Oral Ciprofloxacin Prophylaxis Research Articles

Comparing infective complications from transrectal ultrasound guided prostate biopsy following transition to single dose oral ciprofloxacin prophylaxis.

PurposeTo examine the incidence of infective complications post Transrectal Ultrasound Guided Prostate Biopsy (TRUSPB), after transition to preoperative administration of single dose oral ciprofloxacin.Materials and MethodsA retrospective study of 766 consecutive patients undergoing TRUSPB at St Vincent's Hospital Melbourne (2002–2016). Antibiotic prophylaxis between 2002–2014 consisted of 3 days of perioperative oral norfloxacin±intravenous (IV) antibiotics (Group A, n=687). From November 2014 patients received a single dose of oral 750 mg ciprofloxacin pre-biopsy (Group B, n=79), to align with the American Urological Association (AUA) and a Cochrane Database Systematic Review on Antibiotic Prophylaxis for TRUSPB. Groups were compared for all postoperative complications requiring representation and/or readmission within 30 days of biopsy.ResultsIn Group A, 10 of 687 patients (1.5%) re-presented with post-procedural fever (temperature >38℃), requiring readmission and IV antibiotic treatment, compared to 4 of the 79 patients (5.1%) in Group B (p=0.02). Positive blood cultures were isolated in 0.9% (n=6, Group A) versus 3.8% (n=3, Group B) (p=0.02). The 4 infectious readmissions in Group B had no prior genitourinary infections, no recent travel and all had a Charlson Comorbidity Index scores <2. Two patients in Group B cultured Escherichia coli sensitive to ciprofloxacin despite receiving preoperative ciprofloxacin.ConclusionsAntibiotic prophylaxis using single dose ciprofloxacin is associated with higher infective complications post TRUSPB. The episodes of ciprofloxacin sensitive E. coli bacteraemia in Group B suggest consideration of a longer course of perioperative antibiotic prophylaxis.

Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial.

BackgroundAntibiotic prophylaxis for contacts of meningitis cases is not recommended during outbreaks in the African meningitis belt. We assessed the effectiveness of single-dose oral ciprofloxacin administered to household contacts and in village-wide distributions on the overall attack rate (AR) in an outbreak of meningococcal meningitis.Methods and findingsIn this 3-arm, open-label, cluster-randomized trial during a meningococcal meningitis outbreak in Madarounfa District, Niger, villages notifying a suspected case were randomly assigned (1:1:1) to standard care (the control arm), single-dose oral ciprofloxacin for household contacts within 24 hours of case notification, or village-wide distribution of ciprofloxacin within 72 hours of first case notification. The primary outcome was the overall AR of suspected meningitis after inclusion. A random sample of 20 participating villages was enrolled to document any changes in fecal carriage prevalence of ciprofloxacin-resistant and extended-spectrum beta-lactamase (ESBL)–producing Enterobacteriaceae before and after the intervention. Between April 22 and May 18, 2017, 49 villages were included: 17 to the control arm, 17 to household prophylaxis, and 15 to village-wide prophylaxis. A total of 248 cases were notified in the study after the index cases. The AR was 451 per 100,000 persons in the control arm, 386 per 100,000 persons in the household prophylaxis arm (t test versus control p = 0.68), and 190 per 100,000 persons in the village-wide prophylaxis arm (t test versus control p = 0.032). The adjusted AR ratio between the household prophylaxis arm and the control arm was 0.94 (95% CI 0.52–1.73, p = 0.85), and the adjusted AR ratio between the village-wide prophylaxis arm and the control arm was 0.40 (95% CI 0.19‒0.87, p = 0.022). No adverse events were notified. Baseline carriage prevalence of ciprofloxacin-resistant Enterobacteriaceae was 95% and of ESBL-producing Enterobacteriaceae was >90%, and did not change post-intervention. One limitation of the study was the small number of cerebrospinal fluid samples sent for confirmatory testing.ConclusionsVillage-wide distribution of single-dose oral ciprofloxacin within 72 hours of case notification reduced overall meningitis AR. Distributions of ciprofloxacin could be an effective tool in future meningitis outbreak responses, but further studies investigating length of protection, effectiveness in urban settings, and potential impact on antimicrobial resistance patterns should be carried out.Trial registrationClinicalTrials.gov NCT02724046

Single-dose oral ciprofloxacin prophylaxis in response to a meningococcal meningitis epidemic in the African meningitis belt: three-arm cluster-randomized trial

This abstract corresponds with the following slides: https://f1000research.com/slides/7-629 presented at Medecins Sans Frontieres UK Scientific Days: Medical Research 2018. To watch the presentation click here: https://f1000research.com/videos/7-829 This abstract is part of an F1000Research gateway that includes posters, slides and videos from the MSF Scientific Day: Medical Research 2018. To see more please visit: https://f1000research.com/gateways/MSF/scidays

Oral Ciprofloxacin Prophylaxis in Patients Undergoing High DoseTherapy and Autologous Hematopoietic Stem Cell Transplantation.

