ID questions

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ItsOverZyvox said:
You have a study to prove it?
Click to expand...

Hmmm...I'll look. From what I remember (and this nookyoolar girl hasn't touched ID for a little while now), Avelox unchanged reaches concentrations enough to be cidal for simple E. coli UTI...even if you say renal clearance is 20%. Pseudomonas is a different story though, which is why everyone rules it out for empiric or mixed UTI.
 
ItsOverZyvox said:
Oh yeah? Then how come Trovafloxacin with 6%-9% renal clearance was used for UTI while we can't use Moxi with 20% renal clearance?

Are you saying Moxi's renal concentration isn't high enough to treat simple UTI with E. Coli? What say you resident?
Click to expand...

And dude! You're totally engaging in my conversation point now. Way to trash it earlier!
 
SpirivaSunrise said:
And dude! You're totally engaging in my conversation point now. Way to trash it earlier!
Click to expand...


Heck..no one has come forth with the real reason why the change to Avelox/Cipro from Levo/Cipro..
 
What's the incidence of FQ associated tendonitis. I know it's a recent blackbox warning, but I only know of one person who claims to have suffered from it and no institutional info on it.

Just wondering. I know the Levaquin reps at CVS brought it up.
 
ItsOverZyvox said:
Heck..no one has come forth with the real reason why the change to Avelox/Cipro from Levo/Cipro..
Click to expand...

I believe we did it because there was growing levo resistance.

I haven't seen an antibiogram since we made the swap.
 
ItsOverZyvox said:
Heck..no one has come forth with the real reason why the change to Avelox/Cipro from Levo/Cipro..
Click to expand...

:idea: 😛

Again, I say cost savings. But, I'll cheat and retract my statement on levo being cheaper than moxi (although Sanford disagrees :meanie: ), and I'll go with Cipro being considerably less expensive with the former contract than with the latter. 😉
 
ItsOverZyvox said:
You have a study to prove it?
Click to expand...


This is all I can find on Pub-Med (have limited access to resources at home)...so can't pull the articles to see whether it confirms a clinicial application or not. (Both from International J of Antimicrobial Agents).

In vitro activity of gatifloxacin compared with gemifloxacin, moxifloxacin, trovafloxacin, ciprofloxacin and ofloxacin against uropathogens cultured from patients with complicated urinary tract infections.

Naber KG, Hollauer K, Kirchbauer D, Witte W.
Urologic Clinic, St Elisabeth Hospital, St Elisabethstrasse 23, D-94315, Straubing, Germany. [email protected]
Minimum inhibitory concentrations (MICs) of gatifloxacin were compared with those of gemifloxacin, moxifloxacin, trovafloxacin, ciprofloxacin and ofloxacin using an agar dilution method for 400 uropathogens cultured from the urine of urological patients with complicated and/or hospital-acquired urinary tract infections (UTI). The collection of strains was made up of Enterobacteriaceae (34.5%), enterococci (31.5%), staphylococci (21.2%) and non-fermenting bacteria (12.8%). The antibacterial activity of the three newer fluoroquinolones, gatifloxacin, gemifloxacin, and moxifloxacin, were similar, but showed some drug specific differences. Gemifloxacin was most active against Escherichia coli, but less so against Proteus mirabilis. In this series all isolates of E. coli were inhibited at a MIC of 0.25 mg/l gatifloxacin and moxifloxacin and by 0.125 mg/l gemifloxacin. The MIC distribution of all fluoroquinolones showed a bimodal distribution for staphylococci, enterococci and Pseudomonas aeruginosa. The two modes for P. aeruginosa were 1 and 64 mg/l for gemifloxacin and moxifloxacin and 0.5 and 64 mg/l for gatifloxacin. For staphylococci the two modes were 0.125 and 2 mg/l for gatifloxacin, 0.03 and 4 mg/l for gemifloxacin, and 0.03 and 2 mg/l for moxifloxacin; for enterococci, 0.25 and 16 mg/l for gatifloxacin, 0.06 and 2 mg/l for gemifloxacin, and 0.25 and 8 mg/l for moxifloxacin. Compared with trovafloxacin the MICs were similar, but the newer fluoroquinolones were more active than ciprofloxacin and ofloxacin against Gram-positive bacteria. Of the newer fluoroquinolones gatifloxacin had the highest rate of renal excretion and could be considered a promising alternative fluoroquinolone agent for the treatment of UTI.

