Label Randomized Controlled Study of Ciprofloxacin vs Rifaximin as Neutropenia Prophylaxis in Allogeneic Hematopoietic Stem Cell Transplantation

Loss of microbiota diversity has been clearly associated with poor outcomes in the allogeneic hematopoietic stem cell transplantation setting. However, the choice of the optimal antibiotic prophylaxis during the pre-engraftment phase remains unclear. We designed a prospective randomized study to compare our standard-of-care neutropenia prophylaxis (ciprofloxacin) with rifaximin. We enrolled 38 consecutive adult patients who underwent allogeneic hematopoietic stem cell transplantation setting and were randomly assigned to receive ciprofloxacin (20 patients) or rifaximin (18 patients) at day -1. Pretransplant and transplant characteristics did not differ between groups. Cumulative incidence (CI) of acute graft-vs-host disease grade II to IV and moderate/severe chronic graft-vs-host disease was similar in both groups. With a median follow-up of 13.2 months (range, 6.8-30.2) in surviving patients, the 1-year CI of relapse was 20.8% in ciprofloxacin vs 17.8% in rifaximin (P = .616). Importantly, the 1-year CI of treatment-related mortality was significantly reduced in the ciprofloxacin group (10.2% vs 27.8%, P = .032), leading to higher 1-year overall survival (88.9% vs 74.6%, P = .038). In Cox-regression multivariate analysis, antibiotic prophylaxis remained the only predictor of overall survival, independently of donor type, disease risk index, and moderate/severe chronic graft-vs-host disease. Further studies are needed to assess the effects on microbiota diversity and confirm these outcomes.

Antibiotic resistance characteristics of potential probiotic Lactobacillus strains

Antibiotic-resistant bacteria are increasingly common and threaten human health. Recently, antibiotic resistance in food associated bacteria become an emerging threat to this state. These bacteria may act as reservoirs of antibiotic resistance genes and transfer to commensal or pathogenic bacteria in the human intestines. Therefore, either probiotics or starter cultures have to be evaluated for antibiotic interaction. In this study, the antibiotic susceptibility of seven Lactobacillus strains was determined. The MIC values revealed that all strains were resistant to tetracycline, ciprofloxacin, vancomycin and aminoglycoside antibiotics group (gentamicin, neomycin, kanamycin and streptomycin). However, the results from PCR analysis showed that parC gene for ciprofloxacin resistance was only present in Lb. fermentum SMC2; vanX gene, responsible for the vancomycin resistance, was found in two strains Lb. plantarum AS34 and TJ26. Most strains showed susceptibilityto at least one type of protein synthesis inhibit antibiotics: chloramphenicol, erythromycin and clindamycin. Four strains Lb. brevis NCTH24, Lb. casei PK2, Lb. fermentum SBV2, and Lb. plantarum NCDC3 did not carry any antibiotic resistance genes which indicates these antibiotic resistances are intrinsic and nontransmissible.

Heterogeneous Phenotypic Responses of Antibiotic-Resistant Salmonella Typhimurium to Food Preservative-Related Stresses.

