Lower respiratory tract infections account for a large proportion of prescribed antibiotics and, with emerging resistance to standard agents, the introduction of the fluoroquinolones, in particular ciprofloxacin, has provided a further component in the armamentarium. This review encompasses 37 published clinical trials which featured ciprofloxacin; 3274 patients with lower respiratory tract infections were treated with this agent; in 94.1% of patients treatment was clinically successful and 90.9% of cases showed eradication of the causative pathogen. When these data were supplemented with previously unpublished Information from the clinical trial database, specific organism eradication rates of 86.1%, 96.2% and 94.6% for Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, respectively, were observed. These findings suggest that the high respiratory tissue penetration of ciprofloxacin and the achievable minimum inhibitory concentrations lead to acceptable clinical outcomes in lower respiratory tract infections.
BallPTillotsonGWilsonRChemotherapy for chronic bronchitis. Presse Med1995; 24: 189–194.
9.
BylBKaufmanLJacobsFCiprofloxacin vs Comparator Antibiotics in LRTI.Chester (UK): Adis Press, 1994.
10.
CooperBLawlorMPneumococcal bacteraemia during ciprofloxacin therapy for pneumococcal pneumonia. Am J Med1989; 87: 475.
11.
RighterJPneumococcal meningitis during intravenous ciprofloxacin therapy. Am J Med1990; 88: 548.
12.
GordonJJKauffmanCASuperinfection with Streptococcus pneumoniae during therapy with ciprofloxacin. Am J Med1990; 89: 383–384.
13.
FredenTRMangiRJInappropriate use of oral ciprofloxacin. JAMA1990; 264: 1438–1440.
14.
YoungsCH Pneumococcal pneumonia in a renal dialysis patient during ciprofloxacin therapy [Abstract]. American Society of Hospital Pharmacists Mid Year meeting. Las Vegas 1990; Abstr. 229D.
15.
Perez-TralleroEGardia-ArenzanaJMFimenezJATherapeutic failure and selection of resistance to quinolones in a case of pneumococcal pneumonia treated with ciprofloxacin. Eur J Clin Microbial Infect Dis1990; 9: 905–906.
16.
MartinezEDomingoPMarcosAPneumococcal bacteraemia in immunocompetent adults. Lancet1991; 337: 57.
17.
KimbroughRCGerechtWBHustedFCThe failure of ciprofloxacin to prevent the progression of Streptococcus pneumoniae infections to meningitis. Missouri Med1991; 88: 635–637.
18.
KornerRLReevesDSMacGowanAPDangers of oral fluoroquinolone treatment in community acquired upper respiratory tract infections. Br Med J1994; 308: 191–192.
19.
LindsayGScorerHJNCarnegieCSafety and efficacy of temafloxacin versus ciprofloxacin in lower respiratory tract infections; a randomised, double-blind trial. J Antimicrob Chemother1992; 30: 89–100.
20.
DewhurstJCarpentierPCerasoliJ Temafloxacin versus ciprofloxacin in the treatment of lower respiratory tract infections. [Abstract] Third International Symposium on New Quinolones. Vancouver: 1990; Abstr. 315.
21.
AfarianJCarpentierPPernetA A comparison of temafloxacin to ciprofloxacin in the treatment of lower respiratory tract bacterial infections. [Abstract] Third International Symposium on new Quinolones. Vancouver: 1990; Abstr. 316.
22.
BarashMKhanFClarkREfficacy and safety of oral ciprofloxacin versus amoxycillin/clavulanate in the treatment of lower respiratory tract infections in adults. Eur J Clin Microbiol Inf Dis1991; 10 (Suppl): 8–10.
23.
RaoofSWollschlangerCKhanFTreatment of respiratory tract infections with ciprofloxacin. J Antimicrob Chemother1986; 18 (Suppl D): 139–145.
24.
PolubiecAJoraszIDietrzakJA randomized study comparing low dose ciprofloxacin and ofloxacin in the treatment of respiratory tract infections. Infection1994; 22: 62–64.
