Vol.57 No.3 May 2009
Clinical efficacy of injectable ciprofloxacin in ventilator-associated pneumonia
1)Department of Internal Medicine, Yonabaru Chuo Hospital, 2905 Yonabaru, Okinawa, Japan
2)Department of Medicine and Therapeutics, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of The Ryukyus
3)Department of Infectious Diseases and Respiratory Medicine, Nakagami General Hospital
4)Department of Respiratory Medicine, Heart Life Hospital
5)Japanese Red Cross Nagasaki Genbaku Isahaya Hospital
Abstract
Background: The injectable fluoroquinolone ciprofloxacin(CPFX) was approved in November 2000 in Japan. In refractory pulmonary infection, in particular, injectable CPFX is expected to be useful based on its excellent penetration of respiratory tissue and stronger antimicrobial activity and clinical experience in other countries. No clinical evaluation of injectable CPFX in ventilator-associated pneumonia(VAP) has been done in Japan.
Objective: We clarified the clinical utility of injectable CPFX in empiric therapy for VAP.
Patients and methods: Patients with VAP were administered injectable CPFX (300 mg bid), and clinical efficacy, safety, bacteriological effectiveness, and duration of treatment were investigated.
Results: All 11 patients enrolled complied with the protocol and were evaluated for safety, and 9 for clinical efficacy. Clinical efficacy was 55.6% (5/9 patients). Injectable CPFX was effective in 4 of 4 primary VAP patients, and 1 of 5 patients with VAP exacerbation. On examination of the bacteriological effectiveness of injectable CPFX, 3 cases of elimination, 3 of decrease, and 3 of persistent. Pseudomonas aeruginosa was estimated as a causative pathogen in 8 of 9 patients. Of six patients who received other antimicrobial agents prior to initiation of treatment with injectable CPFX, three exhibited a response to those agents. No serious adverse event occurred for which a causal relationship to injectable CPFX could not be ruled out, although minor hepatic dysfunction and aggravation of anemia were seen.
Discussion: Injectable CPFX exhibited strong efficacy in VAP treatment, especially in primary VAP patients. Efficacy was also observed in exacerbation and patients for whom prior antibiotic treatment was ineffective. These results suggest that injectable CPFX is an important and useful drug in empiric VAP therapy.
Key word
ventilator-associated pneumonia, ciprofloxacin, nosocomial infection
Received
November 13, 2008
Accepted
March 13, 2009
Jpn. J. Chemother. 57 (3): 219-225, 2009
