Ciprofloxacin pharmacokinetics in critically ill patients: a prospective cohort study.

نویسندگان

  • Arthur R H van Zanten
  • Kees H Polderman
  • Ingeborg M van Geijlswijk
  • Gert Y G van der Meer
  • Marinus A Schouten
  • Armand R J Girbes
چکیده

PURPOSE Optimal dosing of antibiotics is important for efficacy and avoidance of resistance. Fluoroquinolones are frequently used to treat severe infections in critically ill patients. We studied ciprofloxacin pharmacokinetics after administration of 400 mg twice a day (bid) intravenously (IV). MATERIAL AND METHODS Serum concentrations were measured in 32 intensive care unit patients (age, 68.7 +/- 17.4 years; Sepsis-related Organ Failure Assessment (SOFA) scores, 7.3 +/- 3.4). Blood samples were drawn at 7 time points after ciprofloxacin infusion. We evaluated whether areas under the curve (AUCs) exceeded minimal inhibitory concentration (MIC) values of 0.125, 0.25, 0.5, 1.0, and 2.0 mg/L by 125 times and peak concentrations (C(max)) 10 x MIC (C(max)/MIC >10). RESULTS The AUC/MIC more than 125 was achieved in 100% for MIC 0.125. For MIC values 0.25, 0.5, 1.0, and 2.0, results were 84%, 31%, 3%, and 0%, respectively (P < .01). The C(max)/MIC more than 10 for MIC values of 0.125, 0.25, 0.5, 1.0, and 2.0 was realized in 100%, 97%, 69%, 25%, and 0%, respectively (P < .01). Female sex, SOFA(pulmonary) points, and SOFA(renal) points predicted higher AUC. Cumulative SOFA scores were most predictive of high AUCs. CONCLUSIONS Ciprofloxacin 400 mg bid IV leads to inadequate AUC/MIC and C(max)/MIC ratios in many cases. Effective killing concentrations were only achieved in pathogens with MIC less than 0.25. As bacteria in intensive care unit patients often exceed this threshold, we recommend to use higher doses of ciprofloxacin (1200 mg daily) to ensure optimal bacterial killing and avoid antibiotic resistance.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

The administration of ciprofloxacin during continuous renal replacement therapy: pilot study.

Continuous renal replacement therapy (CRRT) is a common technique in critically ill patients. However, there is no uniformity in the pharmacokinetics of ciprofloxacin (CPFX) used during CRRT. The aims of the present study were to estimate the pharmacokinetics of CPFX and to determine the appropriate administration of CPFX for critically ill patients undergoing CRRT. The pharmacokinetics of cipr...

متن کامل

Pharmacokinetics Alterations of Midazolam Infusion versus Bolus Administration in Mechanically Ventilated Critically Ill Patients

There is no randomized study carried out in order to compare their pharmacokinetic parameters although midazolam, as a sedative, has been widely administered via continuous infusion as well as intermittent bolus doses in mechanically ventilated critically ill patients. We prospectively investigated the effect of these two principal methods on pharmacokinetic parameters in 23 of mentioned patien...

متن کامل

Pharmacokinetics Alterations of Midazolam Infusion versus Bolus Administration in Mechanically Ventilated Critically Ill Patients

There is no randomized study carried out in order to compare their pharmacokinetic parameters although midazolam, as a sedative, has been widely administered via continuous infusion as well as intermittent bolus doses in mechanically ventilated critically ill patients. We prospectively investigated the effect of these two principal methods on pharmacokinetic parameters in 23 of mentioned patien...

متن کامل

Pharmacokinetics of levofloxacin and ciprofloxacin during continuous renal replacement therapy in critically ill patients.

The pharmacokinetics of intravenously administered levofloxacin and ciprofloxacin were studied in intensive care unit patients during continuous venovenous hemofiltration (CVVH; four patients received levofloxacin, and five received ciprofloxacin) or hemodiafiltration (CVVHDF; six patients received levofloxacin, and five received ciprofloxacin). Levofloxacin clearance was substantially increase...

متن کامل

The PK/PD index for ciprofloxacin in critically ill patients

Introduction. The aim of the study was an analysis of pharmacokinetics and PK/PD parameters Cmax/MIC and AUC/MIC for ciprofloxacin in intensive care unit patients. Material and methods. Patients (n=3) received ciprofloxacin intravenously at 400 mg/ 8 h. Blood samples were collected on day 1st of the ciprofloxacin therapy. Plasma drug concentrations were measured by HPLC-UV method. Results. The ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Journal of critical care

دوره 23 3  شماره 

صفحات  -

تاریخ انتشار 2008