Eradication of non-typhi salmonella colonization by ciprofloxacin: implications for health care workers and institutionalized patients

Article Abstract:

Non-typhoid salmonella infections are common in the US, but antibiotic treatment is not usually recommended unless complications occur. However, the bacterial colonization may persist in the intestines for up to six months. Health care workers and patients in institutions are at particular risk for this infection, and termination of this colonization may be desirable. However, until the introduction of norfloxacin and ciprofloxacin, this could not be reliably done. Four cases of salmonella colonization successfully treated with ciprofloxacin are described. Three of the four patients were ineffectively treated with other antibiotics before ciprofloxacin. Stools were negative for the bacteria within 24 hours of treatment in all patients. Two of the patients, health care workers, could not return to work until they were free of bacteria. A seven-day treatment regimen was successful in these patients. The third patient, who had AIDS, represents another group at risk for salmonella, those with compromised immune systems. Oral ciprofloxacin was effective when given for 14 days, but Staphylococcus aureus organisms, resistant to the antibiotic, colonized the intestine as a result of treatment. The fourth patient was from a nursing home and was at particular risk for transmission of infection due to incontinence. A 14-day treatment regimen was given. Ciprofloxacin provides a promising infection control measure in eradicating non-typhoid salmonella colonization, but possible complications, including development of resistant bacteria, should be considered in each case. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Salmonella

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Superinfection with Streptococcus pneumoniae during therapy with ciprofloxacin

Article Abstract:

Ciprofloxacin is a new antibiotic approved for use in community-acquired infections such as lower respiratory tract infections. However, laboratory tests have shown that this antibiotic is not fully effective against the most common organism in community-acquired pneumonia, Streptococcus pneumoniae. A case is reported of a patient who developed a hospital-acquired pneumonia following treatment with ciprofloxacin and tobramycin. The patient, a 61-year-old man, had entered the hospital for treatment of irregular heartbeat. The patient had a complicated course in the hospital, and developed pneumonia due to infection by Pseudomonas aeruginosa. This initially responded to tobramycin plus piperacillin, but further pneumonia developed which was best treated with ciprofloxacin and tobramycin. One day after completion of this therapy, pneumonia again developed, and S. pneumoniae was isolated from sputum. Treatment with penicillin was effective. The results suggest that the initial pneumonia, probably associated with ventilation support, was due to gram-negative bacteria. Removal of these bacteria by ciprofloxacin and tobramycin encouraged the growth of S. pneumoniae, which is relatively resistant to these antibiotics. The study suggests that ciprofloxacin should be used less frequently in treatment of respiratory tract infections, particularly when pneumococcus may be involved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Pneumonia, Bacterial pneumonia

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