This study was designed to evaluate the response of antibiotic-resistant Salmonella Typhimurium to food preservative-related stresses, such as lactic acid and sodium chloride (NaCl). S. Typhimurium cells were exposed to 1 µg/mL of ciprofloxacin (CIP), 0.2% lactic acid (LA), 6% NaCl, CIP followed by LA (CIP-LA), and CIP followed by NaCl (CIP-NaCl). The untreated S. Typhimurium cells were the control (CON). All treatments were as follows: CON, CIP, LA, NaCl, CIP-LA, and CIP-NaCl. The phenotypic heterogeneity was evaluated by measuring the antimicrobial susceptibility, bacterial fluctuation, cell injury, persistence, and cross-resistance. The CIP, CIP-LA, and CIP-NaCl groups were highly resistant to ciprofloxacin, showing MIC values of 0.70, 0.59, and 0.54 µg/mL, respectively, compared to the CON group (0.014 µg/mL). The susceptibility to lactic acid was not changed after exposure to NaCl, while that to NaCl was decreased after exposure to NaCl. The Eagle phenomenon was observed in the CIP, CIP-LA, and CIP-NaCl groups, showing Eagle effect concentrations (EECs) of more than 8 µg/mL. No changes in the MBCs of lactic acid and NaCl were observed in the CIP, LA, and CIP-LA groups, and the EECs of lactic acid and NaCl were not detected in all treatments. The bacterial fluctuation rates of the CIP-LA and CIP-NaCl groups were considerably increased to 33% and 41%, respectively, corresponding to the injured cell proportions of 82% and 89%. CIP-NaCl induced persister cells as high as 2 log cfu/mL. The LA and NaCl treatments decreased the fitness cost. The CIP-NaCl treatment showed positive cross-resistance to erythromycin (ERY) and tetracycline (TET), while the LA and NaCl treatments were collaterally susceptible to chloramphenicol (CHL), ciprofloxacin (CIP), piperacillin (PIP), and TET. The results provide new insight into the fate of antibiotic-resistant S. Typhimurium during food processing and preservation.

Effects of Enrofloxacin and Ciprofloxacin on Growth and Toxin Production of Microcystis aeruginosa

Microcystis aeruginosa is a common cyanobacterium found in water blooms and often causes ecological harm. Antibiotics are also increasingly used for the prevention and treatment of bacterial infections in aquaculture. However, since most antibiotics cannot be fully metabolized, they enter the water environment and cause ecological impacts. In this paper, the effects of the two fluoroquinolone antibiotics (enrofloxacin and ciprofloxacin) on the population density and microcystins (MCs) production of M. aeruginosa were studied. It is of great significance for the ecological risk assessment of antibiotics in the water environment. The results showed that the 96h EC50 values of enrofloxacin and ciprofloxacin to M. aeruginosa were 56.10 mg/L and 49.80 mg/L, respectively, and the toxicity of ciprofloxacin to M. aeruginosa was slightly stronger than that of enrofloxacin. With the increase in the two antibiotic concentration, the growth inhibition rate (IR) increased, but when the concentration reached a certain level, the IR would reach its threshold. Long-term exposure to low concentrations of these two antibiotics is not only more likely to lead to the outbreak of M. aeruginosa, but also increase its toxin production capacity. The highest contents of MCs in enrofloxacin and ciprofloxacin groups were 95.539 μg/g and 93.720 μg/g, respectively. The MCs value of these three enrofloxacin treatment groups was more than above 51.8 times that of control group (CK) on the 4th day; from 8th day to 14th day, the MCs value of these three enrofloxacin treatment groups was more than above 3.2 times that of CK group. For ciprofloxacin, the MCs value of the treatment group was more than 64.98 times that of the CK group on the 4th day, and from 8th day to 14th day, the MCs value of the treatment group was more than 2.7 times that of the CK group. These findings provide crucial management rationale.

