Thursday, July 17, 2008
Ciprofloxacin-induced acute cholestatic liver injury and associated renal failure. Case report and review.
Minerva Gastroenterol Dietol. 2008 Sep
Dichiara AJ, Atkinson M, Goodman Z, Sherman KE.
Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA Kenneth.firstname.lastname@example.org.
Ciprofloxacin, a commonly prescribed fluoroquinolone antibiotic, has generally been well-tolerated; however, there are rare reports of associated hepatic failure or renal failure. We describe a case of a 65 year-old man with a history of ischemic cardiomyopathy who was treated with ciprofloxacin 500 mg twice daily for cellulitis. Six days into his treatment course, he developed acute cholestatic jaundice and acute anuric renal failure. Clinical, laboratory, and pathologic data suggest that the patient had developed reversible, severe ciprofloxacin-induced cholestatic liver injury and acute tubular necrosis requiring hemodialysis. Within two months of stopping the ciprofloxacin, the patient was off dialysis and back to his baseline creatinine in three months. Liver tests normalized by five months.
This report illustrates a case of cholestatic liver injury and renal failure involving ciprofloxacin use.
We review the literature regarding hepatic and renal injury as it relates to ciprofloxacin. To our knowledge, this represents the first case report of simultaneous acute cholestatic liver injury and renal failure secondary to ciprofloxacin.
Sunday, July 13, 2008
Ann Pharmacother. 2008 Jul 9
Gallagher JC, Rouse HM.
Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, ILClinical Assistant Professor; Clinical Specialist, Infectious Diseases, Temple University School of Pharmacy, Philadelphia, PA.
BACKGROUND: Acinetobacter infections resistant to multiple classes of antibiotics have become prevalent in many institutions. Tigecycline has in vitro activity against Acinetobacter spp. and has been suggested as a therapeutic option in these infections.
OBJECTIVE: To describe the clinical and microbiologic outcomes of patients who received tigecycline for the treatment of infections caused by Acinetobacter spp. at our institution.
METHODS: A retrospective review was conducted of the medical records of 29 sequential patients who received tigecycline for treatment of Acinetobacter infections. The outcomes assessed for efficacy were clinical improvement or cure and microbiologic cure in evaluable patients.
RESULTS: Patients received tigecycline a median of 30 days into hospitalization for a median of 11 days. Common indications were pneumonia (15 pts.), bacteremia (6), and urinary tract infection (3). Positive clinical outcomes (clinical cure or improvement) were seen in 8 (28%) of 29 patients. Of the 25 microbiologically evaluable patients, 11 (44%) had resolution of their cultures. Eleven patients had susceptibility testing performed, and the median minimum inhibitory concentration was 4 microg/mL (range 3-8).
CONCLUSIONS: In this case series, most patients did not have clinically or microbiologically favorable outcomes with tigecycline therapy. No patient had an isolate that was fully susceptible to tigecycline. Data from more studies are needed before tigecycline can be recommended for the treatment of Acinetobacter infections.Annals of Pharmacotherapy (PubMed)
Better outcomes through continuous infusion of time-dependent antibiotics to critically ill patients?
Curr Opin Crit Care. 2008 Aug
Roberts JA, Lipman J, Blot S, Rello J.
Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia.
PURPOSE OF REVIEW: Increasing interest is being directed toward possible benefits associated with continuous infusion of time-dependent antibiotics such as beta-lactams and vancomycin to critically ill patients. The background, emerging evidence and practical considerations associated with continuous infusions are discussed.
RECENT FINDINGS: One large retrospective cohort study has found clinical outcome benefits of administering a beta-lactam antibiotic by extended infusion compared with bolus administration. This complements a smaller randomized controlled trial comparing continuous infusion and intermittent bolus administration. For vancomycin, clinical outcome benefits have only been shown in a ventilator-associated pneumonia cohort of critically ill patients. No clinical outcome studies have been conducted for other time-dependent antibiotics.
SUMMARY: Continuous infusion of vancomycin and beta-lactam antibiotics enables faster and more consistent attainment of therapeutic levels compared with intermittent bolus dosing. Although the clinical benefits have not been conclusively shown at this time, compelling pharmacokinetic/pharmacodynamic support for continuous infusion nevertheless exists. Given that critically ill patients may develop very large volumes of distribution as well as supranormal drug clearances, individualized therapy through the use of therapeutic drug monitoring is required. A definitive determination of the relative clinical efficacy of intermittent bolus and continuous administration of beta-lactams or vancomycin will only be achieved after a large-scale multicenter randomized controlled trial has been performed.Lippincott, Williams & Wilkins