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Long-term oral ciprofloxacin: experience in the treatment of incurable infective endocarditis
G L Daikos1, S B Kathpalia, V T Lolans
1Department of Medicine, University of Illinois, College of Medicine, Chicago 60680.
Abstract:
Acute septic infective endocarditis caused by Pseudomonas aeruginosa, in two patients with conditions that made it incurable, was treated with long-term orally administered ciprofloxacin. Bacteremia and symptoms cleared, resulting in subjective well-being without cure for three and one half and 22 months, respectively. Large amounts of ciprofloxacin, 150 and 1,440 g, respectively, were given continuously without apparent adverse reactions. Blood isolates of P. aeruginosa after treatment had limited progression of resistance to ciprofloxacin. Use of orally administered ciprofloxacin provides new opportunities for the long-term treatment of serious infections with restricted risk of bacterial drug resistance and no appreciable side effects.
Insights
Long-term oral ciprofloxacin effectively managed severe Pseudomonas aeruginosa infections in two patients, clearing bacteremia and symptoms. This approach offers a new treatment option with limited drug resistance and minimal side effects.
Area of Science:
- Infectious Diseases
- Pharmacology
- Microbiology
Background:
- Acute septic infective endocarditis presents significant treatment challenges, particularly with drug-resistant pathogens.
- Pseudomonas aeruginosa is an opportunistic pathogen frequently associated with severe nosocomial infections.
Observation:
- Two patients with incurable conditions presented with acute septic infective endocarditis caused by Pseudomonas aeruginosa.
- Treatment involved long-term, high-dose oral administration of ciprofloxacin.
Findings:
- Bacteremia and clinical symptoms resolved in both patients, leading to sustained subjective well-being for 3.5 and 22 months.
- Extensive cumulative doses of ciprofloxacin (150g and 1,440g) were administered without apparent adverse reactions.
- Post-treatment blood isolates of P. aeruginosa exhibited limited progression of ciprofloxacin resistance.
Implications:
- Oral ciprofloxacin represents a novel therapeutic strategy for managing serious P. aeruginosa infections.
- Long-term oral ciprofloxacin therapy may offer a favorable risk-benefit profile, with reduced risk of bacterial resistance and minimal toxicity.
- This approach holds promise for improving patient outcomes in challenging infectious disease cases.