Analysis of the toxic effects of fluoroquinolones in laboratory rabbit models

Introduction. Fluoroquinolones are antibacterials for which the development of cardiotoxicity, hepatotoxicity, nephrotoxicity and connective tissue damage has been noted. The likely mechanism for the development of these reactions is magnesium metabolism disorder. An available method to detect fluoroquinolones toxicity in animal experiments is a blood biochemical test.The aim of the work was to identify the biochemical signs of the toxic effects of fluoroquinolones in laboratory rabbit models.Materials and methods. Twenty male rabbits randomised into three groups were included in the study: 6 control animals; 7 rabbits treated with ciprofloxacin 150 mg/kg 14 days; 7 rabbits treated with levofloxacin 150 mg/kg 14 days. Serum levels of albumin, alanine aminotransferase (liver damage marker), creatinine (nephrotoxicity marker), creatine kinase MB (cardiotoxicity marker), matrix metalloproteinase 9 (connective tissue damage marker), serum and plasma magnesium content were studied in this work. Data are presented as mean (standard deviation).Results. Serum levels of albumin, alanine aminotransferase and creatinine did not change during the experiment. Rabbits treated with levofloxacin had 2.0–2.5 times lower values of CF creatine kinase activity than control animals. There was double increase of serum concentration of matrix metalloproteinase 9 in ciprofloxacin group in comparison with control (70,17 (20,88) and 38,10 (16,04) ng/ ml, p = 0,019). Magnesium content was unchanged with both fluoroquinolones.Discussion. The absence of signs of hepatotoxicity and nephrotoxicity is consistent with their low frequency of detection in clinical and experimental studies. A decrease in the activity of creatine kinase MB in animals treated with levofloxacin has not been described in the literature. An increase in the concentration of metalloproteinase 9 is evidence of destruction of connective tissue structures. The absence of changes in serum and plasma concentrations of magnesium is explained by the functioning of the systems maintaining the constancy of its content in blood.Conclusion. No biochemical evidence of hepato-, nephro- and cardiotoxic effects of ciprofloxacin and levofloxacin at the doses of 150 mg/kg for 14 days was shown in rabbits; no magnesium metabolism disorders were shown, and the ability of ciprofloxacin to increase the serum content of matrix metalloproteinase type 9 was demonstrated. The proposed model can be used to investigate ways to prevent the toxic effects of fluoroquinolones on connective tissue structures.

Peptide barcode of multidrug-resistant strains of Neisseria gonorrhoeae isolated from patients in Thailand.

The emergence of multidrug-resistant strains of Neisseria gonorrhoeae constitutes a serious threat to public health. The present study aimed to investigate peptidome-based biomarkers of multidrug-resistant N. gonorrhoeae, using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and liquid chromatography tandem mass spectrometry (LC-MS). The peptide barcode database of multidrug resistant N. gonorrhoeae was generated from the whole-cell peptides of 93 N. gonorrhoeae isolated from patients in Thailand. The dendrogram of 93 independent isolates of antibiotic-resistant N. gonorrhoeae revealed five distinct clusters including azithromycin resistance group (AZ), ciprofloxacin resistance group (C), ciprofloxacin and penicillin resistance group (CP), ciprofloxacin and tetracycline resistance group (CT), ciprofloxacin, penicillin and tetracycline resistance group (CPT). The peptidomes of all clusters were comparatively analyzed using a high-performance liquid chromatography-mass spectrometry method (LC-MS). Nine peptides derived from 9 proteins were highly expressed in AZ (p value < 0.05). These peptides also played a crucial role in numerous pathways and showed a strong relationship with the antibiotic resistances. In conclusion, this study showed a rapid screening of antibiotic-resistant N. gonorrhoeae using MALDI-TOF MS. Additionally, potential specific peptidome-based biomarker candidates for AZ, C, CP, CT and CPT-resistant N. gonorrhoeae were identified.

Comparison of intravenous ceftriaxone and ciprofloxacin in prevention of infection in cirrhosis patients with variceal bleeding

Background: Patients with variceal gastrointestinal bleeding are very susceptible to bacterial infections. This study was designed to examine the effectiveness of ciprofloxacin and ceftriaxone in controlling in-hospital morbidity, mortality, and infection in variceal bleeding patients. Methods: From August 2010 to August 2012, an interventional randomized controlled clinical trial was conducted in the Department of Gastroenterology, East Medical Ward, Mayo Hospital, Lahore. Adult patients who were diagnosed to have gastroesophageal variceal bleeding after endoscopic examination were included. These patients were randomly distributed to 2 groups. Group ceftriaxone: receiving injection Ceftriaxone 1000 mg intravenously 12 hourly for 7 days, Group ciprofloxacin: receiving injection ciprofloxacin 200 mg intravenously 12 hourly for 7 days. Results: Most common viral etiology was Hepatitis C in both the study groups. It was observed that in the ceftriaxone group, 4.8% had rebleeding, while in the ciprofloxacin group 5.6% had rebleeding (p=0.77), one case each had porto-systemic encephalopathy (p=0.99), 0.8% in ceftriaxone group and 3.2% in ciprofloxacin group had spontaneous bacterial peritonitis (p=0.39) and 4.8% in ceftriaxone group and 8% in ciprofloxacin group had systemic inflammatory response syndrome (p=0.31). No patients died during one week follow up. Conclusions: From our study, it was concluded that ciprofloxacin and ceftriaxone had same efficacy when used intravenously for prevention of bacterial infection and improvement in mortality and morbidity in patient of variceal bleeding. Future multicentric studies are required with a longer patient follow to support our findings.