Urinary concentrations and bactericidal activities of newer fluoroquinolones in healthy volunteers.

Stein GE, Schooley S.
B323 Life Science Building, Michigan State University, East Lansing, MI 48824, USA. [email protected]
Eleven healthy male subjects participated in a crossover study to compare the urine concentrations and bactericidal activities of newer fluoroquinolones against common uropathogens. Each volunteer received a single oral dose of gatifloxacin (400 mg), levofloxacin (250 mg), moxifloxacin (400 mg) and trovafloxacin (200 mg), and a urine sample was obtained at 2, 6, 12 and 24 h after the dose. Urine concentrations were highest with gatifloxacin and levofloxacin and lowest with trovafloxacin. Each drug concentration was studied against a levofloxacin susceptible and moderately-susceptible strain of Escherichia coli (minimal inhibitory concentration, MICs: 0.125 and 4 mg/l), K. pneumoniae (MICs: 0.125 and 4 mg/l), Pseudomonas aeruginosa (MICs: 0.5 and 4 mg/l) and Enterococcus faecalis (MICs: 0.25 and 4 mg/l). The duration of urine bactericidal activity (UBA) was based upon the median bactericidal titre at each time period. Both gatifloxacin and levofloxacin exhibited prolonged (> or = 6 h) UBA against all of the study isolates. Moxifloxacin exhibited prolonged UBA against both isolates of E. coli, K. pneumoniae and E. faecalis but not against either strain of P. aeruginosa. Prolonged UBA was not observed for trovafloxacin against the moderately-susceptible strains with the exception of E. faecalis. Furthermore, UBA was not observed for trovafloxacin against the susceptible strain of P. aeruginosa. Although these newer fluoroquinolones exhibited similar in vitro activity against these uropathogens, only those compounds with the highest urinary concentrations (gatifloxacin and levofloxacin) produced prolonged UBA against both strains of P. aeruginosa. The findings from this study suggest that both microbiological activity and urinary concentrations are important parameters to consider when choosing a fluoroquinolone for empirical treatment of urinary tract infections (UTIs).
 
Farmercyst said:
What's the incidence of FQ associated tendonitis. I know it's a recent blackbox warning, but I only know of one person who claims to have suffered from it and no institutional info on it.

Just wondering. I know the Levaquin reps at CVS brought it up.
Click to expand...

This is occuring more and more especially since they upped the CAP recommended dosing regimen to 750mg Daily..

It's not tendonitis actually...it's ruptured tendons. It happens..
 
Glycerin said:
:idea: 😛

Again, I say cost savings. But, I'll cheat and retract my statement on levo being cheaper than moxi (although Sanford disagrees :meanie: ), and I'll go with Cipro being considerably less expensive with the former contract than with the latter. 😉
Click to expand...

Hmmm..somebody is getting warm...
 
SpirivaSunrise said:
This is all I can find on Pub-Med (have limited access to resources at home)...so can't pull the articles to see whether it confirms a clinicial application or not. (Both from International J of Antimicrobial Agents).

In vitro activity of gatifloxacin compared with gemifloxacin, moxifloxacin, trovafloxacin, ciprofloxacin and ofloxacin against uropathogens cultured from patients with complicated urinary tract infections.

