Ciprofloxacin kidney infection

Acute pyelonephritis may be accompanied by septicaemia and it is advisable to start with gentamicin plus amoxicillin i.v. or alternatively cefotaxime i.v. alone. If oral therapy is considered suitable, ciprofloxacin or norfloxacin is recommended for 2 weeks. This is an infection of the kidney substance and so needs adequate blood as well as urine concentrations. 

A 66-year-old kidney transplant recipient developed a gangrenous lesion on the left foot infected with S. aureus and Escherichia coli. He was given ciprofloxacin and chndamycin for 6 weeks and then fusidic acid 1500 mg/day for 2 weeks. He became Ul, with myalgia and no active movement of his legs, and rhabdomyolysis was established by laboratory tests. He had also taken atorvastatin 10 mg/day and he slowly recovered after withdrawal of both atorvastatin and fusidic acid. 

ABSORPTION, FATE, AND EXCRETION The quinolones are weU absorbed after oral administration and are widely distributed. Peak serum levels of the fluoroquinolones occur within 1-3 hours of an oral dose of 400 mg. Relatively low serum levels are reached with norfloxacin and limit its usefulness to the treatment of urinary tract infections. Food does not impair oral absorption but may delay the time to peak serum concentrations. Oral doses in adults are 200-400 mg every 12 hours for ofloxacin, 400 mg every 12 hours for norfloxacin and pefloxacin, and 250-750 mg every 12 hours for ciprofloxacin. Bioavailabrlity of the fluoroquinolones exceeds 50% for all agents and 95% for several. The serum half-lives range from 3 to 5 hours for norfloxacin and ciprofloxacin to 20 hours for sparfloxacin. The volume of distribution of quinolones is high, with concentrations in urine, kidney, lung and prostate tissue, stool, bUe, and macrophages and neutrophils higher than serum levels. Quinolone concentrations in CSF, bone, and prostatic fluid are lower than in serum. Pefloxacin and ofloxacin levels in ascites fluid approach serum levels, and ciprofloxacin, ofloxacin, and pefloxacin have been detected in human breast milk. 

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