Cost-minimization analysis of oral versus intravenous antibiotic treatment for Klebsiella pneumoniae liver abscess

A cost-minimization analysis was conducted for Klebsiella pneumoniae liver abscess (KLA) patients enrolled in a randomized controlled trial which found oral ciprofloxacin to be non-inferior to intravenous (IV) ceftriaxone in terms of clinical outcomes. Healthcare service utilization and cost data were obtained from medical records and estimated from self-reported patient surveys in a non-inferiority trial of oral ciprofloxacin versus IV ceftriaxone administered to 152 hospitalized adults with KLA in Singapore between November 2013 and October 2017. Total costs were evaluated by category and payer, and compared between oral and IV antibiotic groups over the trial period of 12 weeks. Among the subset of 139 patients for whom cost data were collected, average total cost over 12 weeks was $16,378 (95% CI, $14,620–$18,136) for the oral ciprofloxacin group and $20,569 (95% CI, $18,296–$22,842) for the IV ceftriaxone group, largely driven by lower average outpatient costs, as the average number of outpatient visits was halved for the oral ciprofloxacin group. There were no other statistically significant differences, either in inpatient costs or in other informal healthcare costs. Oral ciprofloxacin is less costly than IV ceftriaxone in the treatment of Klebsiella liver abscess, largely driven by reduced outpatient service costs.Trial registration: ClinicalTrials.gov Identifier NCT01723150 (7/11/2012).

MP15-09 TADALAFIL VERSUS COMBINED TAMSOLUSIN AND CIPROFLOXACIN FOR TREATMENT OF CHRONIC PELVIC PAIN SYNDROME: A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP15-09 TADALAFIL VERSUS COMBINED TAMSOLUSIN AND CIPROFLOXACIN FOR TREATMENT OF CHRONIC PELVIC PAIN SYNDROME: A RANDOMIZED CONTROLLED TRIAL Marwan Anas, Ahmed EL-Hefnawy, and Ahmed Shoma Marwan AnasMarwan Anas More articles by this author , Ahmed EL-HefnawyAhmed EL-Hefnawy More articles by this author , and Ahmed ShomaAhmed Shoma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic prostatitis /Chronic pelvic pain syndrome (CP/CPPS) is still presenting true considerable challenge to urologists .It is characterized by confluence of symptoms including mainly suprapubic or deep perineal pain, and voiding symptoms. The exact etiology and pathogenesis of CP/CPPS remain unknown up till now. A specific diagnostic test for CP/CPPS is still not yet determined. Until now, there are no proven therapies for CP/CPPS. A wide variety of pharmacologic and non-pharmacologic therapies have been studied in clinical trials, but most have shown limited curative efficacy in symptom alleviation. Our aim To assess the efficacy and safety of PDEI-5 (Tadalafil) for treatment of CP/CPPS. METHODS: It is a prospective randomized controlled single blinded phase III clinical trial. Between May 2020 and April 2022, 97 patients with a diagnosis of type IIIa chronic non-bacterial prostatitis were enrolled in the final analysis at the end of study. Forty-nine for tadalafil (group A), who received combined tadalafil 5 mg once daily before bed time and placebo (sugar pills) after meal once daily for 12 weeks and forty-eight for combined tamsulosin and ciprofloxacin (group B) who received ciprofloxacin 1000 mg once daily PO after meal and tamsulosin 0.4 mg before bed time for the same period. Patients were followed for 12 weeks after administration of treatment. Primary end point was pain relief which was assessed by NIH-CPSI at 12 weeks after treatment. RESULTS: Patients baseline characteristics were comparable in both groups. At the end of RCT, tadalafil-group patients showed significant improvement in total, pain, urinary and Qol domains of NIH-CPSI compared to baseline (17.92±2.3, 7.41±1.56, 4.96±0.86, 5.55±0.79 vs. 30.88±3.62, 14.67±2.2, 6.67±1.17, 9.53±1.15 respectively, p<0.0001). When compared to combined tamsulosin and ciprofloxacin, all 12th week NIH-CPSI domains scores, except for urinary, were significantly better in tadalafil group (p<0.0001). Side-effects among group B were much higher than in group A. The most common side-effects in group A were dyspepsia (8.2%) and back pain (6.1%) while in group B were retrograde ejaculation (18.8%) and dizziness (16.7%). By the end of 12th week, 39 (79.6%) patients in group A showed marked improvement in GRA, while in group B, 41 (85.4%) patients showed moderate improvement. CONCLUSIONS: Tadalafil is effective and safe treatment modality for CP/CPPS. It has the advantage of giving more pain relief and improvement of sexual function compared with combined tamsulosin and ciprofloxacin. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e195 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marwan Anas More articles by this author Ahmed EL-Hefnawy More articles by this author Ahmed Shoma More articles by this author Expand All Advertisement PDF downloadLoading ...