Naber KG, Hollauer K, Kirchbauer D, Witte W.
Urologic Clinic, St Elisabeth Hospital, St Elisabethstrasse 23, D-94315, Straubing, Germany. [email protected]
Minimum inhibitory concentrations (MICs) of gatifloxacin were compared with those of gemifloxacin, moxifloxacin, trovafloxacin, ciprofloxacin and ofloxacin using an agar dilution method for 400 uropathogens cultured from the urine of urological patients with complicated and/or hospital-acquired urinary tract infections (UTI). The collection of strains was made up of Enterobacteriaceae (34.5%), enterococci (31.5%), staphylococci (21.2%) and non-fermenting bacteria (12.8%). The antibacterial activity of the three newer fluoroquinolones, gatifloxacin, gemifloxacin, and moxifloxacin, were similar, but showed some drug specific differences. Gemifloxacin was most active against Escherichia coli, but less so against Proteus mirabilis. In this series all isolates of E. coli were inhibited at a MIC of 0.25 mg/l gatifloxacin and moxifloxacin and by 0.125 mg/l gemifloxacin. The MIC distribution of all fluoroquinolones showed a bimodal distribution for staphylococci, enterococci and Pseudomonas aeruginosa. The two modes for P. aeruginosa were 1 and 64 mg/l for gemifloxacin and moxifloxacin and 0.5 and 64 mg/l for gatifloxacin. For staphylococci the two modes were 0.125 and 2 mg/l for gatifloxacin, 0.03 and 4 mg/l for gemifloxacin, and 0.03 and 2 mg/l for moxifloxacin; for enterococci, 0.25 and 16 mg/l for gatifloxacin, 0.06 and 2 mg/l for gemifloxacin, and 0.25 and 8 mg/l for moxifloxacin. Compared with trovafloxacin the MICs were similar, but the newer fluoroquinolones were more active than ciprofloxacin and ofloxacin against Gram-positive bacteria. Of the newer fluoroquinolones gatifloxacin had the highest rate of renal excretion and could be considered a promising alternative fluoroquinolone agent for the treatment of UTI.

Urinary concentrations and bactericidal activities of newer fluoroquinolones in healthy volunteers.

Stein GE, Schooley S.
B323 Life Science Building, Michigan State University, East Lansing, MI 48824, USA. [email protected]
Eleven healthy male subjects participated in a crossover study to compare the urine concentrations and bactericidal activities of newer fluoroquinolones against common uropathogens. Each volunteer received a single oral dose of gatifloxacin (400 mg), levofloxacin (250 mg), moxifloxacin (400 mg) and trovafloxacin (200 mg), and a urine sample was obtained at 2, 6, 12 and 24 h after the dose. Urine concentrations were highest with gatifloxacin and levofloxacin and lowest with trovafloxacin. Each drug concentration was studied against a levofloxacin susceptible and moderately-susceptible strain of Escherichia coli (minimal inhibitory concentration, MICs: 0.125 and 4 mg/l), K. pneumoniae (MICs: 0.125 and 4 mg/l), Pseudomonas aeruginosa (MICs: 0.5 and 4 mg/l) and Enterococcus faecalis (MICs: 0.25 and 4 mg/l). The duration of urine bactericidal activity (UBA) was based upon the median bactericidal titre at each time period. Both gatifloxacin and levofloxacin exhibited prolonged (> or = 6 h) UBA against all of the study isolates. Moxifloxacin exhibited prolonged UBA against both isolates of E. coli, K. pneumoniae and E. faecalis but not against either strain of P. aeruginosa. Prolonged UBA was not observed for trovafloxacin against the moderately-susceptible strains with the exception of E. faecalis. Furthermore, UBA was not observed for trovafloxacin against the susceptible strain of P. aeruginosa. Although these newer fluoroquinolones exhibited similar in vitro activity against these uropathogens, only those compounds with the highest urinary concentrations (gatifloxacin and levofloxacin) produced prolonged UBA against both strains of P. aeruginosa. The findings from this study suggest that both microbiological activity and urinary concentrations are important parameters to consider when choosing a fluoroquinolone for empirical treatment of urinary tract infections (UTIs).
Click to expand...

Will you consider being my little assistant and pull studies for me when I need them? I don't pay much and you have to make coffee for me daily..and make my travel arrangements and stuff.. You must volunteer for 3 years before being considered for a salary.

I actually have those studies.. :meanie: But now you've read it..so you're that much smarter!
 
njac said:
I believe we did it because there was growing levo resistance.

I haven't seen an antibiogram since we made the swap.
Click to expand...

