Failure of ciprofloxacin to eradicate convalescent fecal excretion after acute salmonellosis: experience during an outbreak in health care workers

Article Abstract:

Acute salmonellosis, or infection with the bacteria Salmonella, accounts for 20,000 hospital admissions, 500 deaths, and $50 billion in health care costs each year in the US. This infection is also responsible for lost wages and decreased productivity due to absenteeism. It may take several weeks for the bacteria to be completely excreted in the feces. Infected health care workers and food handlers cannot resume work until their stools no longer show evidence of Salmonella infection. This may lead to disruptions in hospital services and short-term nursing shortages. Salmonellosis resolves spontaneously and does not usually require drug treatment. Antibiotics may even prolong the period of fecal excretion of Salmonella. However, the increased incidence of this infection and development of drug-resistant strains of Salmonella have resulted in the need for effective antibiotic treatment of salmonellosis. The fluoroquinolone antibiotic ciprofloxacin may be particularly active against salmonellosis because this drug reaches high levels in the gastrointestinal tract (a common site of Salmonella infection); prevents growth of the bacteria at low drug levels; and enters into infected cells. Ciprofloxacin can also accumulate in the biliary tract, a site of persistent Salmonella infection. The effectiveness of ciprofloxacin in treating salmonellosis was assessed in 15 health care workers infected with Salmonella java. Although ciprofloxacin eliminated S. java from the stools of all eight treated patients for up to 14 days, four patients relapsed within 14 to 21 days after the start of drug treatment. Another three hospitalized patients treated with ciprofloxacin relapsed. Hence, relapse of salmonellosis occurred in 7 of 11 patients, including four who experienced a longer duration of fecal excretion of S. java than the untreated patients. Relapse was not related to lack of patient compliance; drug resistance; or co-existing biliary disease. These findings show that ciprofloxacin is not effective in treating salmonellosis and may actually prolong fecal excretion of the bacteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical examination, Feces

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Natural history of disseminated Mycobacterium avium complex infection in AIDS

Article Abstract:

The human immunodeficiency virus (HIV, the virus that causes AIDS) attacks and destroys the immune system, making individuals with AIDS very susceptible to other types of infection. Mycobacterium avium (M. avium) is a common bacterial cause of lung infection in patients with AIDS. Once M. avium infects the lungs it can spread (disseminate) to other parts of the body and cause M. avium complex infection (MAC). Many studies have reported that MAC reduces the survival time of patients with AIDS, but the validity of these studies has been challenged. In an attempt to gain a better understanding of the role that MAC plays in altering the survival time of AIDS patients, the medical records were reviewed of 137 AIDS patients attending the San Francisco General Hospital between 1983 and 1986. Thirty-four of the patients were diagnosed with lung infections caused by M. avium. In 22 of the 34 cases, the infection had spread to other parts of the body. When the infection spread to other parts of the body, the survival time of the patient was indeed shortened. It is concluded that a lung infection with M. avium predicts the development of disseminated MAC, and disseminated MAC reduces the survival time of patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Complications and side effects, AIDS patients, Mycobacterium avium complex, Mycobacterium avium

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Ciprofloxacin for salmonella bacteremia in the acquired immunodeficiency syndrome (AIDS)

Article Abstract:

Patients with the acquired immunodeficiency syndrome (AIDS) are prone to bacterial infections in the blood. Although salmonella bacterial infections in AIDS patients can be treated with the standard antibiotic therapy consisting of ampicillin, trimethoprim-sulfamethoxazole and chloramphenicol, in some cases salmonella infections will return after initial therapy. Additionally, the levels of antibiotics needed to control the infection in AIDS patients exceed current recommendations. Ciprofloxacin is an antibiotic that has been shown in laboratory studies to eradicate salmonella. Ciprofloxacin was given to four AIDS patients experiencing recurrent salmonella blood infections after standard antibiotic therapy. Ciprofloxacin 750 mg was given every 12 hours for a minimum of 14 days, and continued to be given to the four patients for one to eight months after the recurrence of the salmonella bacteremia. Blood cultures remained negative for salmonella during ciprofloxacin therapy. Ciprofloxacin was safe and effective treatment for recurring salmonella infection. Outpatient management with ciprofloxacin therapy may reduce the need to hospitalize AIDS patients with recurring salmonella infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Bacteremia

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