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Fallstudien zu den indizierten Erregern

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Registriert: 7. Nov 2016, 17:40

Fallstudien zu den indizierten Erregern

Beitragvon spacerat » 29. Jun 2017, 11:46

Bacillus anthracis

Fatal Inhalational Anthrax in a 94-Year-Old Connecticut Woman. (2002)
The urine culture grew more than 100 000 colony-forming units/mL of Escherichia coli... Oral ciprofloxacin, 500 mg every 12 hours, and ampicillin/sulbactam, 3 g intravenously every 6 hours, were added... Intravenous vancomycin and oral ciprofloxacin were continued... On November 19, review of the preliminary microbiologic analysis of the blood isolate raised suspicion for anthrax... the route of ciprofloxacin administration was changed from oral to intravenous... The isolates were susceptible to ciprofloxacin... The patient's condition continued to deteriorate, and she died on November 21.

Treatment of anthrax infection with combination of ciprofloxacin and antibodies to protective antigen of Bacillus anthracis. (2004)
In mice infected with a dose of Bacillus anthracis Sterne strain corresponding to 10 LD(50), antibiotic treatment with ciprofloxacin alone only cured 50% of infected animals.

Effective antiprotease-antibiotic treatment of experimental anthrax. (2005)
Mice were challenged intraperitoneally (i.p.) with about 1 × 10⁷ of B. anthracis Sterne spores. Treatment with a single daily dose of ciprofloxacin (50 mg/kg, i.p.) began immediately after challenge, as well as at 24 h or 48 h post challenge, and continued for 10 days. In our conditions the ciprofloxacin treatment initiated immediately after spore challenge was only 70% effective in preventing death. The survival rate after a 24 h delay in antibiotic administration produced a sharp decline to 20% but remained statistically reliable (compared to untreated group, p = 0.015). After a 48 h delay the antibiotic was completely ineffective (p = 0.23).
http://bmcinfectdis.biomedcentral.com/a ... -2334-5-25

Short-course postexposure antibiotic prophylaxis combined with vaccination protects against experimental inhalational anthrax. (2006)
Two groups of 10 rhesus macaques were exposed to ≈1,600 LD50 of spores by aerosol... In the ciprofloxacin-only group, four of nine monkeys (44%) survived the challenge. [Die Studie wurde von Bayer beaufsichtigt]

Though we cannot say that ciprofloxacin is the best antibiotic for anthrax therapy, it is at least one of the best among the antibiotics that have been relatively widely used for this infection. It is warranted, however, to preclinically and clinically test other antibiotics that could give higher survival and less toxicity...
Fong, IW, Alibek, K (Hgg.), Bioterrorism and Infectious Agents: A New Dilemma for the 21st Century. New York 2009, S. 28.

Efficacy of Single and Combined Antibiotic Treatments of Anthrax in Rabbits. (2015)
We demonstrate that treatment with amoxicillin-clavulanic acid, imipenem, vancomycin, and linezolid were as effective as doxycycline and ciprofloxacin, curing rabbits exhibiting bacteremia levels of up to 10(5) CFU/ml.

Brucella spp.

Failure of prolonged treatment with ciprofloxacin in acute infections due to Brucella melitensis. (1990)
Although all patients responded rapidly, five of the six patients receiving ciprofloxacin relapsed following cessation of therapy. There were no relapses among the patients who received doxycycline/rifampicin... Despite its in-vitro activity against B. melitensis (MIC 0.5 mg/l), ciprofloxacin, administered twice daily, does not appear to constitute adequate therapy for acute brucellosis.

Lack of Effective Bactericidal Activity of New Quinolones against Brucella spp. (1991)
The in vitro activities of six fluoroquinolones against 43 Brucella spp. were compared by testing three different inocula at two medium pH values... Results indicate the lack of effective bactericidal activity of quinolones against most strains of Brucella spp., particularly B. abortus... In summary, fluoroquinolones must not be considered for use as a primary regimen for the treatment of brucellosis because of the selection of resistant strains and the lack of effective bactericidal activity at attainable intracellular concentrations, mainly at pH 5, the pH of phagolysosomes. https://www.ncbi.nlm.nih.gov/pmc/articl ... 9-0178.pdf

