A clinical, microbiological and pharmacokinetic study of ciprofloxacin plus vancomycin as initial therapy of febrile episodes in neutropenic patients

Vancomycin in combination with ciprofloxacin exhibited synergy against 7 of 10 strains of Pseudomonas aeruginosa. MICs for the microbial strains used in this study ranged from 0.0325 to 3.0 micrograms/ml for ciprofloxacin and from 23.5 to > 188 micrograms/ml for vancomycin. Combinations of these antibiotics, tested in a checkerboard pattern, gave fractional inhibitory concentrations of 0.5 or less for 7 of the 10 strains tested.

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confidence: 90%

“…Vancomycin used in combination with ciprofloxacin against gram-positive microorganisms had an antagonistic effect (14,16,18). An in vivo study of a combination of ciprofloxacin and vancomycin for treatment of bacteremias showed a 70% improvement for treatment of gram-negative infections and no antagonism between the antibiotics.…”

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confidence: 99%

Increased susceptibility of Pseudomonas aeruginosa to ciprofloxacin in the presence of vancomycin

Day¹,

Marceau-Day²,

Day³

1993

“…Agents such as norfloxacin and ciprofloxacin are used in most large cancer treatment centers for antimicrobial prophylaxis in high-risk patients with prolonged neutropenia, including patients with acute leukemia and recipients of bone marrow transplantations (2,4,15). Ciprofloxacin has also been used in combination with various agents (aminoglycosides, beta-lactams, vancomycin, and clindamycin) for the treatment of febrile episodes in neutropenic patients, both in the hospital and in an ambulatory care setting (1,3,10,12,13). Aniong the currently available quinolones, ciprofloxacin is the most potent, particularly against gram-negative bacilli, including Pseuydomonas aeruginosa, and any promising newer agents belonging to this class need to be compared with ciprofloxacin.…”

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confidence: 99%

Susceptibilities of bacterial isolates from patients with cancer to levofloxacin and other quinolones

Dholakia

Rolston

et al. 1994

The antibacterial activity of levofloxacin was compared with those of ofloxacin and ciprofloxacin against bacterial isolates from patients with cancer. In general, levofloxacin was as active or was twofold more active than ofloxacin and was two-to fourfold less active than ciprofloxacin against most gram-negative pathogens. Against Pseudomonas aeruginosa, ciprofloxacin was the most active agent tested (MIC for 90% of isolates tested, 1.0 jig/ml). Overall, all three agents had similar activities against gram-positive organisms and were moderately active against methicillin-susceptible Staphylococcus aureus and coagulase-negative staphylococci, Streptococcus species, and Enterococcus species.During the past decade a large number of newer quinolones have been developed. Most of these agents, including norfloxacin, ciprofloxacin, ofloxacin, lomefloxacin, and fleroxacin, have broader antimicrobial spectra and improved bioavailabilities in comparison with those of naladixic acid (16). Some have been used for infection prevention and for the treatment of established infections in neutropenic cancer patients (2, 6, 10, 15). More recently, broad-spectrum quinolones such as ciprofloxacin, which are available for parenteral and oral administration, have made it possible to shorten the duration of antibiotic administration to febrile cancer patients in the hospital by facilitating the early discharge of such patients on oral antibiotic therapy (3). Certain low-risk neutropenic patients have even been treated as outpatients during the entire febrile episode (12). These newer applications have widened the scope of the quinolones as antibacterial agents. However, the widespread prophylactic and therapeutic usage of quinolones in neutropenic cancer patients has raised concern about the emergence of resistance to them and a reduction in their overall impact as clinically useful antibiotics.Ofloxacin exists as two optically active isomers because of the asymmetric center at C-3 of the oxazine ring, and levofloxacin (l-ofloxacin) is the more active isomer (4,5,14 796-8578. Anderson Cancer Center at Houston during the past 5 years. The majority (>90%) of these isolates were from blood culture specimens, and the rest were from various clinical sources including sputum, wounds, urine, bile, and cerebrospinal fluid. Many isolates came from patients who had received cephalosporins, penicillins, carbapenems, monobactams, and quinolones for therapy or prophylaxis. Only one isolate per patient was used for testing in order to avoid duplication. Staphylococcus aureus and Staphylococcus epidermidis isolates were considered penicillin G susceptible on the basis of an MIC of <0.1 ,ug/ml, methicillin susceptible on the basis of an MIC of s4.0 ,ug/ml, and methicillin resistant on the basis of an MIC of .8.0 ,tg/ml.Susceptibility testing was performed in accordance -with the guidelines established by the National Committee for Clinical Laboratory Standards by using a previously described microtiter broth dilution method (8,11). Briefly, orga...

“…shown mean peak concentrations of 3.6 + 2.2 ,ug/ml following oral doses of 750 mg twice daily in such patients (14).…”

Section: 7%])mentioning

confidence: 86%

Randomized trial comparing ciprofloxacin plus netilmicin versus piperacillin plus netilmicin for empiric treatment of fever in neutropenic patients

Chan

Oppenheim

Anderson

et al. 1989

To assess the efficacy of ciprofloxacin in neutropenic patients, we conducted a randomized prospective trial comparing the combination of ciprofloxacin and netilmicin against piperacillin plus netilmicin as an empiric treatment of fever in cancer patients with neutropenia. Of 214 evaluable episodes, 115 and 99 were randomly assigned to the ciprofloxacin and the piperacillin arms, respectively. The overall response rates were very similar (59 and 62% for the ciprofloxacin and piperacillin arms, respectively). The response for the gram-positive bacteremias was almost identical (around 40%); this low response was due in part to an outbreak of infection by a multiply resistant strain of Staphylococcus epidermidis (for which the ciprofloxacin MIC was >128 ,ug/ml) which occurred during the second half of the trial. Among gram-negative bacteremias, 9 of 11 infections (82%) responded to the ciprofioxacin combination compared with 3 of 7 (43%) that responded to the piperacillin combination (P = 0.23). The incidences of persistent, profound neutropenia were comparable in both treatments, but the susceptibility of the gram-negative organism to ciprofloxacin and netilmicin was significantly higher than was susceptibility to the other combination. Ciprofloxacin was well tolerated, and patients were able to convert from intravenous to oral therapy in 64 of 115 episodes.Prompt initiation of broad-spectrum empiric antibiotic therapy is essential to prevent death in febrile neutropenic patients (1), and a standard combination of drugs in many centers is an aminoglycoside plus a semisynthetic penicillin with antipseudomonal activity (7, 12).Ciprofloxacin is a new 4-quinolone antibiotic with a broad spectrum of activity, including activity against Pseudomonas aeruginosa (3, 13), and is available in both injectable and oral formulations. We have compared the use of ciprofloxacin in combination with netilmicin (NC) against our previous standard regimen of piperacillin plus netilmicin (NP). In particular, we were interested in observing whether the new combination was more effective in preventing death due to gram-negative septicemia and in the possibility of converting from intravenous to oral ciprofloxacin therapy.MATERIALS AND METHODS Eligibility criteria. The trial was conducted in a single oncology unit, the