Pneumococcal bacteremia during ciprofloxacin therapy for pneumococcal pneumonia

Article Abstract:

Streptococcus pneumoniae, a gram-positive bacteria, is the most common cause of community-acquired pneumococcal pneumonia and carries a mortality rate of five to seven percent of cases per year. Incidence rate reports for pneumococcal pneumonia vary from 68 to 250 cases per 100,000 population in the US. Ciprofloxacin, an antibiotic, has effective broad-spectrum activity against gram-negative bacteria, but variable efficacy against gram-positive organisms. Although isolates of streptococcus pneumonia often test susceptible to ciprofloxacin, the results have been equivocal and clinical trials have been poorly designed. Ciprofloxacin has nonetheless gained some popularity in the treatment of acute lower respiratory tract infections. The case of an otherwise healthy 57-year-old white male with a two-day history of right-sided chest pain, fever and chills is presented. The patient was diagnosed with pneumonia on the basis of physical examination and abnormal chest x-ray and ciprofloxacin was prescribed. Two days later the dosage was increased because of continued productive cough, fever, chills and headache. The patient subsequently came to the emergency room with worsening symptoms. Blood and sputum cultures grew Streptococcus pnuemoniae. After the patient's antibiotic therapy was changed he recovered uneventfully from the bacteremia (bacterial infection in the blood) and pneumonia. Penicillin G is the drug of choice in the treatment of pneumococcal pneumonia and should be prescribed as soon as that diagnosis is suspected. Further study of the activity of ciprofloxacin against pneumococci is necessary.

Care and treatment, Bacteremia, Pneumonia, Pneumococcal, Pneumococcal pneumonia

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Pneumococcal meningitis during intravenous ciprofloxacin therapy

Article Abstract:

Oral treatment with the antibiotic ciprofloxacin has been associated with the development of pneumococcal bacteremia, or infection of the blood with pneumococcal bacteria. A case is described of a 77-year-old woman who developed pneumococcal meningitis, or inflammation of the membranes of the spinal cord and brain, resulting from pneumococcal infection after treatment with ciprofloxacin. The patient was admitted in septic shock, a condition of inadequate blood flow due to bacterial infection of the blood. X-ray findings indicated an accumulation of fluid within the lung cavity. She was treated with ciprofloxacin given directly into the circulation, and her condition improved. Blood tests indicated that the infection was caused by the bacteria, Streptococcus pneumoniae. However, five days after admission, the patient relapsed and was shown to have meningitis resulting from infection with S. pneumoniae. Ciprofloxacin is only moderately effective against S. pneumoniae infection, and the use of the oral form of this antibiotic to treat pneumonia is not recommended. The patient recovered when the antibiotic therapy was switched to ampicillin. Although intravenous ciprofloxacin should be effective in treating bacteremia, the development of pneumococcal meningitis is unusual. Oral ciprofloxacin may not be wise for treating pneumonia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antibiotics, Causes of, Physiological aspects, Drug therapy, Meningitis

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Brief report: combination effects of ciprofloxacin, clindamycin, and metronidazole intravenously in volunteers

Article Abstract:

Most anaerobic bacteria are resistant or are insensitive to the fluoroquinolone antibiotic ciprofloxacin, and several gram-positive bacteria are moderately sensitive to this drug. The effectiveness of ciprofloxacin to prevent the growth of these bacteria may be increased if the drug is combined with other antibiotic agents such as metronidazole or clindamycin. The antibacterial effects of ciprofloxacin with or without clindamycin or metronidazole were examined in ten healthy volunteers. The drugs were given intravenously (directly into the circulation) for 30 minutes, and drug levels in the urine and blood were monitored. Blood samples were taken one and six hours after the infusions to determine the antibacterial effects on five different aerobic and two anaerobic bacterial species. The results demonstrate that ciprofloxacin and clindamycin were effective against the gram-positive bacteria streptococci and staphylococci, but none of the combinations were effective against the anaerobic bacteria. The usefulness of combination therapy must be evaluated further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Metronidazole, Chemotherapy, Combination, Combination chemotherapy, Clindamycin

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