Efficacy of ciprofloxacin for treatment of Brucella melitensis infections. (1992)
A rapid response to ciprofloxacin was seen in all 16 patients, but the blood cultures of 1 patient remained positive and the treatment was changed. During a 104-week follow-up period, 4 of the 15 responding patients relapsed or were reinfected within 8 to 32 weeks after completion of therapy. We conclude that treatment with ciprofloxacin alone, although effective for the acute symptoms, is associated with an appreciable rate of relapse; therefore, it should be given with other agents for treatment of brucellosis.
https://www.ncbi.nlm.nih.gov/pmc/articl ... 5-0190.pdf

Use of Ciprofloxacin in the Treatment of Brucellosis. (1992)
Between April 1990 and December 1990, 14 patients with brucellosis (13 acute cases and 1 subacute) were admitted to the study... Our study was discontinued because the cost of ciprofloxacin therapy was nine to ten times higher than the present regimen used for treatment of brucellosis and the relapse rate using ciprofloxacin (21%) was higher than that observed for conventional therapy.
https://www.ncbi.nlm.nih.gov/pubmed/1563389 → DOI:10.1007/BF01971279

Failure of Ciprofloxacin to Eradicate Brucellosis in Experimental Animals. (2016)
In this study, ciprofloxacin and tetracycline were used to treat B. melitensis and B. abortus infections in mice... It is concluded that ciprofloxacin is probably not suitable for the treatment of brucellosis.
http://www.tandfonline.com/doi/abs/10.1 ... ode=yjoc20

Salmonella spp.

Failure of Ciprofloxacin to Eradicate Convalescent Fecal Excretion after Acute Salmonellosis: Experience during an Outbreak in Health Care Workers. (1991)
Despite its excellent antimicrobial activity against salmonellae and its favorable pharmacokinetic profile, ciprofloxacin at a dosage of 750 mg orally twice daily had an unacceptably high failure rate in patients with acute salmonellosis and may have prolonged fecal excretion of salmonellae. The late occurrence of relapses indicates the need to obtain stool cultures up to 21 days after therapy to document fecal eradication in acute salmonellosis.
http://annals.org/aim/article/704448/fa ... experience

Treatment failure in typhoid fever with ciprofloxacin susceptible Salmonella enterica Serotype Typhi. (2004)
In this case series of 109 consecutive patients hospitalized with typhoid fever (S. Typhi grown from blood), we documented clinical failure (fever persisting >6 days) in 25 of 46 (54.3%) adults who could be evaluated... Among these, eight (17.4%) had microbiological failure (S. Typhi recovered from blood after 6 days of ciprofloxacin therapy) despite adequate serum ciprofloxacin levels, and all required alternative drugs for treatment. These 8 S. Typhi strains, although susceptible to ciprofloxacin (MIC < 1 μg/mL), had MICs (median MIC 0.5 μg/mL) that were increased 15-fold compared to S. Typhi strains from patients with typhoid fever seen at our center in 1995.

Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series. (2004)
Given the accumulating evidence, including our own clinical experience, enteric fever due to Salmonella spp. with reduced susceptibility to fluoroquinolones is clinically significant.

Clinical outcomes in typhoid fever: adverse impact of infection with nalidixic acid-resistant Salmonella typhi. (2005)
In this population, nalidixic acid-resistance is very common among isolates of S. typhi and is associated with reduced susceptibility to fluoroquinolones in vitro. Clinically this translates into frequent failure of fluoroquinolone therapy. However, this is not reflected in current NCCLS breakpoints and hence the fluoroquinolone breakpoints need to be redefined for S. typhi. Moreover, use of fluoroquinolones as firstline therapy for typhoid fever delays initiation of appropriate antibiotic in this setting and is likely to result in poor outcomes. For these reasons, fluoroquinolones should no longer be used as the first-line therapy, in populations where nalidixic acid-resistance is common among isolates of S. typhi.

Alternatives to Ciprofloxacin Use for Enteric Fever, United Kingdom. (2008)
Although the levels of resistance to ciprofloxacin were for the most part below that regarded as therapeutic (MIC 0.25–1.0 mg/L), at least 21 treatment failures have been documented since 2005. These findings demonstrate that the efficacy of ciprofloxacin for first-line treatment of enteric fever in the United Kingdom has been seriously jeopardized.