Antibiotic prophylaxis is usually used in allogeneic stem cell transplantation, but its use in Autologous Stem Cell Transplantation (ASCT) is controversial. We evaluated the efficacy of ciprofloxacin prophylaxis in ASCT. To identify the efficacy of ciprofloxacin on the incidence of neutropenic fever and its complications, 72 patients that had been admitted to Taleghani Hospital for ASCT between 2010 and 2012 were evaluated in our study. Oral ciprofloxacin 500 mg every 12 h was administered to 30 patients on the same day of high dose chemotherapy until the first febrile episode or until the recovery of neutropenia and the results were analyzed and compared with the historical control group 42 other transplanted patients who had not previously received ciprofloxacin. The incidence of neutropenic fever was 80% with no difference between the two groups. But in ciprofloxacin group, duration of fever (1.7 days VS 3.5 days P=0.017), hospitalization due to stem cell transfusion (18.2 days VS 12.2 days p=0.03), incidence of bacteremia 3.3 % VS 33.3%, p=0.002) and platelet recovery (13.9 VS 17.7 days= 0.035) and platelet transfusions (P=0.04) were significantly lower than the control group no side effects and no delay in. Based on this study oral ciprofloxacin prophylaxis is rational, efficacious and economic in ASCT.

Transmission of Aeromonas hydrophila by leeches

On July 1, 2012, a 47-year-old man sustained a crush injury of the left hand and was admitted to the Hand Emergency Unit, Conception Hospital, Marseille Public Hospitals, Marseille, France, with a large palmar skin defect. Emergency reconstruction of the palmar wound was done with a radial forearm fl ap. From day 2 to day 6 after surgery, ten leeches were applied to the fl ap to treat venous congestion, and oral ciprofl oxacin prophylaxis (1 g per day) was given. On day 6, the patient developed a body temperature of 37·8°C. On examination, the fl ap was foul smelling. 3 days later, surgical debridement was done because of some fl ap necrosis and the presence of pus. A daily combination of oral clindamycin, metronidazole, and cotrimoxazole was started. Perioperative sampling enabled isolation of an Aeromonas hydrophila strain that was resistant to ciprofl oxacin (minimum inhibitory concen tration [MIC] 3·0 μg/mL by Epsilometer test [AB-Biodisk, Solna, Sweden]), a phenotype that had not been previously seen in our hospital. Subsequently, cotrimoxa zole alone was given for a further 16 days. The patient was last seen on Oct 23, 2013, when he was judged cured. On July 25, 2012, the same ciprofl oxacin-resistant A hydrophila strain was isolated from the necrotising righthand dorsal fl ap of a 35-year-old patient who had been treated with 11 leeches from the same batch, despite ciprofl oxacin prophylaxis. Of the seven patients treated with leeches from the same batch in July, 2012, surgical site A hydrophila infection was identifi ed in two. Cultures of 100 mL of water from the two leech aquariums grew ciprofl oxacin-resistant A hydrophila, but bottled mineral water used to fi ll these aquariums was sterile. Ciprofl oxacinresistant A hydrophila was also grown from a new batch of 50 leeches that were tested on arrival. Lancet 2013; 381: 1686

Increased intestinal permeability as a predictor of bacterial infections in patients with decompensated liver cirrhosis and hemorrhage

There have been no trials comparing the prophylactic effect of oral quinolone and intravenous cephalosporin antibiotics and elucidating the predictive factors for the occurrence of bacterial infections in cirrhotic patients with gastrointestinal bleeding in Asian-Pacific region. One hundred and thirteen patients with advanced liver cirrhosis and active gastrointestinal hemorrhage were enrolled in our study. The patients were randomly allocated into either the oral ciprofloxacin group (n = 50, 500 mg every 12 h) or the intravenous ceftriaxone group (n = 63, 2.0 g per day for 7 days). Proven or possible infections were significantly more frequent in the patients in the oral ciprofloxacin group (34.0%) than the intravenous ceftriaxone group (14.3%, P = 0.002). The intestinal permeability index (IPI, mean [SD]) measured the day after admission was significantly higher in the patients with proven or possible infections (1.45 [0.96]) compared with the no infection group (0.46 [0.48], P <0.01). By multivariate analysis, oral ciprofloxacin prophylaxis and higher IPI at the time of inclusion were independent and significant predictors for proven or possible infections. By receiver operating characteristic curve analysis, the best cutoff value of IPI for the prediction of the occurrence of bacterial infection was 0.62%. The frequency of proven or possible infections was significantly lower in the intravenous ceftriaxone group compared with the oral ciprofloxacin group. The IPI measured the day after admission is a good clinical parameter predicting the occurrence of infection in these patients.