ROLE OF DIMETHYL FUMARATE (NRF2 ACTIVATOR) IN REDUCING OF CIPROFLOXACIN-INDUCED HEPATOTOXICITY IN RATS VIA THE NRF2/HO-1 PATHWAY.

The aim: The present study aims to study the effect of DMF on ciprofloxacin-induced liver damage as assessed by liver function and liver pathology and to study this effect if it is thought to activate the Nrf2 antioxidant defense mechanism. Materials and methods: G1 (control), G2 (ciprofloxacin group), G3 and G4 (two DMF groups rats treated with DMF 50mg and 100mg), and G5 and G6 (two DMF groups rats treated with DMF 50mg and 100mg) (two ciprofloxacin Plus DMF at 50 mg and 100 mg). The tests included study of liver function, Nrf2 analysis, and anti-oxidant enzyme analysis. Results: The serum blood Nrf2, HO-1, and tissue anti-oxidant enzymes all increased after ciprofloxacin treatment. The serum levels of Nrf2 and HO-1 were higher in the ciprofloxacin plus DMF groups, but anti-oxidant enzymes were lower. DMF increased Nrf2 expression in rats when ciprofloxacin caused hepatotoxicity. Conclusions: DMF lowers experimental hepatotoxicity in vivo. This effect is thought to activate the Nrf2 antioxidant defense mechanism.

Hyperbaric oxygen therapy augments ciprofloxacin effect against Pseudomonas aeruginosa biofilm infected chronic wounds in a mouse model

IntroductionChronic wounds have a compromised microcirculation which leads to restricted gas exchange. The majority of these hypoxic wounds is infested with microorganisms congregating in biofilms which further hinders the antibiotic function. We speculate whether this process can be counteracted by hyperbaric oxygen therapy (HBOT). MethodologyTwenty-eight BALB/c mice with third-degree burns were included in the analyses. Pseudomonas aeruginosa embedded in seaweed alginate beads was injected under the eschar to mimic a biofilm infected wound. Challenged mice were randomized to receive either 4 days with 1 x ciprofloxacin combined with 2 × 90 min HBOT at 2.8 standard atmosphere daily, 1 x ciprofloxacin as monotherapy or saline as placebo. The mice were clinically scored, and wound sizes were estimated by planimetry daily. Euthanasia was performed on day 8. Wounds were surgically removed in toto, homogenized and plated for quantitative bacteriology. Homogenate supernatants were used for cytokine analysis. ResultsP. aeruginosa was present in all wounds at euthanasia. A significant lower bacterial load was seen in the HBOT group compared to either the monotherapy ciprofloxacin group (p = 0.0008), or the placebo group (p < 0.0001). IL-1β level was significantly lower in the HBOT group compared to the placebo group (p = 0.0007). Both treatment groups had higher osteopontin levels than the placebo group (p = 0.002 and p = 0.004). The same pattern was seen in the S100A9 analysis (p = 0.01 and p = 0.008), whereas no differences were detected between the S100A8, the VEGF or the MMP8 levels in the three groups. ConclusionThese findings show that HBOT improves the bactericidal activity of ciprofloxacin against P. aeruginosa wound biofilm in vivo. HBOT in addition to ciprofloxacin also modulates the host response to a less inflammatory phenotype.

