News HIV/AIDS News & Information - Part 9

30 Nov

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Cost Analysis

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Cost AnalysisCost Analysis
Intravenous ciprofloxacin or another comparable intravenous quinolone has, as yet, not been approved by federal drug agency, and thus, the market cost of the intravenous preparation is not available. However, comparable cost analysis of oral ciprofloxacin with other conventional therapies is available. In one study, IV cefotaxime was compared with oral ciprofloxacin in the treatment of soft-tissue infections. Thirty-two patients were treated with cefotaxime, 2 g IV every eight hours. Ciprofloxacin was given to 24 patients at a dose of750 mg orally every 12 hours. The mean duration of therapy in both groups was approximately 11.5 days and the clinical results were comparable in both groups. The daily cost of cefotaxime totaled $59 per day compared to approximately $9.00 per day for ciprofloxacin, and the cost savings of $50/ day or $579/total course of therapy could be achieved. If the 32 patients who had received cefotaxime had been treated with ciprofloxacin, a total savings of $18,000 could have been realized without any compromise in clinical efficacy. Continue Reading »

29 Nov

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Penetration of the drug

The average penetration of the drug into bronchial mucosa was 161 percent but was found to be quite variable. Although the sputum levels are low, the bronchial mucosa levels are very high. Marlin et al studied the distribution ratio of enoxacin between plasma and bronchial mucosa in patients after distribution equilibrium was established. They also compared the absolute bronchial mucosal concentration achieved with the in vitro bacterial activity of enoxacin. Eighteen patients received enoxacin, 400 mg twice daily, for four days; on the fifth morning, a 500 mg dose of enoxacin was given to all 18 patients. Bronchial mucosal biopsies and plasma samples were obtained at three, four, or five hours in six patients each, and the samples were assayed for enoxacin by high-pressure liquid chromatography. Marlin et al concluded that equilibrium between bronchial mucosa and plasma is achieved within three hours of dose. Continue Reading »

28 Nov

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Bronchial mucosa

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Bronchial mucosaThe four quinolones, enoxacin, pefloxacin, ciprofloxacin, ofloxacin, have unique properties of penetrating into the bronchial lining and achieving high concentrations in the lung, in the bronchial mucosa, and in the sputum. Bergogne et al studied 21 patients who received a single oral dose of 500 mg ciprofloxacin. Ten successive samples of the sputum were collected over a 12-hour period. The serum levels peaked at 2.2 ± 1.3 mg/L at two hours and decreased slowly to .6 ±0.4 mg/L at six hours. The corresponding bronchial levels were .5 mg/L at two hours and they stayed stable until six hours with a range of 0.5 to 0.8 mg/L. The ratio of serum to bronchial fluid levels at two hours was 0.19 to 0.95 at six hours. In another study, the same author reported on the penetration of ciprofloxacin into the lung parenchymal tissue. Intravenous 100 mg ciprofloxacin was given and surgical samples of the lung were obtained. More info
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27 Nov

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Role of ciprofloxacin

In our center, the most common bacteria identified during exacerbations of chronic lung disease or nosocomial infection are Hemophilus, Pseudomonas aeruginosa, Klebsiella, and Staphylococcus aureus. These organisms, as well as other Gram-negative and Gram-positive organisms tested, were highly susceptible to ciprofloxacin with MICs of 1 jig/ml or less in all cases. Thus, ciprofloxacin can be expected to be effective in hospitalized patients with nosocomial, Gram-negative infections or elderly patients who have a higher incidence of Staphylococcus aureus infection. The adverse reactions to ciprofloxacin were generally mild and self-limiting, the most common being skin rash; and in one of the patients, the drug therapy was discontinued because of the skin rash. Contrary to our earlier experience where we encountered significant interaction between ciprofloxacin and theophylline when 750 mg was used twice a day, in this study, we encountered no interaction between ciprofloxacin and theophylline in the 21 patients who received both drugs. In another study where we compared the effectiveness of oral 250 mg bid vs ampicillin in the treatment of mild respiratory infection, we also did not encounter any interaction between ciprofloxacin and theophylline. We now feel that this interaction is dose-related and encountered only when more than 1,000 mg of ciprofloxacin is used. canadian health & care mall
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26 Nov

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Cystic Fibrosis

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Cystic FibrosisCystic Fibrosis
A number of studies have reported on the effectiveness of oral ciprofloxacin in the treatment of bacterial infection in cystic fibrosis. Oral ciprofloxacin is of special interest in the treatment of patients with cystic fibrosis in view of ciprofloxacins special activity against Pseudomonas aeruginosa, S aureus, and Hemophilus influenzae, the three pathogens which, not uncommonly, cause exacerbations in patients with cystic fibrosis. The attraction lies in safety, oral bioavailability, and possible outpatient use. Some studies show the emergence of resistance. Interestingly, this resistance does not predict clinical failure. Ciprofloxacin might be useful for prolonged chemotherapy following maximum suppression of Pseudomonas aeruginosa by parenteral agents. there
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25 Nov

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Discussion

Oral ciprofloxacin has been found to be quite effective in the treatment of various forms of respiratory tract infection. Contrary to the favorable results found by Gleedhill et al and Kobayashi, Davies, in his study of oral ciprofloxacin for respiratory tract infection, reported several problems; most of the problems were due to resistance or recurrence of streptococcal pneumonia infection or failure to eradicate Pseudomonas. We also reported on a large, prospective, double-blind, randomized study where we compared ciprofloxacin, 750 mg twice a day, with ampicillin in the treatment of bacterial respiratory tract infection. Eight-seven patients received either ciprofloxacin or oral ampicillin. Ciprofloxacin was as effective as ampicillin and produced a 98 percent clinical cure rate. Significantly more pretreatment bacterial isolates were susceptible to ciprofloxacin (p value of less than 0.05), and ciprofloxacin had a significantly higher rate of sputum bacterial eradication than ampicillin (p values of less than 0.05). Continue Reading »

24 Nov

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Microbiologic Results

Sequential Intravenous-Oral Administration of Ciprofloxacin vs Ceftazidime in Serious Bacterial Respiratory Tract Infections: Microbiologic ResultsMicrobiologic Results
Table 1 summarizes the type and number of isolates recovered in the 87 patients, as well as the disk susceptibility for these isolates and the available MIC values of 118 isolates. Significantly more isolates were susceptible to ciprofloxacin than to ceftazidime as determined by the diflusion technique. The MIC values reveal that ciprofloxacin was more active in vitro than ceftazidime against the strains of Gram-negative bacteria tested. All nine of the Enterobacter isolates were susceptible to ciprofloxacin at a concentration equal to or less than 0.06 μg/ml, while four of these nine isolates were resistant to ceftazidime. The MIC values of ciprofloxacin for the Pseudomonas aeruginosa species range from .06 to 1.0 μg/ml. Ciprofloxacin was more active than ceftazidime against isolates of Hemophilus influenzae. All the isolates were susceptible to ciprofloxacin (MIC less than 1 μg/ml), with an MIC range equal to or less than .008 to 0.5 μg/ml. mycanadianfamilypharmacy.net

The isolates of Staphylococcus aureus tested were sensitive to ciprofloxacin. Ceftazidime was more effective than ciprofloxacin against the 12 isolates of Streptococcus pneumoniae, with 12 of 12 of the isolates susceptible to ceftazidime and nine of 12 susceptible to ciprofloxacin. Three of the 46 patients in the ciprofloxacin group and three of the 41 patients in the ceftazidime group had organisms persisting at the end of the treatment. Continue Reading »

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