Use of ofloxacin in open fractures and in the treatment of post-traumatic osteomyelitis

Ketterl, R.; Beckurts, T.; Stübinger, B.; Claudi, B.

doi:10.1093/jac/22.supplement_c.159

Cited by 27 publications

(5 citation statements)

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“…Nonetheless, few data exist with respect to fracture prophylaxis with a quinolone, and these are conflicting. Carsenti-Etesse et al [45] and Ketterl et al [69] reported relatively low infection rates in patients treated with a quinolone who had primarily Grade I/II, and Grade II/III open fractures, respectively. However, Patzakis et al found low infection rates in lowergrade fractures but excessive infection rates in Grade III fractures [9].…”

Section: Role Of Aminoglycosides and Fluoroquinolonesmentioning

confidence: 99%

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Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

Hauser

Adams

Eachempati

2006

Surgical Infections

218

116

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The data support the conclusion that a short course of first-generation cephalosporins, begun as soon as possible after injury, significantly lowers the risk of infection when used in combination with prompt, modern orthopedic fracture wound management. There is insufficient evidence to support other common management practices, such as prolonged courses or repeated short courses of antibiotics, the use of antibiotic coverage extending to gram-negative bacilli or clostridial species, or the use of local antibiotic therapies such as beads. Large, randomized, blinded trials are needed to prove or disprove the value of these traditional approaches. Such trials should be performed in patients with high-grade fractures who (1) are well-stratified according to the degree of local injury and (2) undergo standardized fracture and wound management. Trials also must be powered to study the effects of extended antibiotic coverage on nosocomial infections. Antibiotic regimens confirmed to improve local fracture outcomes in such studies could then be used rationally, balancing the risks of local fracture-related infections and of multi-drug-resistant systemic infections to achieve optimal global outcomes.

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Section: Role Of Aminoglycosides and Fluoroquinolonesmentioning

confidence: 99%

“…In 1988, Ketterl et al used ofloxacin to both prevent and treat open fracture infections [69]. The 61 patients with primarily Gustilo Grade II or III fractures given prophylactic ofloxacin had an infection rate of 6.5%.…”

Section: Retrospective Non-randomized (Class Iii) Studiesmentioning

confidence: 99%

Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

Hauser

Adams

Eachempati

2006

Surgical Infections

218

116

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“…However, this agent is not used as monotherapy because resistance develops rapidly (30,48,49). Quinolones have been used in several clinical studies as single agents in the therapy of staphylococcal infections (12,13,18,19,27). There is also considerable concern about the increasing development of S. aureus resistance to quinolones (6,10,40,42), both during therapy and on the epidemiological level.…”

Section: Discussionmentioning

confidence: 99%

Influence of rifampin on fleroxacin pharmacokinetics

Schrenzel

Dayer

Leemann

et al. 1993

Antimicrob Agents Chemother

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Staphylococcus aureus infections have been successfully treated in animal models with the combination of fleroxacin and rifampin. We studied the influence of rifampin, a potent cytochrome P-450 inducer, on the pharmacokinetics and biotransformation of fleroxacin in 14 healthy young male volunteers. Subjects were given 400 mg of fleroxacin orally once a day for 3 days to reach steady state. After a wash-out period of 2 days, the same subjects received 600 mg of rifampin orally once daily for 7 days. On days 5 to 7 of rifampin treatment, 400 mg of fleroxacin was again administered once daily. Concentrations of fleroxacin as well as its two major urinary metabolites, N-demethyl-and N-oxide-fleroxacin, in plasma and urine were determined by reverse-phase high-performance liquid chromatography. The extent of hepatic enzyme induction by rifampin was confirmed by a significant increase of 6-13-hydroxycortisol urinary output from 160.8 ± 41.4 to 544.8 ± 120.7 ,ug/4 h. There were no significant changes in the peak fleroxacin concentration in plasma (6.3 ± 1.2 versus 6.2 ± 1.9 mg/liter), time to maximum concentration of fleroxacin in plasma (1.1 ± 0.9 versus 1.3 ± 1.1 h), or renal clearance (58.3 ± 16.4 versus 61.9 ± 19.2 mVmin). The area under the curve AUC (71.4 ± 15.8 versus 62.2 ± 13.7 mg. h/liter) and the terminal half-life of fleroxacin (11.4 ± 2.2 versus 9.2 + 1.1 h) decreased (P < 0.05), while the total plasma clearance increased from 97.7 ± 21.6 to 112.3 ± 25.8 ml/min (P < 0.01).Despite being statistically significant, this 15% increase in total plasma clearance does not appear to be clinically relevant. Metabolic clearance by N demethylation was increased (6.9 ± 2.4 versus 12.5 ± 3.2 ml/min; P < 0.01), whereas clearance by N oxidation did not change (5.8 ± 1.1 versus 5.8 ± 1.5 ml/min). Fleroxacin elimination was slightly increased (about 15%) through induction of metabolic clearance to N-demethylfleroxacin. Since fleroxacin levels remained above the MIC for 90%o of the tested isolates of methicillinsusceptible S. aureus for at least 24 h, dose adjustment does not appear necessary, at least for short-term treatments.Fluoroquinolones, including fleroxacin, have recently emerged as interesting antibacterial agents in the therapy of deep-seated infections. This is in part attributable to their antibacterial spectra, the extent of their oral absorption, and their high rate of penetration into biological fluids and tissues (45).Rifampin has long been used as an adjunctive treatment of staphylococcal infections because of its antibacterial effects on staphylococci and its extensive distribution into tissues. However, rifampin monotherapy almost invariably leads to failure due to development of resistance. The combined use of both families of antibacterial agents, fluoroquinolones and rifampin, has been advocated for the treatment of serious staphylococcal infections to avoid the emergence of resistant bacteria, especially in long-term treatments (3, 14-16, 22, 23, 25, 26, 28, 35, 38, 44, 48).The combination of fleroxa...

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“…The drug showed promising results with bone or soft-tissue infections developing in 6.5 percent of patients and posttraumatic osteomyelitis in 3.3 percent of patients. 89 …”

Section: Bone Infectionsmentioning

confidence: 99%

Ofloxacin: A Review

Smythe¹,

Rybak²

1989

DICP

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Ofloxacin is a new fluorinated quinolone antibiotic with a broad spectrum of activity against a variety of gram-positive and -negative bacteria including Enterobacteriaceae, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus. In addition, ofloxacin has significant activity against Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycobacterium tuberculosis and this may give rise to new indications for the class of quinolone antibiotics. Clinical trials to date have demonstrated the efficacy of ofloxacin in the treatment of lower respiratory tract infections, urinary tract infections, and sexually transmitted diseases. Adverse effects to ofloxacin are usually mild and include gastrointestinal, central nervous system, and hypersensitivity reactions. Significant drug interactions with ofloxacin have not been reported.

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Use of ofloxacin in open fractures and in the treatment of post-traumatic osteomyelitis

Cited by 27 publications

References 0 publications

Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

Influence of rifampin on fleroxacin pharmacokinetics

Ofloxacin: A Review

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