title: Influence of low dose ciprofloxacin on microbial colonization of the digestive tract in healthy volunteers during normal and during impaired colonization resistance.
abstract: Ciprofloxacin in low doses is, in volunteers, effective for decontaminating the digestive tract [elimination of aerobic Gram-negative bacilli (GNB)] without disturbing colonization resistance. Before using this concept in neutropenic patients, we investigated if a low dose quinolone is still effective when the colonization resistance is disturbed by another antimicrobial agent. Ciprofloxacin 20 mg daily was effective in eliminating Gram-negative bacilli from the digestive tract in 4/5 volunteers, in 1 volunteer the GNB persisted in low concentration. No colonization with exogenous resistant GNB occurred. Following impairment of colonization resistance by addition of clindamycin 300 mg daily, 3/5 volunteers became colonized by spontaneously acquired exogenous GNB resistant to ciprofloxacin. We conclude that selective decontamination with a quinolone in low dosage cannot be recommended in neutropenic patients because there is, in the case of disturbed colonization resistance, a real risk of acquisition of quinolone-resistant strains.
authors.affiliation: Department of Internal Medicine, Conisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: van de Leur
authors.forename: E J
authors.initials: EJ
authors.lastname: Vollaard
authors.forename: A J
authors.initials: AJ
authors.lastname: Janssen
authors.forename: A S
authors.initials: AS
authors.lastname: Dofferhoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002175:Candida / Q000187:drug effects / Q000254:growth & development; D002939:Ciprofloxacin / Q000008:administration & dosage*; D002981:Clindamycin / Q000008:administration & dosage; D004064:Digestive System / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects / Q000254:growth & development; D005243:Feces / Q000382:microbiology*; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000254:growth & development; D006801:Humans; D008297:Male
chemical_list: D000890:Anti-Infective Agents; D002981:Clindamycin; D002939:Ciprofloxacin