You should go ask your DOP. First ask him if he knows your name...make sure you have your badge turned.. :meanie:
 
ItsOverZyvox said:
Will you consider being my little assistant and pull studies for me when I need them? I don't pay much and you have to make coffee for me daily..and make my travel arrangements and stuff.. You must volunteer for 3 years before being considered for a salary.

I actually have those studies.. :meanie: But now you've read it..so you're that much smarter!
Click to expand...

Deal! But I want your database access. And FF miles. I make great coffee though...

Seriously...you already had those studies?
 
ItsOverZyvox said:
Well, I'm answering one of my questions no one answered. Cipro, considered one of the earlier generation of quinolones tends to have a slight better coverage against Pseudomonas. So, cipro has an indication for Nosocomial pneumonia while other quinlones don't. But cipro's coverage against streptococcus pneumoniae isn't quite so good where Levo and Moxi usually have 100% sensitivity. So Cipro is a No No for community acquired pneumonia while good for Nosocomial.

But in real practice, I would never recommend Cipro for HAP or VAP.

Now.. pneumonia is usually "respiratory." :meanie:
Click to expand...

Thanks. I just got into stocks. Is there anyway I can benefit from Ortho McNeil's new drug? I cant find the company and if I did. . . . is the drug already factored into the drug price? AMLN dropped 20% + cuz its Exenatide LAR was send back for another study by the FDA. Would you recommend me buying it? Will would the side effect profile of pancreatitis affect the drug? Is there a chance it can kill it?
 
SpirivaSunrise said:
Deal! But I want your database access. And FF miles. I make great coffee though...

Seriously...you already had those studies?
Click to expand...

My database access is our Drug Info department.. who slaves residents to pull the studies and write monographs for me! I rock!

Yes, I already had those studies and read it thoroughly. :meanie:
 
Aznfarmerboi said:
Thanks. I just got into stocks. Is there anyway I can benefit from Ortho McNeil's new drug? I cant find the company and if I did. . . . is the drug already factored into the drug price? AMLN dropped 20% + cuz its Exenatide LAR was send back for another study by the FDA. Would you recommend me buying it? Will would the side effect profile of pancreatitis affect the drug? Is there a chance it can kill it?
Click to expand...

Ortho McNeil is a Johnson and Johnson company...so I doubt this abx will have that much influence over J&J stock pricing.

After all, MRSA market isn't hurting for another drug...it's a crowded market.
 
Glycerin said:
OMG! Yes, he's so nice. 🙂 I just talked to him, actually, about 10 minutes ago. 🙂 He and his wife just had a baby.
Click to expand...

No, she had the baby...he sat on the sideline and cheered her on!
 
SpirivaSunrise said:
No way!! Oooh, I'm going to have to PM you and have you say hi to him for me; and ask him if he's still keeping up with hockey! 😀
Click to expand...

I'm sure he is. :laugh: I think he plays that, too. Or at least he did his first year here. And I think he plays rugby and baseball, too. He sure made biostats a LOT more interesting than it would have been.
 
nafcillin said:
which drugs cover pseudomonas? any easy way to remember which ones they are?

Which drugs cover anaerobes and which kinds of infections are you most likely to see anaerobes?
Click to expand...

anareobes seen in gut mostly, we throw on flagyl for that, or zosyn, unasyn, clindamycin (this doesnt cover aerobic gram - and its a biggest C diff causer, so i stay away from it), among others, avelox will also give u anerobe coverage

but we like to use flagyl, cuz it covers bacteriodes fragilis

for psuedomonas, it depends, for empiric coverage, meaning if we suspect it, we double cover, and then we can streamline down afterwards

u can use: ceftazidime, ticarcillin, cefepime aminoglycosides, imipenem, meropenem, levofloxacin, and ciprofloxacin, zosyn also has coverage

again, it depends on sensitivities and resistance rates in ur area

for quinolones, just remember: for CAP, cipro is not used but avelox/levo are, and for pseudomonas: cipro and levo are used, but not avelox


do I get a cookie?🙂
 
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