CIPROFLOXACIN ABSORPTION IS IMPAIRED IN PATIENTS GIVEN ENTERAL FEEDINGS ORALLY AND VIA GASTROSTOMY AND JEJUNOSTOMY TUBES

Twenty-six hospitalized patients participated in a randomized crossove r study to evaluate the effect of enteral feedings on ciprofloxacin ab sorption when given orally or via gastrostomy or jejunostomy tubes, Pa tients in the oral group received an intact 500-mg ciprofloxacin table t alone or ciprofloxacin plus three oral doses of Sustacal (240 ml giv en 8 h before, with, and 4 h after ciprofloxacin administration). Pati ents with gastrostomy or jejunostomy tubes received 500 mg of crushed ciprofloxacin in 60 ml water via the feeding tube, After a washout per iod, the patients received ciprofloxacin with a continuous enteral for mula (Jevity) given at 60 to 90 ml/h beginning 6 h before drug adminis tration and continuing for 10 h, Serial blood samples were analyzed fo r ciprofloxacin concentration by high-performance Liquid chromatograph y. The maximum ciprofloxacin concentrations in serum for ciprofloxacin given and for ciprofloxacin plus enteral feeding for the oral, gastro stomy, and jejunostomy groups were (mean +/- standard deviation) 2.59 +/- 1.24 versus 1.43 +/- 0.61 mu g/ml (P < 0.05), 3.68 +/- 1.36 versus 2.27 +/- 0.67 mu g/ml (P < 0.05), and 3.78 +/- 1.87 versus 1.45 +/- 0 .38 mu g/ml (P < 0.05), respectively; Corresponding values for area un der the concentration-time curve were 13.4 +/- 8.32 versus 9.44 +/- 4. 74 mu g/h/ml (P < 0.05) 15.9 +/- 6.62 versus 7.44 +/- 3.16 (mu g/h/ml (P < 0.05), and 18.1 +/- 9.37 versus 5.82 +/- 2.63 mu g . h/ml (P < 0. 05), We conclude that enteral feedings given orally or via gastrostomy or jejunostomy tubes resulted in a 27 to 67% reduction in the mean bi oavailability of ciprofloxacin in hospitalized patients, The decreased absorption may be clinically important, especially when the enteral f eeding is coadministered with ciprofloxacin by the oral and jejunostom y tube routes. Reductions in maximum levels of ciprofloxacin in serum as a result of feedings given via a gastrostomy tube are similar to th ose following oral administration on an empty stomach, making a clinic ally important interaction by this route less likely.