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Does anybody have any information re using higher than FDA recommended
doses for IV ciprofloxacin in the treatment of Pseudomonas aeruginosa
infections in order to achieve an optimal AUIC?
Thanks,
William Murray Pharm.D.
Rady Children's Hospital San Diego
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The following message was posted to: PharmPK
William -
You wrote " Does anybody have any information re using higher than FDA
recommended
doses for IV ciprofloxacin in the treatment of Pseudomonas aeruginosa
infections in order to achieve an optimal AUIC?"
As a pediatric infectious diseases physician and clinical
pharmacologist, the question in my mind is not so much information about
the dose, but the exposure or AUC. You are probably aware that most
PK-PD breakpoints and simulations show poor rates of target attainment
of quinolones vs. pseudomonas and lower breakpoints than those of CLSI.
I don't know if you are talking about general or specific patient(s).
Firstly, do you have the ability to know what the AUC is, i.e. can you
measure cipro concentrations with rapid turnaround?
Can you adjust the dose to achieve the target you want?
Are you talking about a situation where the MIC is known?
Personally, I believe that what we really need to know is the
exposure-response relationship, and if there are any data about the
safety and efficacy of higher *exposures* than those achieved by the
maximum adult dose of 400 mg IV tid. That gives us the chance of having
truly personalized medicine.
Here are a couple of references which might be interesting.
Garrison. Pharmacodynamic assessment of the activity of high-dose (750
mg) levofloxacin, ciprofloxacin, and gatifloxacin against clinical
strains of Pseudomonas aeruginosa.
Diagn Microbiol Infect Dis. 2006 Jan;54(1):51-6.
Anderson et al. Levofloxacin : a review of its use as a high-dose,
short-course treatment for bacterial infection. Drugs.
2008;68(4):535-65.
--
Michael Neely, MD
Assistant Professor of Pediatrics
University of Southern California
Division of Pediatric Infectious Diseases
Laboratory of Applied Pharmacokinetics
1640 Marengo St., #300
Los Angeles, CA 90033
email: mneely.aaa.usc.edu
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