Protective effect of cinnamon oil against ciprofloxacin toxicity on liver and kidney of male Wistar rats

Cinnamon zeylanicum is one of many herbal medications. This herb contains different materials like, cumarin, cinnamaldehyde and cinnamic acid. The plant plays a role as antiallergic, antiviral, antimicrobial, anti-inflammatory and antioxidant and other health conditions. This study focused on the therapeutic effect of cinnamon oil on hepatorenal toxicity induced by ciprofloxacin in male rats. Forty rats were housed in the animal house of the College of Pharmacy, University of Kerbala, Karbala city, Iraq. The animals were separated into four groups: Group 1. Control group (not taken drug nor cinnamon oil), Group 2. Ciprofloxacin group (drenched 250 mg/kg/day of ciprofloxacin for 30 days), Group 3. Cinnamon oil group (drenched 1ml/kg/day of cinnamon oil for 30 days) and Group 4. Cinnamon+ciprofloxacin group (drenched 1ml/kg/day of cinnamon + 250 mg/kg/day of ciprofloxacin for 30 days). Finally, 2ml of blood was collected from each rat and the serum was separated for estimating the biochemical parameters of the liver like, Aspartate transaminase (AST), alanine transaminase(ALT) and alkaline phosphatase(ALP) and the kidney (Creatinine, Urea and albumin) . The results proved that ciprofloxacin significantly elevates the parameters of the liver and kidney (p≤0.05). The results also proved the benefit of cinnamon oil in improving health by reducing the toxic effect of ciprofloxacin by lowering the elevated levels of (liver enzymes, creatinine, urea and albumin). The study showed that this oil reduced the toxic effect of ciprofloxacin on the kidney and liver.

Influence of Antibiotic Administration on the Urinary Bladder Cancer Early Recurrence Rate.

Bladder cancer tends to recur, making treatment one of the most expensive in oncology. The limited efficacy and high cost of adjuvant therapies in the treatment of bladder cancer prompt research on new drugs which could replace them. In vitro studies have established that antibiotics can have a cytostatic and cytotoxic effect on urinary bladder cancer cells. The objective of the study was to investigate the influence of antibiotics on the recurrence rate of bladder cancer. In a retrospective study, we analyzed a group of 199 patients with urinary bladder cancer from four urological centers. The study groups consisted of 40 patients who received ciprofloxacin and 83 patients who received beta-lactams as perioperative antimicrobial prophylaxis. The control group included 76 patients who did not get perioperative antimicrobial prophylaxis. The groups were analyzed for risk stratification, degree of malignancy, and size of the primary tumor. The average follow-up time was 24 months. The main focus of the study was to investigate the early recurrence rate of bladder cancer among studied groups, which could correlate with the effectiveness of currently used intravesical instillations. Additionally, cancer's early progression was examined. Regardless of the division used, the highest recurrence rate was found in the ciprofloxacin group. There were no statistical differences in the recurrence rate between patients who received beta-lactams and patients who did not receive any antibiotics. In addition, there were no differences due to the progression rate between the groups. Perioperative antibiotic administration does not influence the early recurrence rate in patients with nonmuscle invasive urothelial bladder cancer.