Corporate for lung infection?

[Lexington2012]

Advertisement - Members don't see this ad

I had a patient who was prescribed Cipro for a lung infection. I called the PA who prescribed it and mentioned the respiratory flouroquonolones. He said cipro would work and he'd send me documentation.

He faxed me a study from 1991. i was surprised at the efficacy, as I was taught in pharmacy school that you only use levo/gemi/moxifloxacin and the other FQs don't penetrate the lung.

Why isn't cipro included on the respiratory FQ list we are all taught in school?

 

[zelman]

I had a patient who was prescribed Cipro for a lung infection. I called the PA who prescribed it and mentioned the respiratory flouroquonolones. He said cipro would work and he'd send me documentation.

He faxed me a study from 1991. i was surprised at the efficacy, as I was taught in pharmacy school that you only use levo/gemi/moxifloxacin and the other FQs don't penetrate the lung.

Why isn't cipro included on the respiratory FQ list we are all taught in school?

I think it became less preferred due to resistance of S. pneumoniea but I’m pretty weak on virology knowledge. Susceptibility of Streptococcus pneumoniae to Fluoroquinolones in Canada

 

[pencilandpen]

a study from 1991??? i am pretty sure resistance patterns have changed since then??

 

[PharmDBro2017]

From 1994: "Many quinolones have borderline activity against the pneumococcus - for example, the MIC90 of ciprofloxacin to this organism is 2 mg/l and concentrations of about 3 mg/l in epithelial lining fluid have been reported.28"

http://thorax.bmj.com/content/thoraxjnl/49/2/104.full.pdf

It could work in theory, but is it optimal? I assume the PA sent you this? Penetration of ciprofloxacin and metabolites into human lung, bronchial and pleural tissue after 250 and 500 mg oral ciprofloxacin. - PubMed - NCBI

edit: "
“Currently, the quinolones fall into several “generations.” The first-generation agents had Gram-negative activity only and were used for urinary tract infections, epitomized by the agent nalidixic acid. The second-generation agents had added Gram-positive activity and could be used for systemic infections; they included ciprofloxacin, ofloxacin, pefloxacin, fleroxacin, and lomefloxacin. These agents had limited value for respiratory infections because of relatively high MIC values among pneumococci, making it necessary to use high doses to achieve efficacy against this pathogen. The third-generation agents are characterized by better Gram-positive activity, particularly against pneumococcus. These agents include levofloxacin, gatifloxacin, and moxifloxacin, which are currently available. Among the third-generation agents, the most active against pneumococcus is moxifloxacin, followed by gatifloxacin and then levofloxacin. These new agents also have long half-lives, allowing once-daily dosing with most of the thirdgeneration agents. In addition, quinolones that are active against pneumococcus are likely to be effective regardless of penicillin susceptibility patterns because penicillin and quinolone resistance do not generally occur together in the same organisms, and pneumococcal resistance rates to new quinolones are low.”

http://www.saithan.net/critical care/Antibiotoc In ICU.pdf

 

[deleted205891]

Cipro is fine if one has something that speciates that is sensitive to it. We just don't use it as empiric treatment because it's not active against S. pneumo. I've had all except 1 of my students tell me that cipro doesn't get into the lungs...not sure who is teaching them this nonsense.

 

[CetiAlphaFive]

I had a patient who was prescribed Cipro for a lung infection. I called the PA who prescribed it and mentioned the respiratory flouroquonolones. He said cipro would work and he'd send me documentation.

He faxed me a study from 1991. i was surprised at the efficacy, as I was taught in pharmacy school that you only use levo/gemi/moxifloxacin and the other FQs don't penetrate the lung.

Why isn't cipro included on the respiratory FQ list we are all taught in school?

LOL- I can't tell if you're trolling.

It stopped working in the 90s because it was overprescrobed

 

[owlegrad]

Cipro is fine if one has something that speciates that is sensitive to it. We just don't use it as empiric treatment because it's not active against S. pneumo. I've had all except 1 of my students tell me that cipro doesn't get into the lungs...not sure who is teaching them this nonsense.

Are they thinking of Daptomycin (although that does "get into the lungs" but still, what else could they be thinking of)? That seems like a very random thing to get confused.

Also can someone explain to me what "Corporate for lung infection" means???

 

[PharFromNormal]

Anyone else have a customer call corporate on them cuz of a lung infection?

 

[Rouelle]

Maybe autocorrect cipro->corporate

 

[CetiAlphaFive]

Maybe autocorrect cipro->corporate

Thatsthejoke.mov

 

[Sabril]

i don't think I would go with such an old piece of info especially for infectious disease. Cipro does get where it is supposed to go (used for HAP/VAP and is also indicated for some lower respiratory tract infections) so i guess that is the "respiratory" part that tickles people's fancy. It can also kill strep pneumo but it needs an insane dose especially for PCN resistant strains.

having said all of this, I think either the PA or the patient will call corporate for real to get me fired.

 

[BidingMyTime]

Maybe it wasn't a real lung infection, it was just someone with a "cold", and the PA wanted to give them antibiotic to make them happy, and didn't really care about the effectiveness. Then again, he did fax you the study. Unless cultures had been done showing Cipro was the antibiotic needed (and of course they hadn't been done, and if they had, they wouldn't show that), then I fail to see how Cipro will help.

 

[deleted205891]

Are they thinking of Daptomycin (although that does "get into the lungs" but still, what else could they be thinking of)? That seems like a very random thing to get confused.

Also can someone explain to me what "Corporate for lung infection" means???

Not sure either who teaches them this...but happens ALL THE TIME.

 

[smercer]

Not sure either who teaches them this...but happens ALL THE TIME.

Likely due to poor clarification or misunderstanding from both the students and professors. I know we were taught Moxi does not get into the urine, which makes it worthless for UTIs. Maybe they were given that fact and assumed the respiratory quinolones were the only ones that could penetrate the lungs.