Treatment of Typhoid Fever in Children: Comparison of Efficacy of Ciprofloxacin with Ceftriaxone. (2016)
The study indicates that although the S. typhi strains were susceptible to ciprofloxacin in vitro, the patients did not respond clinically and bacteriologically to ciprofloxacin therapy. Hence, ciprofloxacin may not represent a reliable and useful option for treating MDR typhoid fever; thus, ceftriaxone may be an effective alternative for the treatment of such cases.
http://eujournal.org/index.php/esj/arti ... /7069/6830

Acalculous Nontyphoidal Salmonellal Cholecystitis Requiring Surgical Intervention despite Ciprofloxacin Therapy: Report of Three Cases. (1997)
https://www.jstor.org/stable/4481076?se ... b_contents

Failure of Ciprofloxacin Therapy for Invasive Nontyphoidal Salmonellosis. (1998)
https://www.researchgate.net/publicatio ... e_Nontypho idal_Salmonellosis

Ciprofloxacin Treatment Failure in Typhoid Fever Case, Pakistan. (2003)

Ciprofloxacin treatment failure in a case of typhoid fever caused by Salmonella enterica serotype Paratyphi A with reduced susceptibility to ciprofloxacin. (2007)

The trials of the returning traveler: ciprofloxacin failure in enteric fever. (2008)

Treatment failure in case of typhoid fever imported from India to Czech Republic, December 2008-January 2009.
http://www.eurosurveillance.org/ViewArt ... leId=19122

Severe sepsis from a Ciprofloxacin resistant salmonellosis in a kidney transplant recipient. (2016)
http://www.scielo.br/pdf/jbn/v39n1/0101 ... 1-0082.pdf

Vibrio spp.

Single-Dose Azithromycin for the Treatment of Cholera in Adults. (2006)
Our study has three important findings: a single dose of azithromycin is effective in the treatment of cholera; a single dose of ciprofloxacin is clinically and bacteriologically ineffective in the treatment of cholera caused by strains of V. cholerae O1 that have diminished in vitro susceptibility to ciprofloxacin, such as those found in patients in this study; and the current thresholds of antimicrobial susceptibility to ciprofloxacin may be inappropriate for V. cholerae O1.
http://www.nejm.org/doi/full/10.1056/NE ... #t=article

Single dose azithromycin versus ciprofloxacin for cholera in children: a randomized controlled trial. (2010)
Single dose azithromycin is superior to ciprofloxacin for treating cholera in children.

Haitian variant ctxB producing Vibrio cholerae O1 with reduced susceptibility to ciprofloxacin is persistent in Yavatmal, Maharashtra, India, after causing a cholera outbreak. (2013)
The therapeutic effect of ciprofloxacin was diminished whereas use of doxycycline in moderate to severe cholera patients was found to be effective in outbreak management.
http://www.clinicalmicrobiologyandinfec ... 98-743X(14)60090-2/pdf

Efficacy of Ciprofloxacin for Treatment of Cholera Associated with Diminished Susceptibility to Ciprofloxacin to Vibrio cholerae O1. (2015)
We identified a poor clinical response to treatment of cholera with a single 1 g dose of ciprofloxacin, a standard treatment for cholera... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536225/


Shortening Tuberculosis Treatment With Fluoroquinolones: Lost in Translation?
The disappointing recent failure of fluoroquinolone-containing regimens to shorten the duration of tuberculosis treatment in costly phase 3 trials has raised serious questions about the reliability of preclinical tuberculosis models, especially mice, and the current paradigm of regimen development.

Impact of fluoroquinolone treatment on delay of tuberculosis diagnosis: A systematic review and meta-analysis.
Although the available literature has several limitations and study results are heterogeneous, the evidence suggests that the use of fluoroquinolones in patients with respiratory infections might delay the diagnosis of active pulmonary TB by nearly 2 weeks. Consistent with the International Standards for TB Care, their use should be avoided when tuberculosis is suspected.
http://www.sciencedirect.com/science/ar ... 9416300419

Fluoroquinolones are associated with delayed treatment and resistance in tuberculosis: a systematic review and meta-analysis.
Current guidelines for treating community-acquired pneumonia recommend the use of fluoroquinolones for high-risk patients. Previous studies have reported controversial results as to whether fluoroquinolones are associated with delayed diagnosis and treatment of pulmonary tuberculosis (TB) and the development of fluoroquinolone-resistant Mycobacterium tuberculosis. We performed a systematic review and meta-analysis to clarify these issues... Empirical fluoroquinolone prescriptions for pneumonia are associated with longer delays in diagnosis and treatment of pulmonary TB and a higher risk of developing fluoroquinolone-resistant M. tuberculosis.

