Enteral feeds Ciprofloxacin

Antibiotics (selected) Potential for reduced bioavailability due to complexation of drug with divalent and trivalent cations found in enteral feeding May influence quinolone antibiotics, penicillin, tetracycline, isoniazid, and rifampin Consider holding tube feeding before and after administration Avoid jejunal administration of ciprofloxacin Monitor clinical response... 

The absorption of ciprofloxacin can be reduced by enteral feeds such as Ensure, JevUy, OsnwUte, Pubnocare and Sustacal. An in vitro study found a significant reduction in the concentration of ciprofloxacin, levofloxacin and ofloxacin with Ensure but other studies surest the interaction with moxifloxacin or ofloxacin is much smaller than that with ciprofloxacin and probably of little clinical importance. 

Other enteral feeds given orally (Osmolite, Pubnocare, and Resource) similarly reduced the bioavailability and maximum serum levels of ciprofloxacin by about one-quarter to one-third in two other studies. One comparative study found that Ensure reduced the AUC of ciprofloxacin by 40.2% in men but by only 14.5% in women. ... 

It has also been suggested that alteration in pH as well as the presence of cations are required to form chelates with ciprofloxacin and while this helps explain the lack of effect of high calcium in a high fat breakfast, it does not explain the significant effect with enteral feeds or calcium-fortified orange juice. The differences seen in men and women are possibly due to a slower gastric emptying rate in men, which increases the exposure of the quinolone to the enteral feed. ... 

Noer BL, Angaran DM. The effect of enteral feedings on ciprofloxacin pharmacokinetics. Pharmacotherapy ( 990) 10, 254. 

Sowinski KM, Abel SR, Clark WR, Mueller BA Effect of gender on relative oral bioavailability of ciprofloxacin and ofloxacin when administered with an enteral feeding product. Pharmaco erapy ( 99T) 17,1112. 

Healy DP, Brodbeck MC, Clendening CE. Ciprofloxacin absorption is impaired in patients given enteral feedings oraUy and via gastrostomy and jejunostomy tubes. Antimicrob Agents Chemo0ter 996) 40, 6-10. 

Yuk JH, Nightingale CH, Sweeney Quintiliani R, Lettieri JT, Frost RW. Relative bioavailability in healthy volunteers of ciprofloxacin administered through a nasc astric tube witii and without enteral feeding. Antimicrob Agents Chemoffter (1989) 33, 111 8-20. 

Mimoz O, Binter V, Jacolot A, Edouard A, Tod Nf Petitjean O, Samii K. Pharmacokinetics and absolute bioavailability of ciprofloxacin administered through a nasogastric tube with continuous enteral feeding to critically ill patients. Intensive Care Med (1998) 24, 1047-51. 

Absorption of antimicrobial agents such as fluoroquinolones and tetracyclines that can be bound by divalent and trivalent cations potentially could be compromised by administration with EN formulas containing these cations. The fluoroquinolones (e.g., levofloxacin and ciprofloxacin) have been best studied in this regard, and results of studies are not consistent. Mechanisms for an interaction between fluoroquinolones and EN formulas other than chelation by cations have been postulated.40 Some institutions hold tube feedings for 30 to 60 minutes or more before and after enteral dosages of fluoroquinolones. Because ciprofloxacin absorption has been shown to be decreased with jejunal administration, this drug probably should not be given by jejunal tube.41... 

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