Evaluation of intravenous ciprofloxacin in patients with nosocomial lower respiratory tract infections; impact of plasma concentrations, organism, minimum inhibitory concentration, and clinical condition on bacterial eradication

Article Abstract:

The antibiotic drug ciprofloxacin, which inhibits the growth of gram-negative bacteria in pulmonary (lung) secretions, was administered intravenously to 50 elderly hospitalized patients suffering from lower respiratory tract infections. This study of 50 patients was undertaken to determine the minimum inhibitory concentration (MIC) of ciprofloxacin required to safely and effectively inhibit the growth of enterobacteriaceae or haemophilus influenzae. A dosage of 200 mg was given every 12 hours during the study period, which was a minimum of five days of therapy and a maximum of 10 days. The pharmacologic characteristics of drug interactions in these patients were analyzed by charting the relationship between host infection risk factors (HIRFs, patient health problems complicating treatment) and the clinical outcome of the drug trial. Researchers determined that patients who were dependent on ventilators and those with more than four HIRFs were most likely to experience poor results. Patients in this category were at the greatest risk for suffering recurrent pneumonia following ciprofloxacin therapy. Most of the patients in this study had developed resistant strains of pneumonia prior to the initiation of ciprofloxacin therapy; before the study began, 50 percent of the patients had failed to respond to an antimicrobial form of treatment aimed at eradicating their pneumonia. Furthermore, 60 percent of the patients suffering from P.aeruginosa pneumonia had been unsuccessfully treated with piperacillin sodium or ticarcillin disodium plus tobramycin sulfate prior to the initiation of ciprofloxacin therapy. A regimen of ciprofloxacin proved to be very effective in countering enterobacteriaceae in patients, regardless of their ventilator status. P.aeruginosa was difficult for ciprofloxacin to eradicate, and patients infected with the organism required higher doses of ciprofloxacin MICs than those infected with enterobacteriaceae. Researchers speculate that the failure to respond to antibiotics is due to a wide range of factors involving the host (patient), the type of pathogen (bacterial strain), the type of drug and treatment regimen (e.g., dosage) chosen. Researchers suggest that the failure to eradicate P.aeruginosa may be addressed by increasing the dose of ciprofloxacin to a level of 300 mg administered intravenously every 12 hours. In 200 mg doses, the drug was effective against enterobacteriaceae or Haemophilus influenzae, although it was not able to adequately fight Pseudomonas pneumonia. Additional trials are required to evaluate the effectiveness of this drug in patients suffering from nonpneumonia lower respiratory tract infections.

Lungs, Lung, Respiratory system agents, Respiratory agents

---

Nosocomial pneumonia in Medicare patients: hospital costs and reimbursement patterns under the prospective payment system

Article Abstract:

Approximately 5 percent of hospitalized patients will develop an infection acquired during their hospitalization. Medicare patients, because they are generally elderly, account for a large proportion of those who develop hospital-acquired or nosocomial infections. Nosocomial infections often prolong the length of hospital stay, and therefore result in greater costs to the hospital. Because Medicare payments to hospitals are now based on a prospective payment system, whereby a fixed sum is paid to the hospital based on the patient's primary diagnosis, complications, such as nosocomial infections, are often not reimbursable. Hospitals therefore have the potential to lose money on patients who develop complications. The medical records of 33 patients who developed nosocomial pneumonia were reviewed. Eighteen of these patients required some time in an intensive care unit, and the costs of their hospitalizations ranged from approximately $6,000 to $111,000. Reimbursements for their care ranged from approximately $2,500 to $67,000, indicating enormous revenue losses to the hospital for the care of these patients. Those patients who did not require intensive care generally incurred lower costs, and there were fewer discrepancies between their charges and Medicare's reimbursement, but nevertheless, 31 of the 33 patients sustained hospital charges in excess of their Medicare reimbursement. Because of the financial drain of treating patients for complications which will not be covered by their insurance, hospitals have incentive to develop methods to prevent these complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Finance, Prevention, Hospitals, Nosocomial infections, Cross infection

---

Oral ciprofloxacin vs parenteral cefotaxime in the treatment of difficult skin and skin structure infections

Article Abstract:

Infections of the skin are usually caused by bacterial organisms that are susceptible to treatment with oral antibiotics and are generally benign. However, traumatic wound infections and infections on the soles of the feet of diabetic patients are often much more resistant to treatment, frequently requiring hospitalization and intravenous treatment. A group of 570 patients with infections of the skin that required hospitalization were included in a multicenter cooperative study to compare the efficacy of an oral antibiotic, ciprofloxacin, with that of intravenously administered cefotaxime. The oral ciprofloxacin was found to be as safe and efficacious and it was not associated with any more or worse side effects than the intravenous antibiotic. The use of oral antibiotics for these infections is of considerable value, as shorter periods of hospitalization and reduced cost should result. The daily cost of ciprofloxacin is approximately $8.00 and its use in this study averaged 9.3 days for a total treatment cost of $74.40; intravenous therapy cost approximately $96 per day or $854.40 for the course of treatment, not including the disposable supplies required to administer the drug. Additional savings should result because oral therapy should allow for earlier hospital discharge.

Skin, Cefotaxime

Similar abstracts:

• Abstracts: Acquired malposition of the colon and gallbladder in patients with cirrhosis: CT findings and clinical implications
• Abstracts: Comparison of three species of dietary fish: effects on serum concentrations of low-density-lipoprotein cholesterol and apolipoprotein in normotriglyceridemic subjects
• Abstracts: Evaluation of vitamin A toxicity. Carbohydrate and lipid metabolism in patients with non-insulin-dependent diabetes mellitus: effects of a low-fat, high-carbohydrate diet vs a diet high in monounsaturated fatty acids
• Abstracts: National study of internal medicine manpower XIV: patterns of residency and fellowship over time, 1987 update
• Abstracts: Mycobacterial disease in patients with human immunodeficiency virus infection. Human immunodeficiency virus-associated nephropathy

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.