The Penetration of Oral Ciprofloxacin Into the Aqueous Humor, Vitreous, and Subretinal Fluid of Humans

Lesk, Mark R.; Ammann, Hélène; Marcil, G; Vinet, Bernard; Lamer, L; Sébag, Mikaël

doi:10.1016/s0002-9394(14)71460-6

Cited by 94 publications

(45 citation statements)

References 11 publications

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“…In the first group with oral administration route, mean aqueous humor concentration of ciprofloxacin (0.63∫0.29 microgram/ml) is consistent with previous studies (( Lesk et al 1993;Mounier et al 1988;Fern et al 1986). Obtained concentrations state that the penetration into the eye are sufficient for prophylactic therapy.…”

Section: Discussionsupporting

confidence: 90%

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Penetration of oral and topical ciprofloxacin into human aqueous humor

Çelebi

Aykan

et al. 1998

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: This study was planned to investigate the penetration of ciprofloxacin into aqueous humor following oral and topical application as a prophylactic antimicrobial agent. Methods: Forty-six patients undergoing cataract surgery were randomly divided into two groups. In the first group, the patients received 500 mg oral ciprofloxacin eight hours before surgery and in the second, 5 drops of 0.3% ciprofloxacin were applied to the patients every twenty minutes, starting 100 minutes before the surgery. By paracentesis, aqueous samples were taken just before the operation so the interval between the first topical application and paracentesis was 100 minutes. Results: The mean concentration of ciprofloxacin in aqueous humor was 0.63∫0.29 mg/ml in the first group. The concentration was 0.69∫0.30 mg/ml in the second group. Both of these mean concentrations were higher than the levels of MIC 90 of S.aureus , S. epidermidis, P. aeruginosa and Gram (ª) bacteriae. Conclusion: As a result, both topically and orally applied ciprofloxacin achieved a significant aqueous concentration. Each route studied might be suitable for surgical prophylaxis or treatment of infections.

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Section: Discussionsupporting

confidence: 90%

“…These aqueous humour levels exceed the MIC 90 for many bacteria, including methicillin-sensitive Staphylococcus aureus (0.61 mg/ml), Staphylococcus epidermidis (0.49 mg/ml), Haemophilus species (0.03 mg/ml), Neisseria gonorrhea (0.004 mg/ml) and most of the Enterobacteriaceae (Lesk et al 1993).…”

Section: Discussionmentioning

confidence: 92%

Penetration of oral and topical ciprofloxacin into human aqueous humor

Çelebi

Aykan

et al. 1998

Acta Ophthalmologica Scandinavica

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“…Among previously studied systemic antibiotics, fluoroquinolones and, in particular ciprofloxacin, ofloxacin, and levofloxacin (all of which can be administered orally), have been found to have significant penetration into aqueous humour and less so into the vitreous body, with concentrations usually exceeding MICs of pathogens implicated in intraocular infections. [7][8][9] Ciprofloxacin and ofloxacin are second generation fluoroquinolones while levofloxacin comprises the third generation of these drugs.…”

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confidence: 99%

Penetration of moxifloxacin into the human aqueous humour after oral administration

Kampougeris

Antoniadou²,

Kavouklis³

et al. 2005

British Journal of Ophthalmology

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Aims: To determine the pharmacokinetics of moxifloxacin, a new generation fluoroquinolone, in the anterior chamber of the human uninflamed eye. Methods: 35 patients undergoing cataract surgery received two doses of 400 mg of oral moxifloxacin with a 12 hour interval and were divided into six groups. Moxifloxacin levels in aqueous humour and serum were determined by a microbiological agar well diffusion technique at 2, 4, 6, 8, 10, and 12 hours after the second dose in each group respectively. Results: Mean moxifloxacin levels in the anterior chamber were 1.20 (SD 0.35) mg/ml at the 2 hours group, 1.22 (0.48) mg/ml at the 4 hours group, 1.20 (0.45) mg/ml at the 6 hours group, 1.58 (0.38) mg/ ml at the 8 hours group, 1.37 (0.44) mg/ml at the 10 hours group, and 1.23 (0.55) mg/ml at the 12 hours group. The mean ratio of aqueous to serum moxifloxacin level was 38%. Conclusion: Moxifloxacin penetrates well into the anterior chamber of the human uninflamed eye after oral administration, reaching early significant levels, which are maintained for at least 12 hours and are much higher than the MIC 90 values of Gram positive and Gram negative pathogens commonly implicated in intraocular infections with the exceptions of fluoroquinolone resistant staphylococci, MRSA, and Pseudomonas aeruginosa. Bacterial endophthalmitis is one of the most serious complications following intraocular operations and penetrating ocular trauma. In the first setting the commonest micro-organisms involved are either Gram positive (Staphylococcus epidermidis, Staphylococcus aureus, streptococci, Propionibacterium acnes) or Gram negative (Pseudomonas aeruginosa, Haemophilus influenza, and Serratia marcescens) while in post-traumatic endophthalmitis there is significant involvement of Bacillus cereus and Staphylococcus aureus.