Efficacy of Oral Ciprofloxacin Prophylaxis in BMT Recipients: A Case-Control Study.

Bacterial infections remain a major source for morbidity and mortality in peripheral stem cell (PSC) and bone marrow (BM) transplant recipients. Despite the considerable number clinical trials, there is still no consensus of opinions for the use of antibiotic prophylaxis. In order to analyze the impact on bacteraemia of withdrawing ciprofloxacin prophylaxis from PSC and BM transplant patients during neutropenia, a total of 617 records were reviewed and found suitable for analysis; 310 autologous and 307 allogenic from Jan 4, 2001 to Dec 27, 2005. Ciprofloxacin was used as a prophylactic measure among all these autologous and allogenic stem cell and bone marrow transplant patients until January 31, 2004. As of February 1, 2004, it was no longer given as a prophylactic measure. Patient characteristics were found similar in the group with ciprofloxacin prophylaxis and the group without ciprofloxacin prophylaxis. Resistant bacteraemia was defined as either ciprofloxacin resistant gram negative bacteria, or VRE, or MRSA. For the analysis the two proportions were compared with a log binomial regression model using generalized estimating equations to account for the lack of independence in the observations. Bacteraemia was the dependent variable, and time periods prior transplant year and year of transplant were included as independent variables. The model was used to generate variance estimates for the proportions, and to check for confounding. Prior transplant year or year of transplant were not confounding variables so, there was no need for adjusted estimates. The analysis shows that the relative risk of developing bacteraemia in the autologous and allogenic groups after ciprofloxacin prophylaxis was discontinued compared with when it was used routinely in the same group was 0.6 (95% CI: 0.2–1.6) and 0.8 (95% CI: 0.4–1.6) respectively. The change in the proportion of patients developing bacteraemia was not statistically significant .The estimation of 100 day-survival from transplant was determined by time period using the Kaplan-Meier Method. The analysis was limited to patients who did not have a prior transplant. In the autologous group, no difference was found when ciprofloxacin prophylaxis was used routinely (n=155): 93.6 (95% CI: 88.3–96.5) versus ciprofloxacin prophylaxis not used (n=112): 94.1 (95% CI: 88.1–97.2). Likewise, no difference was found in the allogenic group when ciprofloxacin prophylaxis used routinely (n=135): 88.9 (95% CI: 82.3–93.2) versus Ciprofloxacin prophylaxis not used (n=106): 87.7 (95% CI: 79.8–92.7). The incidence of bacteraemia with resistant organisms was not statistically significant in both groups. In the autologous groups the incidence was 2 (18.2%) with ciprofloxacin prophylaxis and 1 (20.0%) without ciprofloxacin prophylaxis. In the allogenic group the incidence was 5 (2.8%) with ciprofloxacin prophylaxis and 3 (2.3%) without ciprofloxacin prophylaxis . Overall, in our institution, stopping ciprofloxacin prophylaxis did not significantly affect the incidence of bacteraemia, the 100 days all-cause mortality or the incidence of antibiotic resistant bacteraemia among allogenic and autologous transplant patients. As a result, ciprofloxacin prophylaxis has been suspended and a surveillance program has been adopted.

Single-dose oral ciprofloxacin compared with single-dose intravenous cefazolin for prophylaxis in inguinal hernia repair: a controlled randomized clinical study

The aim of this study was to compare the efficacy of single-dose intravenous cefazolin prophylaxis with single-dose oral ciprofloxacin prophylaxis in patients undergoing tension-free inguinal hernia repair with polypropylene mesh. In a prospective and randomized setting, 395 patients received either a single dose of 500 mg of ciprofloxacin orally, 1--2h before the operation, or a single dose of 1g cefazolin intravenously on induction of anaesthesia. The primary outcome was to determine the wound infection rate within one year. The overall infection among the entire study population was 2% (eight of 395) including 2% (four of 199) of those receiving intravenous cefazolin and 2% (four of 196) of those treated with oral ciprofloxacin. There was no statistically significant difference between groups (P=0.59). All the infections were superficial incisional surgical site infections, and none progressed to a deep infection. Escherichia coli was the most commonly isolated bacterium. None of the infected patients developed recurrence of hernia. The rate of recurrence was 1.3% (five of 395) at one year including 2% (four of 199) of those receiving cefazolin and 0.5% (one of 196) of those receiving ciprofloxacin. Oral ciprofloxacin prophylaxis was found to be an attractive option with its wide antibacterial spectrum, low cost and ease of administration in patients undergoing tension-free inguinal hernia repair with polypropylene mesh.

