Tuberculosis ciprofloxacin

Ciccone R, F Mariani, A Cavone, T Persichini, G Venturini, E Ongini, V Volizzi, M Colasanti (2003) Inhibitory effect of NO-releasing ciprofloxacin (NCX 976) on Mycobacterium tuberculosis survival. Antimicrob Agents Chemother Al 2299-2302. 

Most of the fluoroquinolones antibiotics (see Chapter 44) have activity against M. tuberculosis and M. avium-intracellulare. Ciprofloxacin, ofloxacin, and levofloxacin inhibit 90% of the strains of susceptible tubercula bacilli at concentrations of less than 2 xg/mL. Levofloxacin is preferred because it is the active L-optical isomer of ofloxacin and is approved for once-daily use. The... 

Quinolones are important recent additions to the therapeutic agents used against M. tuberculosis, especially in MDR strains. Clinical trials of ofloxacin in combination with isoniazid and rifampin have indicated activity comparable to that of ethambutol. In addition, quinolones, particularly ciprofloxacin, are used as part of a combined regimen in HIV-infected patients. 

Ciprofloxacin and levofloxacin are no longer recommended for the treatment of gonococcal infection in the USA as resistance is now common. However, both drugs are effective in treating chlamydial urethritis or cervicitis. Ciprofloxacin, levofloxacin, or moxifloxacin is occasionally used for treatment of tuberculosis and atypical mycobacterial infections. These agents may be suitable for eradication of meningococci from carriers or for prophylaxis of infection in neutropenic patients. 

M kansasii Resembles tuberculosis Ciprofloxacin, clarithromycin, ethambutol, isoniazid, rifampin, trimethoprim-sulfamethoxazole... 

Moxifloxacin s MIC90 value of 1 mg L"1 means that it has the same in vitro activity against M. tuberculosis as levofloxacin, and is more effective than ofloxacin (MIC90 = 2 mg L"1) and ciprofloxacin (MIC90 = 4 mg IT1) [192-194]. A combination of moxifloxacin and isoniazid proved to be more effective in vivo than the individual compounds [195,196], whereas a combination with ethambutol was less effective [196]. Based on the mutant prevention concentration (MPC), which is a parameter for the selection of resistant pathogens during antibiotic treatment, moxifloxacin was found to be the most effective fluoroquinolone against M. tuberculosis [197]. 

Sirgel F, Venter A, Heilmann HD. Comparative in-vitro activity of Bay y 3118, a new quinolone, and ciprofloxacin against Mycobacterium tuberculosis and Mycobacterium avium complex. /. Antimicrob. Chemother., 1995, 35, 349-351. 

Psychosis occurred in a 32-year-old woman who was taking ciprofloxacin for multidrug resistant tuberculosis the symptoms resolved within 48 hours after the ciprofloxacin was withdrawn (169). 

Norra C, Skobel E, Breuer C, Haase G, Hanrath P, Hoff P. Ciprofloxacin-induced acute psychosis in a patient with multi-drug-resistant tuberculosis. Eur Psychiatry 2003 18 262-3. 

As far as synthetic agents were concerned, isoniazid (a pyridine hydrazide structure) was found to be effective against human tuberculosis in 1952, and in 1962 nalidixic acid (Fig. 10.74) (the first of the quinolone antibacterial agents) was discovered. A second generation of this class of drugs was introduced in 1987 with ciprofloxacin (Fig. 10.74). 

Unfortunately, MAC is resistant to the standard drugs used for tuberculosis, such as isoniazid and pyrazinamide. Multiple agents such as rifampin, rifabutin (ansamycin), clofazimine, imipenem, amikacin, ethambutol, ciprofloxacin, clarithromycin, and azithromycin have varying degrees of in vitro anti-MAC activity. Controversy formerly existed as to whether treatment for MAC is beneficial, but data indicate that an aggressive therapeutic approach decreases symptoms... 

Among anti-bacterial agents, the simplest must be isoniazide (Rimifon), an important anti-tuberculosis drug. Heterocyclic contributions to mainstream antibiotics include a group of quinolones e.g. the broad-spectrum anti-bacterial ciprofloxacin (Cipro) perhaps best known in connection with terrorist use of anthrax and the diamino-pyrimidine trimethoprim (Triprim). Many of the sulfonamides, the hrst synthetic antibiotics, contain heterocyclic residues. 

Aminoglycosides such as capreomycin, viomycin, kana-mycin and amikacin and the newer quinolones (e.g. pefloxacin, ofloxacin and ciprofloxacin) were only used in drug resistance situations. Tuberculosis in particular experienced a resurgence. In the mid-1980s, the worldwide decline in tuberculosis cases levelled off and then began to rise. 

Ciprofloxacin and ofloxacin are often active against strains of M tuberculosis resistant to first-line agents. The fluoroquinolones should always be used in combination regimens with two or more other active agents. 

The second-line drugs for tuberculosis are found to be more toxic but may be required with certain resistance problems. These drugs essentially include fluroquinolones (e.g., ofloxacin, ciprofloxacin), cycloserine, ethionosamide, aminosalicylic acid, aminoglycosides (viz., amikacin, kanamycin), clofazimine, and capreomycin. 

The MICs of ofloxacin and ciprofloxacin for the organism Mycobacterium tuberculosis invariably vaiy between 0.12-2.0 mcg.mL Importantly, both these drygs are bacterial in nature, and the ensuing MBC-MIC ratio being from 2 to 4. 

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