Healy D P, Brodbeck M C, Clendening C E
College of Pharmacy, University of Cincinnati, Ohio 45267, USA.
Antimicrob Agents Chemother. 1996 Jan;40(1):6-10. doi: 10.1128/AAC.40.1.6.
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.
26名住院患者参与了一项随机交叉研究，以评估经口、胃造口术或空肠造口术管给予肠内营养时对环丙沙星吸收的影响。口服组患者单独服用一片完整的500毫克环丙沙星片，或服用环丙沙星加三次口服的苏答卡（在环丙沙星给药前8小时、给药时和给药后4小时各给予240毫升）。胃造口术或空肠造口术管的患者通过饲管接受60毫升水中碾碎的500毫克环丙沙星。在洗脱期后，患者在给药前6小时开始以60至90毫升/小时的速度接受持续肠内配方（能全力），并持续10小时。通过高效液相色谱法分析连续采集的血样中环丙沙星浓度。口服、胃造口术和空肠造口术组单独给予环丙沙星以及环丙沙星加肠内营养时血清中环丙沙星的最大浓度分别为（均值±标准差）2.59±1.24微克/毫升对1.43±0.61微克/毫升（P<0.05）、3.68±1.36微克/毫升对2.27±0.67微克/毫升（P<0.05）、3.78±1.87微克/毫升对1.45±0.48微克/毫升（P<0.05）。浓度-时间曲线下面积的相应值分别为13.4±8.32微克·小时/毫升对9.44±4.74微克·小时/毫升（P<0.05）、15.9±6.62微克·小时/毫升对7.44±3.16微克·小时/毫升（P<0.05）、18.1±9.37微克·小时/毫升对5.82±2.63微克·小时/毫升（P<0.05）。我们得出结论，经口、胃造口术或空肠造口术管给予肠内营养会使住院患者中环丙沙星的平均生物利用度降低27%至67%。吸收减少在临床上可能很重要，尤其是当肠内营养与环丙沙星通过口服和空肠造口术管途径同时给药时。通过胃造口术管给予营养导致血清中环丙沙星最高水平的降低与空腹口服后的降低相似，因此通过该途径产生临床上重要相互作用的可能性较小。
