Typhoid fever, ciprofloxacin, and renal failure

Article Abstract:

The antibiotic ciprofloxacin is commonly used to treat traveler's diarrhea and typhoid fever, an infection caused by the bacteria Salmonella typhi. Ciprofloxacin is particularly effective against strains of S. typhi that are resistant to several other types of antibiotics. Ciprofloxacin may be given orally to treat infections with the bacteria Pseudomonas in children, particularly those associated with cystic fibrosis. A case is described of an 11-year-old boy who developed inflammation of the kidney and subsequent kidney failure after treatment of typhoid fever with ciprofloxacin. The boy had fever, diarrhea, vomiting, and rigors, attacks of muscle stiffness. He had visited Pakistan without being vaccinated against typhoid fever. Evidence of S. typhi was detected in the blood and the patient was treated with chloramphenicol, gentamicin, cefuroxime, and ciprofloxacin. Although the fever was reduced 36 hours after starting ciprofloxacin, the patient became listless, developed a loss of appetite, and began vomiting periodically. Impaired kidney function was indicated by increased blood levels of urea and creatinine, and the presence of blood, protein, and glucose in the urine. The ciprofloxacin was discontinued but creatinine levels did not decline. A biopsy of kidney tissue revealed inflammation, and the patient was treated with the anti-inflammatory agent prednisolone. This resulted in a decrease in creatinine levels without recurrence of typhoid fever. It is recommended that kidney function should be monitored during treatment with ciprofloxacin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Typhoid fever, Acute renal failure, Acute kidney failure

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Benign intracranial hypertension after ciprofloxacin administration

Article Abstract:

Numerous medications, including antibiotics, have been associated with the development of benign intracranial hypertension (BIH), increased pressure of the fluid which bathes the spinal cord and brain. A case is described of BIH in a 14-year-old girl with cystic fibrosis who was treated with ciprofloxacin, an antibiotic not previously associated with BIH. The patient had developed chest symptoms which were resistant to another antibiotic. The girl was seen in the hospital following a 10-day history of headache and vomiting, and she also had intermittent double vision. Cranial nerve palsy was detected, which likely resulted from compression, swelling at the optic nerve, and other visual deficits. Cerebrospinal fluid (CSF) was normal, but an elevated pressure was observed. The antibiotic was changed, and CSF was removed twice. Many symptoms resolved, including the nerve palsy, but optic nerve swelling and inflammation remained. A further removal of CSF resolved the swelling. The parent compound of ciprofloxacin has also been associated with BIH, and one other case of ciprofloxacin-associated BIH is known to have occurred. The antibiotic is currently recommended for treatment of many infections, and has been extensively used for pseudomonas infections, a type of bacterial infection. This report suggests that BIH should be considered as a possible diagnosis in patients treated with ciprofloxacin who develop headaches. (Consumer Summary produced by Reliance Medical Information, Inc.)

Intracranial hypertension

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Endotracheal compared with intravenous administration of atropine

Article Abstract:

Medications are often given to critically ill children by intravenous injection. In a life-threatening situation when a vein is not accessible, an alternative method of giving medication is direct application of the drug into the trachea, or windpipe (known as an endotracheal route). The efficiency of the latter method is controversial, and it has been suggested that not enough of the drug may reach the circulation. Atropine, a drug that affects the nervous system and heart rate, was administered to 20 children between the ages of one and eight years who were scheduled for routine operations. The children were randomly assigned to receive the atropine either intravenously or by the endotracheal route, to compare the two methods of delivery for effects on heart rate. The observed changes in the heart rate, and the time it took for the drug to take effect, were not significantly different for the two drug delivery methods. The authors concluded that endotracheal and intravenous administration of atropine produced equal effects in this study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Anesthesia, Dosage and administration, Injections, Intravenous, Intravenous injections, Atropine

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