Skip to main content
PMC home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1996 Jan;40(1):6–10. doi: 10.1128/aac.40.1.6

Ciprofloxacin absorption is impaired in patients given enteral feedings orally and via gastrostomy and jejunostomy tubes.

D P Healy 1, M C Brodbeck 1, C E Clendening 1
PMCID: PMC163046  PMID: 8787869

Abstract

Twenty-six hospitalized patients participated in a randomized crossover study to evaluate the effect of enteral feedings on ciprofloxacin absorption when given orally or via gastrostomy or jejunostomy tubes. Patients in the oral group received an intact 500-mg ciprofloxacin tablet alone or ciprofloxacin plus three oral doses of Sustacal (240 ml given 8 h before, with, and 4 h after ciprofloxacin administration). Patients with gastrostomy or jejunostomy tubes received 500 mg of crushed ciprofloxacin in 60 ml water via the feeding tube. After a washout period, the patients received ciprofloxacin with a continuous enteral formula (Jevity) given at 60 to 90 ml/h beginning 6 h before drug administration and continuing for 10 h. Serial blood samples were analyzed for ciprofloxacin concentration by high-performance liquid chromatography. The maximum ciprofloxacin concentrations in serum for ciprofloxacin given and for ciprofloxacin plus enteral feeding for the oral, gastrostomy, and jejunostomy groups were (mean +/- standard deviation) 2.59 +/- 1.24 versus 1.43 +/- 0.61 micrograms/ml (P < 0.05), 3.68 +/- 1.36 versus 2.27 +/- 0.67 micrograms/ml (P < 0.05), and 3.78 +/- 1.87 versus 1.45 +/- 0.48 micrograms/ml (P < 0.05), respectively. Corresponding values for area under the concentration-time curve were 13.4 +/- 8.32 versus 9.44 +/- 4.74 micrograms/h/ml (P < 0.05) 15.9 +/- 6.62 versus 7.44 +/- 3.16 (micrograms/h/ml (P < 0.05), and 18.1 +/- 9.37 versus 5.82 +/- 2.63 micrograms.h/ml (P < 0.05). We conclude that enteral feedings given orally or via gastrostomy or jejunostomy tubes resulted in a 27 to 67% reduction in the mean bioavailability of ciprofloxacin in hospitalized patients. The decreased absorption may be clinically important, especially when the enteral feeding is coadministered with ciprofloxacin by the oral and jejunostomy tube routes. Reductions in maximum levels of ciprofloxacin in serum as a result of feedings given via a gastrostomy tube are similar to those following oral administration on an empty stomach, making a clinically important interaction by this route less likely.

