Ciprofloxacin
Antibiotic resistant gonorrhea - another reason for antibiotic regulation
JimHutchinson | 03 Feb 2009An excellent paper and accompanying editorial in today's Canadian Medical Association Journal describes huge increases in fluoroquinolone antibiotic resistance in Ontario from 2002 to 2006. Similar changes have been described in many other parts of the world.
Fluoroquinolones have only been in existence since the 1980s and first licensed for sale in Canada in 1988. They were the first new class of antibiotic introduced for many years and were received with extreme expectations. They were widely touted as the solution to antibiotic resistance to penicillins, tetracyclines, sulfa antibiotics and others.
Empiric diabetic ulcer therapy
JimHutchinson | 10 Oct 2008What do you think about the combination of Ciprofloxacin and Metronidazole (whether iv or po) for decubitus ulcers, necrotizing toes, diabetic feet. If they choose to use antibiotics wouldn't it be a better idea to use an agent with better Staphylococcal coverage? Cipro has some but is it sufficient? Would a better combination be Clindamycin and Ciprofloxacin? This would be for more severe infections. I see the Cipro/metronidazole combination a fair bit and there are times I suggest changing the metronidazole to Clindaycin.
Quinolones for atypicals
JimHutchinson | 10 Oct 2008Cipro for atypical coverage of pneumonia? Pateint is on Clarithromycin/clindamycin/ cipro...On clarithromycin since August 2. I think she came from Burin..unresolving pneumonia..I was going to suggest getting rid of Clarithromycin because of the length of therapy she has received as well as cipro she is on.
Acinetobacter in bile
JimHutchinson | 10 Oct 2008I have a quick question for you regarding acinobacter baumannii and whether double coverage in needed or if ciprofloxacin alone is okay. This patient is a 73 year old female who presented with gallstones and jaundice on Dec 15/00. ERCP was undertaken to r/o common bile duct stones. The procedure showed two stones but the procedure was unsuccessful in retrieving the stone. The patient was sent back to Carbonear for possible open cholecyctectomy and exploration of common bile duct. Over the holidays developed pocket of fluid in liver. Patient had another ERCP and stent placement in jan 2/01. A Bile culture done at this time has grown acinobacter sensitive to pip, cipro, gent and septra but resistant to cefotaxime.
Pseudomonas pneumonia
JimHutchinson | 10 Oct 2008We've a patient in ICU who has a nosocomial pneumonia (with ceftazidime reisistant pseudomonas)who is being treated with piperacillin. Gentamicin was ordered in addition but then d/c'd because the patient is receiving pancuronium bromide, which may interact with gent to cause increased dyspnea and decreased respiration (he is very sick, on ventilator). Anyway, cultures are pending, but piperacillin is in short supply from the manufacturer. Is there an alternative to piperacillin that you could suggest (?Meropenem/imipenem)?
Ciprofloxacin for surgical prophylaxis
JimHutchinson | 10 Oct 2008What antibiotic can you use to surgical prophylaxis for gyne surgery when the pt is allergic to penicillin? Vancomycin or vancomycin+gentamycin? We have an anesthetists using cipro i.v. for this and other surgery type cases.
Moxifloxacin for UTI
JimHutchinson | 10 Oct 2008I had a patient who went into respiratory failure and was rx'd with moxi and clinda. The pt subsequently had proteus mirabilis isolated from an indwelling cath culture. The urinalysis resulted in wbc 10-20/hpf, nitrite positive and a pH of 8. The pt is an 80 year old female with no evidence of renal impairment. From my knowledge and subsequent research, I could not conclude moxi is adequate for such a situation. I did see some literature that did not exclude it entirely in uti's however. I would like to hear your opinion on the topic in general, as well as your thoughts with respect to proteus mirabilis specifically. No rush, the pt is now discharged.
Complicated vascular ulcer
JimHutchinson | 10 Oct 2008I am looking for some advice on a patient. He has peripheral vascular disease. He is not a diabetic. He first developed pain in Jan. 2004 and the ulcers developed in March 2004 on right foot. He was admitted in March, June and July 2004. On dressing changes there is moderate amounts of foul serous drainage and necrotic areas on 3rd and 4th toes of right foot. This guy also has a Penicillin allergy. He was initially placed on Flagyl and vancomycin, medicine was consulted and they suggested d/c Flagyl and add Cipro 400mg iv q12h. I suggested a Vancomycin trough yesterday, but they have no iv access at present so he hasn't had a dose of Vancomycin since 0600 yesterday. The Vancomycin trough was 19.3 (surprise- even though his CRCL seems okay.
Pseudomonas osteomyelitis
JimHutchinson | 10 Oct 2008I have an ID question regarding an Ortho patient who had a broken ankle in March and underwent 3 surgeries(open reduction internal fixation and external pinning of talus and ankle). He was being followed up in ortho clininc and presents with red/swollen pimple like area on the ankle. He was admitted and taken to OR for debridement and insertion of Abx beads. Culture from the OR grew moderate Pseudomonas,he is presently on Cipro 750 mg po bid. The Abx beads apparently contained Tobramycin, so in this type of setting would you need to double cover for Pseudomonas or would Cipro alone be okay? Thanks.
