enteral feed

INTRODUCTION

Economic studies have shown that oral administration of antibiotics reduces drug costs. The advantages of oral or enteral antibiotic administration include ease of administra­tion, ability to continue therapy in an outpatient setting, and reduced IV-related complications, such as excess fluid administration, local or systemic infection, phlebitis, and patient discomfort.

It is well known that concomitant oral or enteral adminis­tration of ciprofloxacin with products containing magnesium, aluminum, and calcium (e.g., nutritional supplements or enteral feeds) decreases the oral bioavailability of the ciprofloxacin. It is postulated that divalent ions bind to the ciprofloxacin, forming an insoluble complex in the gastroin­testinal tract. This drug—food interaction reduces the efficacy of ciprofloxacin and may lead to treatment failure, posing a risk for breakthrough septicemia or emergence of drug resistance. Therefore, the manufacturer’s current recommendation is to administer ciprofloxacin 2 h before and 6 h after enteral feeding. However, this is clinically impractical, since the usual dosing frequency for the drug is twice daily; holding enteral feeds for a total of 16 h/day would not allow sufficient nutri­tional intake for patients receiving enteral feeding. Common clinical practice is to hold feeds for 2 h before and 2 h after administration of ciprofloxacin, despite the potential risk of treatment failure through reduction of serum ciprofloxacin concentration. Therefore, alternative approaches must be sought to reduce the complications associated with holding feeds. canadian cialis online

Published studies of hospital inpatients allow assessment of the effects of enteral feeding on the oral bioavailability of ciprofloxacin. Anecdotal information suggests that a higher dose of oral ciprofloxacin (750 mg BID) might compensate for observee avec la dose de 400 mg administree par voie parenterale, mais la Cmax etait cependant plus faible. Aucun resultat clinique n’a ete mentionne dans cette etude.

Conclusions : Les donnees de cet examen systematique ne sont pas suffisantes pour determiner si les patients qui sont alimentes par voie enterale et qui recjoivent en concomitance une dose de ciprofloxacine de 750 mg BID par voie enterale obtiendront des resultats cliniques semblables a ceux qu’ils obtiendraient avec une dose de 400 mg BID par voie parenterale.

Mots cles : alimentation enterale, ciprofloxacine, quinolone, regime posologique reduced bioavailability and yield adequate plasma concentra­tion for effective bactericidal activity. In a study comparing doses of 500 mg and 750 mg BID given enterally, Debon and others determined that both doses achieved sufficient area under the curve (AUC) and maximum serum concentration (Cmax) for commonly encountered organisms (e.g., Escherichia coli). However, for less susceptible pathogens, such as Pseudomonas spp. and Staphylococcus aureus, the authors stated that the higher dose of ciprofloxacin should be used. To date, no systematic review has been published to evaluate the relative efficacy and safety of ciprofloxacin 750 mg given enterally and ciprofloxacin 400 mg given intravenously for patients who are receiving continuous enteral feeding. Anecdotal information from local clinicians indicated that the 750-mg dose is being used and that, contrary to the manufac­turer’s recommendations, enteral feeds are not being held.
The aim of this systematic review was to gather and summarize existing evidence to evaluate the efficacy of ciprofloxacin 750 mg administered enterally and 400 mg administered intravenously in patients receiving enteral feeds.
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