Full Text

The Full Text of this article is available as a PDF (210.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barriere S. L., Ely E., Kapusnik J. E., Gambertoglio J. G. Analysis of a new method for assessing activity of combinations of antimicrobials: area under the bactericidal activity curve. J Antimicrob Chemother. 1985 Jul;16(1):49–59. doi: 10.1093/jac/16.1.49. [DOI] [PubMed] [Google Scholar]
  2. Blaser J., Stone B. B., Groner M. C., Zinner S. H. Comparative study with enoxacin and netilmicin in a pharmacodynamic model to determine importance of ratio of antibiotic peak concentration to MIC for bactericidal activity and emergence of resistance. Antimicrob Agents Chemother. 1987 Jul;31(7):1054–1060. doi: 10.1128/aac.31.7.1054. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cleophas T. J. Crossover studies: a modified analysis with more power. Clin Pharmacol Ther. 1993 May;53(5):515–520. doi: 10.1038/clpt.1993.64. [DOI] [PubMed] [Google Scholar]
  4. Craig W. A., Andes D. R. Parenteral versus oral antibiotic therapy. Med Clin North Am. 1995 May;79(3):497–508. doi: 10.1016/s0025-7125(16)30052-9. [DOI] [PubMed] [Google Scholar]
  5. Deppermann K. M., Lode H. Fluoroquinolones: interaction profile during enteral absorption. Drugs. 1993;45 (Suppl 3):65–72. doi: 10.2165/00003495-199300453-00013. [DOI] [PubMed] [Google Scholar]
  6. Drusano G. L., Johnson D. E., Rosen M., Standiford H. C. Pharmacodynamics of a fluoroquinolone antimicrobial agent in a neutropenic rat model of Pseudomonas sepsis. Antimicrob Agents Chemother. 1993 Mar;37(3):483–490. doi: 10.1128/aac.37.3.483. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Drusano G. L., Standiford H. C., Plaisance K., Forrest A., Leslie J., Caldwell J. Absolute oral bioavailability of ciprofloxacin. Antimicrob Agents Chemother. 1986 Sep;30(3):444–446. doi: 10.1128/aac.30.3.444. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gallicano K., Sahai J., Zaror-Behrens G., Pakuts A. Effect of antacids in didanosine tablet on bioavailability of isoniazid. Antimicrob Agents Chemother. 1994 Apr;38(4):894–897. doi: 10.1128/aac.38.4.894. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hauschke D., Steinijans V. W., Diletti E. A distribution-free procedure for the statistical analysis of bioequivalence studies. Int J Clin Pharmacol Ther Toxicol. 1990 Feb;28(2):72–78. [PubMed] [Google Scholar]
  10. Hooper D. C., Wolfson J. S. Fluoroquinolone antimicrobial agents. N Engl J Med. 1991 Feb 7;324(6):384–394. doi: 10.1056/NEJM199102073240606. [DOI] [PubMed] [Google Scholar]
  11. Höffken G., Borner K., Glatzel P. D., Koeppe P., Lode H. Reduced enteral absorption of ciprofloxacin in the presence of antacids. Eur J Clin Microbiol. 1985 Jun;4(3):345–345. doi: 10.1007/BF02013667. [DOI] [PubMed] [Google Scholar]
  12. Ledergerber B., Bettex J. D., Joos B., Flepp M., Lüthy R. Effect of standard breakfast on drug absorption and multiple-dose pharmacokinetics of ciprofloxacin. Antimicrob Agents Chemother. 1985 Mar;27(3):350–352. doi: 10.1128/aac.27.3.350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Midha K. K., Ormsby E. D., Hubbard J. W., McKay G., Hawes E. M., Gavalas L., McGilveray I. J. Logarithmic transformation in bioequivalence: application with two formulations of perphenazine. J Pharm Sci. 1993 Feb;82(2):138–144. doi: 10.1002/jps.2600820205. [DOI] [PubMed] [Google Scholar]
  14. Mueller B. A., Brierton D. G., Abel S. R., Bowman L. Effect of enteral feeding with ensure on oral bioavailabilities of ofloxacin and ciprofloxacin. Antimicrob Agents Chemother. 1994 Sep;38(9):2101–2105. doi: 10.1128/aac.38.9.2101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Nix D. E., De Vito J. M., Schentag J. J. Liquid-chromatographic determination of ciprofloxacin in serum and urine. Clin Chem. 1985 May;31(5):684–686. [PubMed] [Google Scholar]
  16. Nix D. E., Watson W. A., Lener M. E., Frost R. W., Krol G., Goldstein H., Lettieri J., Schentag J. J. Effects of aluminum and magnesium antacids and ranitidine on the absorption of ciprofloxacin. Clin Pharmacol Ther. 1989 Dec;46(6):700–705. doi: 10.1038/clpt.1989.207. [DOI] [PubMed] [Google Scholar]
  17. Noyes M., Polk R. E. Norfloxacin and absorption of magnesium-aluminum. Ann Intern Med. 1988 Jul 15;109(2):168–169. doi: 10.7326/0003-4819-109-2-168_2. [DOI] [PubMed] [Google Scholar]
  18. Polk R. E. Drug-drug interactions with ciprofloxacin and other fluoroquinolones. Am J Med. 1989 Nov 30;87(5A):76S–81S. doi: 10.1016/0002-9343(89)90028-4. [DOI] [PubMed] [Google Scholar]
  19. Polk R. E., Healy D. P., Sahai J., Drwal L., Racht E. Effect of ferrous sulfate and multivitamins with zinc on absorption of ciprofloxacin in normal volunteers. Antimicrob Agents Chemother. 1989 Nov;33(11):1841–1844. doi: 10.1128/aac.33.11.1841. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Sahai J., Gallicano K., Oliveras L., Khaliq S., Hawley-Foss N., Garber G. Cations in the didanosine tablet reduce ciprofloxacin bioavailability. Clin Pharmacol Ther. 1993 Mar;53(3):292–297. doi: 10.1038/clpt.1993.24. [DOI] [PubMed] [Google Scholar]
  21. Sahai J., Healy D. P., Stotka J., Polk R. E. The influence of chronic administration of calcium carbonate on the bioavailability of oral ciprofloxacin. Br J Clin Pharmacol. 1993 Mar;35(3):302–304. [PMC free article] [PubMed] [Google Scholar]
  22. Stolley P. D., Strom B. L. Sample size calculations for clinical pharmacology studies. Clin Pharmacol Ther. 1986 May;39(5):489–490. doi: 10.1038/clpt.1986.85. [DOI] [PubMed] [Google Scholar]
  23. Van Slooten A. D., Nix D. E., Wilton J. H., Love J. H., Spivey J. M., Goldstein H. R. Combined use of ciprofloxacin and sucralfate. DICP. 1991 Jun;25(6):578–582. doi: 10.1177/106002809102500601. [DOI] [PubMed] [Google Scholar]
  24. Yuk J. H., Nightingale C. H., Quintiliani R., Yeston N. S., Orlando R., 3rd, Dobkin E. D., Kambe J. C., Sweeney K. R., Buonpane E. A. Absorption of ciprofloxacin administered through a nasogastric or a nasoduodenal tube in volunteers and patients receiving enteral nutrition. Diagn Microbiol Infect Dis. 1990 Mar-Apr;13(2):99–102. doi: 10.1016/0732-8893(90)90092-a. [DOI] [PubMed] [Google Scholar]
  25. Yuk J. H., Nightingale C. H., Sweeney K. R., Quintiliani R., Lettieri J. T., Frost R. W. Relative bioavailability in healthy volunteers of ciprofloxacin administered through a nasogastric tube with and without enteral feeding. Antimicrob Agents Chemother. 1989 Jul;33(7):1118–1120. doi: 10.1128/aac.33.7.1118. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES