Pharmacokinetics of ciprofloxacin in hospitalized geriatric patients: comparison between nasogastric tube and oral administration.
OBJECTIVE
Drug administration to debilitated elderly patients on enteral feeding through a nasogastric tube (NGT) can modify the pharmacokinetic characteristics of the drug and influence its therapeutic blood concentration. The aim of this study was to evaluate the pharmacokinetics of ciprofloxacin administered through an NGT and to compare it with those of a group of patients receiving the drug orally.


METHODS
Twenty patients in stable clinical and hemodynamic condition from the long-term care ward of a geriatric multilevel hospital were studied. Patients in group 1 (n = 10) had oropharyngeal dysphagia and received food and medications, including ciprofloxacin, by NGT. Group 2 (n = 10) included age- and disease-matched orally fed patients from the same department receiving ciprofloxacin orally. Blood samples for ciprofloxacin concentration were taken at steady state, before drug administration, time 0, and at 1, 2, 3, 4, 6, 8, and 10 hours after drug administration. Ciprofloxacin was measured using liquid chromatography with tandem mass spectrometric detection. The mean daily dose was the same in both the groups: 1000 mg (500 mg twice daily).


RESULTS
Pharmacokinetic parameters of ciprofloxacin were not significantly different between the 2 groups: trough concentrations were 1.24 ± 0.95 μg/mL (0.25-3.67 μg/mL) versus 1.30 ± 0.61 μg/mL (0.21-2.36 μg/mL) (P = 0.76); Cmax 3.30 ± 2.16 μg/mL (1.54-8.62 μg/mL) versus 4.24 ± 1.99 μg/mL (2.24-9.02 μg/mL) (P = 0.356); tmax 2.8 ± 1.5 versus 3.1 ± 2.8 hours (P = 0.799); and AUC0-10 20.2 ± 12.1 μg·h·mL (9-51.07 μg·h·mL) versus 24.4 ± 13.0 μg·h·mL (5.57-52.48 μg·h·mL) (P = 0.493), in the oral fed versus NGT, respectively.


CONCLUSIONS
Ciprofloxacin pharmacokinetic parameters are not significantly different between patients receiving the drug through NGT compared with those who received it orally, and therefore, in frail elderly patients, this route of administration can be considered.
*Geriatric Department, Shmuel Harofeh Medical Center, Beer-Yaacob, Israel, †Clinical Pharmacology Unit, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel-Aviv University, and ‡National Residue Control Laboratory, Kimron Veterinary Institute, Ministry of Agriculture, Beit-Dagan, Israel.
Emily
E
Lubart
Matitiahu
M
Berkovitch
Arthur
A
Leibovitz
Malka
M
Britzi
Stefan
S
Soback
Yury
Y
Bukasov
Rafael
R
Segal
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics*; D002939:Ciprofloxacin / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D008297:Male
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin