Back to the Top
Decreases in ciprofloxacin absorption resulting from metal ions
(from antacids, sucralfate, enteral feedings, etc.) should be
expected. It is likely that complexation is affected by surrounding
media (e.g. the complexation of calcium is greater when given as
calcium carbonate as compared to milk as a source of calcium). There
are many substances in enteral feedings that chelate metal ions and
may compete with fluoroquinolones thereby reducing the affect on the
fluoroquinolone absorption. When ciprofloxacin has been
administered with enteral feedings, average decreases in absorption
are about 30%. The problem is that the extent of interaction varies
widely between individuals. The within subject variability in the
extent of the interaction is not known. Therefore simply giving a
higher dose is not the answer. Clearly, I would recommend using a
750 mg dose rather than 500 mg when using ciprofloxacin concomitantly
with enteral feedings.
Mueller BA, et. al. Antimicrob Agents Chemother 1994;28:2101-5
Healy DP, et al. Antimicrob Agents Chemother. 1996;40:6-10.
Yuk JH, et al. Antimicrob Agents Chemother. 1989;1118-20.
Enteral feeding affect Ofloxacin to a lesser extent than
ciprofloxacin (mean 90% relative bioavailability (range 74-105%)).
You may consider using ofloxacin in non-Pseudomonas aeruginosa
infections.
Mueller BA, et. al. Antimicrob Agents Chemother 1994;28:2101-5
David E. Nix, Pharm.D.
The University of Arizona
PharmPK Discussion List Archive Index page
Copyright 1995-2010 David W. A. Bourne (david@boomer.org)