The search identified 121 potentially eligible studies that focused on ciprofloxacin. Initial screening of the abstracts clearly indicated that 113 of these trials did not meet the inclusion criteria. The remaining 8 studies were subjected to a full-text review because the abstracts did not provide sufficient informa­tion to assess whether they met the inclusion criteria. One additional trial, by Yuk and others, was identified by hand- searching the reference list in the report by Mimoz and others. After review, 7 of the 8 studies were excluded. Details about the included trial appear in Table 1 and those for the 7 excluded trials are given in Table 2. The detailed results of the excluded studies are presented in Appendix 1 to give the reader a complete picture of the available evidence. All 8 studies assessed pharmacokinetic parameters, but none assessed clinical outcomes (Table 1, Table 2). Among the 7 excluded studies, 5 trials con­cluded that 750 mg BID given enterally may be used, whereas 2 trials concluded that this dosage regimen may result in a serum concentration that would be insufficient for bactericidal activity.

Because the search strategy included the key word “fluoroquinolone”, 2 articles about other quinolones were identified and retrieved. In the study by Burkhardt and others, healthy volunteers were randomly assigned to receive either mox- ifloxacin 400-mg tablet orally with water, moxifloxacin 400-mg tablet with water through a nasogastric tube, or moxifloxacin 400-mg tablet with enteral feeds through a nasogastric tube. Kanji and others randomly assigned patients who were undergoing tube feeding to receive gatifloxacin either 400 mg IV or 400 mg through a nasogastric tube. Neither of these trials met the inclusion criteria, and they were excluded from anal­ysis in the systematic review. Nonetheless, these trials are summa­rized in Table 2, and the study by Kanji and others is considered in the Discussion, as it provides insight into the topic. viagra soft

Table 1. Summary of Included Study

Mean AUC (95% CI) (Hg h/mL)

Mean Cmax (95% CI) (Hg/mL)

Mean 7maX(95% CI) (h)


Reference
Intervention Comparator Intervention Comparator


Intervention
Comparator


Intervention
Comparator

De Marie Ciprofloxacin Ciprofloxacin
19.3 19.1
et al.8
400 mg
750 mg
(11.8-26.7) (10.8-27.5)
IV
BID BID enterally



6.8


3.2 (3.9-9.8) (1.8-4.6)



2.1


0.6 (0.4-3.8) (0.3-0.9)

AUC= area under the curve, CI = confidence interval, Cmax= maximum serum concentration,

7″max= time to maximum serum concentration.

Included Study

The study by De Marie and others was the only randomized cross-over pharmacokinetic study comparing ciprofloxacin 400 mg IV BID with ciprofloxacin 750 mg BID given enterally (through nasogastric or nasoduodenal tube) and meeting all of the inclusion criteria. The authors reported the AUC, Cmax, and time to maximum serum concentration (Tmax) after steady state was achieved in 5 tube-fed patients with severe gram-negative intra-abdominal infections who were being treated in the intensive care unit (ICU). The study had a 36-h delay between measurements for each dosing regimen (which was appropriate, given the half-life of ciprofloxacin).
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Table 2. Summary of Excluded Studies

Table 2. Summary of Excluded Studies con

Patients received either Nutrison, Nutrison E+, or Nutricia feeds at a rate of 50-75 mL/h. Detailed results of this trial are provided in Table 1. The authors concluded that “enteral administration of ciprofloxacin 750 mg BID during tube feeding in ICU patients with severe gram negative intra- abdominal infections resulted in serum levels comparable to those after 400 mg BID IV”. However, this regimen may be insufficient for Pseudomoras infections, because that organism has a higher MIC.
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