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“…Topical antibiotics and often steroid drops are commenced immediately, together with systemic antibiotics. Few antibiotics given systemically other than ciprofloxacin achieve therapeutic levels inside the eye, so this compound is commonly used 38 .…”

Section: Treatment Of Endogenous Bacterial Endophthalmitismentioning

confidence: 99%

The eye in systemic sepsis

2002

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-Metastatic or endogenous endophthalmitis (EE) is a serious consequence of systemic sepsis. It is defined as intraocular infection resulting from haematogenous spread of organisms in which the initial focus of infection is at a site distal to the eye. A red/sore eye in a patient with a known septic focus needs urgent attention as EE can be a major cause of visual loss. Early diagnosis and treatment are associated with better visual outcome. This article focuses on the two main causes of EE, namely bacterial and fungal infections, and also briefly mentions dissemination of cytomegalovirus to the eye in immunocompromised patients. Although conscious patients may notice an ocular problem, unconscious or very sick patients may not; vigilance by medical staff in looking for early signs of this is extremely important.KEY WORDS: candida, ciprofloxacin, cytomegalovirus (CMV), endophthalmitis, floaters, hypopyon, red eye, retinal infiltrates, retinitis, septicaemia Endogenous fungal endophthalmitisFungal sepsis is identified most frequently in hospitalised patients who are seriously ill. Endogenous fungal endophthalmitis (EFE) occurs in 28-45% of patients with candidaemia 1,2,3 and is the most common form of endogenous endophthalmitis (EE) 4 . Patients usually present with floaters and decreased vision, unilateral or bilateral. Onset is often insidious; in its early stages EFE can be asymptomatic 2 , but if left untreated can have devastating consequences for visual function. Therefore, regular screening of high risk cases is undertaken in many centres 5,6 . High risk characteristics include those listed in Table 1. CandidiasisCandida albicans is the most common pathogen causing EFE and in some series is the causative agent in 85-99% of all cases 6,9 . Non-albicans candida spp are important as aetiological agents 10 because fungaemia with these species is associated with a higher incidence of endophthalmitis than with C. albicans 11 . Other causes of EFE in descending order of importance are Aspergillus fumigatus, cocciodioides, cryptococcus, fusarium, histoplasmosis and paecilomyces 4 .Diagnosis of ocular candidiasis. The clinical diagnosis of ocular candidiasis is largely made on the ocular appearance 8 . The organism typically causes inflammation in the choroid and retina, with subsequent spread into the vitreous cavity 8 . The ophthalmoscopic appearance is of one or more creamy-white, usually round and sometimes elevated retinal lesions, often sited in the posterior pole of the eye (Fig 1). They may vary in size from small pinpoint lesions to two-disc diameter in width 8 . If the vitreous is involved, multiple clumps may form ('puff balls') (Fig 2). Thread-like strands may connect these, producing a so-called 'string of pearls' appearance. Ocular lesions can indicate otherwise occult deep tissue fungal infection and are useful indicators of systemic candidiasis 12,13 . Although autopsy studies have demonstrated a high incidence (78%) of ocular involvement in patients with candidaemia 12 , the eye can be the ...

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The Penetration of Oral Ciprofloxacin Into the Aqueous Humor, Vitreous, and Subretinal Fluid of Humans

Cited by 94 publications

References 11 publications

Penetration of oral and topical ciprofloxacin into human aqueous humor

Penetration of oral and topical ciprofloxacin into human aqueous humor

Penetration of moxifloxacin into the human aqueous humour after oral administration

The eye in systemic sepsis

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