Ciprofloxacin in general practice.
Clearly, ciprofloxacin is not a suitable agent for use in general practice for the blind initial treatment of chest infections and should not be so promoted. We believe that there are major discrepancies between the promoted image and the clinically interpreted usefulness of ciprofloxacin. We hope that this sort of problem is not widespread in the pharmaceutical industry but wonder how extensive it is considering the gamut of drugs being actively promoted, often to those without the time or resources to easily and critically interpret the data presented to them. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540361/

Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis?
In the past 2 yr, ciprofloxacin resistance contributed to the increasing incidence of post-PNB infections in our center. Novel antibacterial prophylaxis approaches need to be evaluated.

Prevention of sepsis prior to prostate biopsy.
Antibiotic resistance, particularly fluoroquinolone resistance, appears to be driving an increase in the number of infective complications, including urosepsis, occurring after prostate biopsy.

The incidence of fluoroquinolone resistant infections after prostate biopsy--are fluoroquinolones still effective prophylaxis?
Fluoroquinolones are still effective as antibiotic prophylaxis for prostate biopsies but there is an increase in infective complications and fluoroquinolone resistance. When patients present with post-prostate biopsy infective symptoms, almost 50% are associated with fluoroquinolone resistant pathogens. Empirical treatment with ceftriaxone, ceftazidime or amikacin should be initiated until culture specific therapy can be implemented.

The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention.
Current guidelines recommend fluoroquinolone prophylaxis for TGBs. However, emerging fluoroquinolone resistance has led to increased frequency and morbidity due to post-TGB infections. Following TGB, 2.15%-3.6% of patients are readmitted with infective complications. We estimate readmissions result in 25,745-37,062 bed days at an annual cost of £ 7.7-11.1 million in England and Wales. Clearly, an increase in post-TGB infections with resistant organisms has a profound clinical and economic impact. We suggest alternative approaches to prophylaxis to reduce post-TGB infections.

Ciprofloxacin for prevention of postoperative recurrence in patients with Crohn’s disease: a randomized, double-blind, placebo-controlled pilot study.
In conclusion, in this pilot study ciprofloxacin was not more effective than placebo for the prevention of postoperative recurrence in patients with Crohn’s disease. Ciprofloxacin was poorly tolerated and led to treatment discontinuation in a high proportion of patients. Any future studies of antibiotics in this patient population should evaluate antibiotics with a more favorable safety profile.

Efficacy of a “Rescue” Ciprofloxacin-Based Regimen for Eradication of Helicobacter pylori Infection after Treatment Failures.
The effectiveness of ciprofloxacin-based therapy was greatly reduced despite the high prevalence of ciprofloxacin sensitive H. pylori strains. Bismuth based quadruple therapy still remain the best choice as a “rescue” regimen in our region... In conclusion, based on the results of our study we have to consider ciprofloxacin-based treatment a nonacceptable option as a “rescue” treatment in our region.

Fluoroquinolones and Risk for Methicillin-Resistant Staphylococcus aureus, Canada.
Fluoroquinolones were the only class of antimicrobial drugs associated with MRSA colonization and infection.

Doch bereits Ende der 80er Jahre zeigten Voruntersuchungen, dass die Verwendung von CiprofloxacinTabletten zur Verhütung bakterieller Infektionen direkt nach der Operation Risiken birgt... Alleine in Southampton erkrankte die Hälfte von 70 PatientInnen an lebensbedrohlichen Infektionen...
http://www.bukopharma.de/Pharma-Brief/P ... 001_06.pdf

Ermittlungen gegen Bayer.
http://www.cbgnetwork.org/Ubersicht/Pre ... ungen.html

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