Ciprofloxacin and <i>Clostridium difficile</i>-associated diarrhoea

Golledge, C.L.; Carson, Christine; O'Neill, G.L.; Bowman, R.A.; Riley, Thomas V.

doi:10.1093/jac/30.2.141

Cited by 40 publications

(30 citation statements)

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“…In addition, levofloxacin inhibited growth of fluoroquinolone-susceptible, but not fluoroquinolone-resistant, C. difficile isolates when administered in combination with ceftriaxone. These data are consistent with reports indicating that monotherapy with agents such as ciprofloxacin and levofloxacin may be less likely to be associated with CDAD than use of these agents in combination with other antibiotics (4,16). However, our findings also suggest that ciprofloxacin and levofloxacin may exert selective pressure on C. difficile, particularly when administered in combination or in sequence with other antibiotics that disrupt the indigenous microflora.…”

Section: Discussionsupporting

confidence: 92%

Effect of Fluoroquinolone Treatment on Growth of and Toxin Production by Epidemic and Nonepidemic Clostridium difficile Strains in the Cecal Contents of Mice

Adams

Riggs

Donskey

2007

Antimicrob Agents Chemother

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Several recent outbreaks of Clostridium difficile-associated disease (CDAD) have been attributed to the emergence of an epidemic strain with increased resistance to fluoroquinolone antibiotics. Some clinical studies have suggested that fluoroquinolones with enhanced antianaerobic activity (i.e., gatifloxacin and moxifloxacin) may have a greater propensity to induce CDAD than ciprofloxacin and levofloxacin do. We examined the effects of subcutaneous fluoroquinolone treatment on in vitro growth of and toxin production by epidemic and nonepidemic C. difficile isolates in cecal contents of mice and evaluated the potential for these agents to inhibit fluoroquinolone-susceptible isolates during treatment. When C. difficile isolates were inoculated into cecal contents collected 2 days after the final antibiotic dose, gatifloxacin and moxifloxacin promoted significantly more growth and toxin production than ciprofloxacin and levofloxacin did. During treatment, gatifloxacin and moxifloxacin inhibited growth of fluoroquinolone-susceptible but not fluoroquinolone-resistant isolates. Ciprofloxacin and levofloxacin promoted growth of C. difficile when administered at higher doses (i.e., 20 times the human dose in mg/kg of body weight), and levofloxacin inhibited growth of fluoroquinolone-susceptible, but not fluoroquinolone-resistant, C. difficile isolates when administered in combination with ceftriaxone. Thus, fluoroquinolones with enhanced antianaerobic activity (i.e., gatifloxacin and moxifloxacin) promoted C. difficile growth to a greater extent than did ciprofloxacin and levofloxacin in this model. However, our findings suggest that fluoroquinolones may exert selective pressure favoring the emergence of epidemic fluoroquinolone-resistant C. difficile strains by inhibiting fluoroquinolone-susceptible but not fluoroquinolone-resistant isolates during treatment and that agents such as levofloxacin or ciprofloxacin can exert such selective pressure when administered in combination with antibiotics that disrupt the anaerobic microflora.

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Section: Discussionsupporting

confidence: 92%

Effect of Fluoroquinolone Treatment on Growth of and Toxin Production by Epidemic and Nonepidemic Clostridium difficile Strains in the Cecal Contents of Mice

Adams

Riggs

Donskey

2007

Antimicrob Agents Chemother

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“…49, 2005 NOTES 3531 studies have shown an association between fluoroquinolones such as ciprofloxacin and levofloxacin and CDAD (10,23). In contrast, other studies have suggested that monotherapy with these agents is rarely associated with CDAD (8,22). Our findings are consistent with the hypothesis that fluoroquinolones such as ciprofloxacin and levofloxacin are likely to present a relatively low risk for CDAD when administered as monotherapy.…”

supporting

confidence: 81%

Effect of Antibiotic Treatment on Growth of and Toxin Production by Clostridium difficile in the Cecal Contents of Mice

Pultz

Donskey

2005

Antimicrob Agents Chemother

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“…There have been few advances in collection methods since then; however, there have been some improvements in cultivation techniques and the use of genetic probes for identification of the microorganism. 7 Over the last 20 years, there has been an increased interest in the study of the microbiota and their role in diseases of the digestive system including neoplasias, 8,9 intestinal inflammatory disease, 10,11 diarrhea associated with antibiotic use, [12][13][14] and bacterial translocation. 15,16 However, one of the difficulties in performing conclusive repeatable studies has always been the lack of a standard collection method that can be used to establish a uniform control group of healthy individuals against which the different diseases could be compared.…”

Section: Introductionmentioning

confidence: 99%

Digestive Tract Microbiota in Healthy Volunteers

Zilberstein

Quintanilha

Santos

et al. 2007

Clinics

136

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PURPOSE:The aim of this study was to standardize the methods of sample collection of mucus from the digestive tract and to determine the microbiota in healthy volunteers from Brazil, collecting samples from the mouth, esophagus, stomach, duodenum, jejunum, ileum, colon, and rectum. METHODS: Microbiota of selected healthy volunteers from the oral cavity (n=10), the esophagus (n=10), the upper digestive tract (n=20), and the lower digestive tract (n=24) were evaluated through distinct collection methods. Collection methods took into account the different sites, using basic scraping and swabbing techniques, stimulated saliva from the oral cavity, irrigationaspiration with sterile catheters especially designed for the esophagus, a probe especially designed for upper digestive tract, and a special catheter for the lower digestive tract. RESULTS: (i) Mixed microbiota were identified in the oral cavity, predominantly Gram-positive aerobic and anaerobic cocci; (ii) transitional flora mainly in the esophagus; (iii) Veillonella sp, Lactobacillus sp, and Clostridium sp in the stomach and duodenum; (iv) in the jejunum and upper ileum, we observed Bacteroides sp, Proteus sp, and Staphylococcus sp, in addition to Veillonella sp; (v) in the colon, the presence of "nonpathogenic" anaerobic bacteria Veillonella sp (average 10 5 UFC) indicates the existence of a low oxidation-reduction potential environment, which suggests the possibility of adoption of these bacteria as biological markers of total digestive tract health. CONCLUSIONS: The collection methods were efficient in obtaining adequate samples from each segment of the total digestive tract to reveal the normal microbiota. These procedures are safe and easily reproducible for microbiological studies.

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Ciprofloxacin and Clostridium difficile-associated diarrhoea

Cited by 40 publications

References 0 publications

Effect of Fluoroquinolone Treatment on Growth of and Toxin Production by Epidemic and Nonepidemic Clostridium difficile Strains in the Cecal Contents of Mice

Effect of Fluoroquinolone Treatment on Growth of and Toxin Production by Epidemic and Nonepidemic Clostridium difficile Strains in the Cecal Contents of Mice

Effect of Antibiotic Treatment on Growth of and Toxin Production by Clostridium difficile in the Cecal Contents of Mice

Digestive Tract Microbiota in Healthy Volunteers

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