Single-dose oral ciprofloxacin compared with cefotaxime and placebo for prophylaxis during transurethral surgery

To determine the efficacy and safety of single-dose oral ciprofloxacin prophylaxis for the prevention of post-operative bacteriuria following transurethral resection of the prostate or bladder tumour, a prospective, randomized, double-blind, placebo-controlled trial was conducted. Five hundred and eighteen patients were randomized in a 2:2:1 ratio to receive ciprofloxacin 500 mg, cefotaxime 1 g or placebo 30-90 min before surgery. Of the 368 efficacy-evaluable patients, five (3.3%) ciprofloxacin, seven (4.8%) cefotaxime and five (7.0%) placebo recipients had post-operative bacteriuria (> or = 10(4) cfu/mL) during post-operative days 2-15. Five (3.4%) ciprofloxacin, five (3.4%) cefotaxime and one (2.4%) placebo recipients were considered clinical failures, of whom one, two and one patients, respectively, had concomitant bacteriuria. Drug-related adverse events were reported in six of 204 (3%) ciprofloxacin, 12 of 197 (6%) cefotaxime and one of 101 (1%) placebo patients. The observed rates of post-operative bacteriuria suggest that a single 500 mg dose of ciprofloxacin is suitable prophylaxis for transurethral surgery.

Post-Intercourse Versus Daily Ciprofloxacin Prophylaxis for Recurrent Urinary Tract Infections in Premenopausal Women

We evaluated and compared the efficacy of post-intercourse and daily oral ciprofloxacin prophylaxis against recurrent lower urinary tract infections in 135 sexually active premenopausal women. Post-intercourse (group 1, 70 patients) and daily (group 2, 65 patients) prophylactic regimens of 125 mg. ciprofloxacin were started following a curative, conventional treatment of the initial acute urinary tract infection. Prophylaxis was maintained for 12 months and during this period patients were followed clinically and bacteriologically with urine and introital samples. Patients were subsequently followed for an additional year after the end of preventive treatment. While 3.67 urinary tract infections per patient in group 1 and 3.74 in group 2 occurred during an identical mean time of 12.2 months before start of the corresponding prophylactic regimen, only 0.043 infection per patient in group 1 and 0.031 in group 2 developed during prophylaxis (p < 0.0001). Before prophylaxis 86% of the vaginal vestibule cultures yielded gram-negative Enterobacteriaceae, equally distributed between both treatment arms, compared to 5.6% and 2.5% during postcoital and daily prophylaxis, respectively. The overall improvement in the incidence of the urinary infections per patient and the rate of introital colonization with enteric gram-negative bacteria was maintained after the end of prophylaxis, with a mean incidence of infections of 0.44 per patient (occurring in 34% of the total patient population), while 36% of all women had abnormal introital colonization. Long-term post-intercourse prophylaxis with ciprofloxacin proved to be equally effective as daily prophylaxis, and the major advantage of the former therapy was use of only a third of the amount of drug consumed in daily prophylaxis.

Short-course intravenous antibiotics with oral quinolone prophylaxis in the treatment of neutropenic fever in autologous bone marrow or peripheral blood progenitor cell transplant recipients.

The effectiveness of short-course intravenous antibiotics concurrent with prophylactic oral ciprofloxacin in the treatment of neutropenic fever was studied in 81 patients undergoing autologous bone marrow or peripheral blood progenitor cell transplantation (ABMT or PBPCT). During the neutropenic period following ABMT or PBPCT, 10/81 (12%) patients did not require treatment with intravenous antibiotics. Seventy-one patients required antibiotics. Forty-seven of the 71 (66%) responded to 72 h treatment with gentamicin, azlocillin or ceftazidime, and vancomycin. Thirty-three of the 47 (70%) responders had a complete resolution of their fever with no further recurrence. Fourteen of the 47 responders developed a second fever between 2 and 25 days after stopping first-line antibiotics. Eleven of the 14 patients responded to a second course of intravenous antibiotics. Twenty-four of the 71 patients did not respond to intravenous antibiotics and were treated with intravenous amphotericin and the intravenous antibacterial agents were discontinued. Eighteen of the 24 patients responded to amphotericin. The 6 patients who had persistent fever resolved their temperature when their neutrophil count recovered. There were no deaths due to infection during the study. Short-duration intravenous antibiotics in conjuction with oral ciprofloxacin prophylaxis are a safe and effective treatment for neutropenic fever.