Bioavailability of ciprofloxacin after multiple enteral and intravenous doses in ICU patients with severe gram-negative intra-abdominal infections

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Abstract

Background:

Few data are available on the pharmacokinetics of multiple enteral dosing of ciprofloxacin in critically ill intensive care patients and none for those with severe gram-negative intra-abdominal infections (GNIAI).

Objective:

To determine the bioavailability of enteral ciprofloxacin in tube-fed intensive care patients with severe GNIAI.

Design:

A randomized crossover study.

Setting:

University-based medical center.

Patients:

5 critically ill intensive care patients with GNIAI and an estimated creatinine clearance > 25 ml/min who received continuous tube feeding.

Interventions:

Multiple doses of enteral 750 mg b. i. d. versus 400 mg b.i.d. i.v. ciprofloxacin.

Measurements:

The calculated 12-h area under the serum concentration versus time curve after 750 mg b. i. d. enteral dosing was equivalent to that after 400 mg b. i. d. i. v. The mean bioavailability of enteral dosing was 53.1% [95% confidence interval (CI) 43.5–62.8]. In seven additional patients, the mean serum steady-state concentration at 2 h after enteral administration was 3.9 μg/ml (95 % CI 1.9–5.9), not significantly different from that found in the crossover study (p=0.4).

Conclusions:

In tube-fed intensive care patients with severe GNIAI, the bioavailability of enteral ciprofloxacin is adequate.

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