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Decreased ciprofloxacin susceptibility in Salmonella Typhi and Paratyphi infections in ill-returned travellers: the impact on clinical outcome and future treatment options.
Eur J Clin Microbiol Infect Dis. 2013 Oct; 32(10):1295-301.EJ

Abstract

The emergence of decreased ciprofloxacin susceptibility (DCS) in Salmonella enterica serovar Typhi and serovar Paratyphi A, B or C limits treatment options. We studied the impact of DCS isolates on the fate of travellers returning with enteric fever and possible alternative treatment options. We evaluated the clinical features, susceptibility data and efficacy of empirical treatment in patients with positive blood cultures of a DCS isolate compared to patients infected with a ciprofloxacin-susceptible (CS) isolate in the period from January 2002 to August 2008. In addition, the pharmacokinetic and pharmacodynamic parameters of ciprofloxacin, levofloxacin and gatifloxacin were determined to assess if increasing the dose would result in adequate unbound fraction of the drug 24-h area under the concentration-time curve/minimum inhibitory concentration (ƒAUC(0-24)/MIC) ratio. Patients with DCS more often returned from the Indian subcontinent and had a longer fever clearance time and length of hospital stay compared to patients in whom the initial empirical therapy was adequate. The mean ƒAUC(0-24)/MIC was 41.3 ± 18.8 in the patients with DCS and 585.4 ± 219 in patients with a CS isolate. For DCS isolates, the mean ƒAUC0-24/MIC for levofloxacin was 60.5 ± 28.7 and for gatifloxacin, it was 97.9 ± 28.0. Increasing the dose to an adequate ƒAUC(0-24)/MIC ratio will lead to conceivably toxic drug levels in 50% of the patients treated with ciprofloxacin. Emerging DCS isolates has led to the failure of empirical treatment in ill-returned travellers. We demonstrated that, in some cases, an adequate ƒAUC(0-24)/MIC ratio could be achieved by increasing the dose of ciprofloxacin or by the use of alternative fluoroquinolones.

Authors+Show Affiliations

Department of Internal Medicine and Infectious Diseases, Erasmus Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands, r.hassing@erasmusmc.nl.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23609512

Citation

Hassing, R-J, et al. "Decreased Ciprofloxacin Susceptibility in Salmonella Typhi and Paratyphi Infections in Ill-returned Travellers: the Impact On Clinical Outcome and Future Treatment Options." European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, vol. 32, no. 10, 2013, pp. 1295-301.
Hassing RJ, Goessens WH, Mevius DJ, et al. Decreased ciprofloxacin susceptibility in Salmonella Typhi and Paratyphi infections in ill-returned travellers: the impact on clinical outcome and future treatment options. Eur J Clin Microbiol Infect Dis. 2013;32(10):1295-301.
Hassing, R. J., Goessens, W. H., Mevius, D. J., van Pelt, W., Mouton, J. W., Verbon, A., & van Genderen, P. J. (2013). Decreased ciprofloxacin susceptibility in Salmonella Typhi and Paratyphi infections in ill-returned travellers: the impact on clinical outcome and future treatment options. European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, 32(10), 1295-301. https://doi.org/10.1007/s10096-013-1878-9
Hassing RJ, et al. Decreased Ciprofloxacin Susceptibility in Salmonella Typhi and Paratyphi Infections in Ill-returned Travellers: the Impact On Clinical Outcome and Future Treatment Options. Eur J Clin Microbiol Infect Dis. 2013;32(10):1295-301. PubMed PMID: 23609512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decreased ciprofloxacin susceptibility in Salmonella Typhi and Paratyphi infections in ill-returned travellers: the impact on clinical outcome and future treatment options. AU - Hassing,R-J, AU - Goessens,W H F, AU - Mevius,D J, AU - van Pelt,W, AU - Mouton,J W, AU - Verbon,A, AU - van Genderen,P J, Y1 - 2013/04/23/ PY - 2013/03/27/received PY - 2013/04/02/accepted PY - 2013/4/24/entrez PY - 2013/4/24/pubmed PY - 2014/4/5/medline SP - 1295 EP - 301 JF - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology JO - Eur J Clin Microbiol Infect Dis VL - 32 IS - 10 N2 - The emergence of decreased ciprofloxacin susceptibility (DCS) in Salmonella enterica serovar Typhi and serovar Paratyphi A, B or C limits treatment options. We studied the impact of DCS isolates on the fate of travellers returning with enteric fever and possible alternative treatment options. We evaluated the clinical features, susceptibility data and efficacy of empirical treatment in patients with positive blood cultures of a DCS isolate compared to patients infected with a ciprofloxacin-susceptible (CS) isolate in the period from January 2002 to August 2008. In addition, the pharmacokinetic and pharmacodynamic parameters of ciprofloxacin, levofloxacin and gatifloxacin were determined to assess if increasing the dose would result in adequate unbound fraction of the drug 24-h area under the concentration-time curve/minimum inhibitory concentration (ƒAUC(0-24)/MIC) ratio. Patients with DCS more often returned from the Indian subcontinent and had a longer fever clearance time and length of hospital stay compared to patients in whom the initial empirical therapy was adequate. The mean ƒAUC(0-24)/MIC was 41.3 ± 18.8 in the patients with DCS and 585.4 ± 219 in patients with a CS isolate. For DCS isolates, the mean ƒAUC0-24/MIC for levofloxacin was 60.5 ± 28.7 and for gatifloxacin, it was 97.9 ± 28.0. Increasing the dose to an adequate ƒAUC(0-24)/MIC ratio will lead to conceivably toxic drug levels in 50% of the patients treated with ciprofloxacin. Emerging DCS isolates has led to the failure of empirical treatment in ill-returned travellers. We demonstrated that, in some cases, an adequate ƒAUC(0-24)/MIC ratio could be achieved by increasing the dose of ciprofloxacin or by the use of alternative fluoroquinolones. SN - 1435-4373 UR - https://www.unboundmedicine.com/medline/citation/23609512/Decreased_ciprofloxacin_susceptibility_in_Salmonella_Typhi_and_Paratyphi_infections_in_ill_returned_travellers:_the_impact_on_clinical_outcome_and_future_treatment_options_ L2 - https://dx.doi.org/10.1007/s10096-013-1878-9 DB - PRIME DP - Unbound Medicine ER -