25.
SalvatiFZubianiMAntilliACiprofloxacin in the oral treatment of severe respiratory tract infections. Rev Infect Dis1988; 10 (Suppl 1: 5220.
26.
MollerMCiprofloxacin therapy in out-patients with lower respiratory tract infections. Int J Clin Pract1990; 6 (Suppl 1): 72–76.
27.
MenonLErnstJASyERBrief report: sequential intravenous/oral ciprofloxacin compared with intravenous ceftazidime in the treatment of serious lower respiratory tract infections. Am J Med1989; 87 (Suppl 5A: 119s–120s.
28.
BantzPMGaloteJPeters-HaertelWLow dose ciprofloxacin in respiratory tract infections. Am J Med1987; 82 (Suppl 4a): 208–210.
29.
GleadhillICFergusonWPLowryRCEfficacy and safety of ciprofloxacin in patients with respiratory infections in comparison with amoxycillin. J Antimicrob Chemother1986; 18 (Suppl D): 133–138.
30.
MaggioloFBianchiWOhnmeissH Clinical and microbiological evaluation of ciprofloxacin in respiratory tract infections. [Abstract] Fourth European Congress on Clinical Microbiology. Nice: 1989; Abstr. 127/PP3.
31.
NonikovVEMakaroveOVZubkovMNLomefloxacin vs ciprofloxacin in lower respiratory infection. Drugs1993; 45 (Suppl 3: 413.
32.
Brutel de la RiviereTDaniels-BosmanMSMten VeldeGPMTwo different dosages of ciprofloxacin in patients with respiratory tract infections. Pharm Weekbl1989; 11: 121–123.
33.
ChodoshSTemafloxacin compared with ciprofloxacin in mild to moderate lower respiratory tracts infections in ambulatory patients. Chest1991; 100: 1497–1502.
34.
Hoogkamp-KorstanjeJAAKleinSJCiprofloxacin in acute exacerbations of chronic bronchitis. J Antimicrob Chemother1986; 18: 407–413.
35.
ChmelHEmmanualGLieTA prospective, double-blind randomized study comparing the efficacy and safety of low-dose ciprofloxacin with ampicillin in the treatment of bronchitis. Diagn Microbiol Infect Dis1990; 13: 149–151.
36.
QuenzerRProspective randomized study comparing the efficacy and safety of ciprofloxacin with cefaclor in the treatment of patients with purulent bronchitis. Diagn Microbiol Dis1990; 13: 143–148.
37.
ChodoshSTuckJStottmeierKDComparison of ciprofloxacin with ampicillin in acute infectious exacerbations of chronic bronchitis. Am J Med1989; 87 (Suppl 5A: 107s–112s.
38.
LeophontePCiprofloxacin vs roxithromycin in lower respiratory tract infections: a double blind comparison. In: Ciprofloxacin in Pulmonology III (ShahPM ed). Munich: Zuckschwerdt Verlag, 1992.
39.
CazzolaMLegnaniDBeghiG Exacerbation of chronic bronchitis, clinical and microbiological efficacy of amoxycillin and clavulanic acid, vs cefixime or ciprofloxacin [Abstract]. Sixth International Congress on Infectious Diseases. Prague: 1994; Abstr. 1240.
40.
AcarJ A randomised comparative study of ciprofloxacin versus josamycin in respiratory tract infections of adults [Abstract]. Third International Congress on Infectious Diseases. Rio de Janeiro: 1988; Abstr. 606.
41.
ChrysanthopoulosCJSkoutelisATStarakisJCUse of intravenous ciprofloxacin in respiratory tract infections and biliary sepsis. Am J Med1987; 82 (Suppl 4A): 357–359.
42.
BraunHRadzynerMCiprofloxacin in respiratory tract infections: a phase IV surveillance study. Curr Ther Res1994; 55: 729–735.
43.
BasranGSJosephJAbbasATreatments of acute exacerbations of chronic obstructive airways disease—a comparison of amoxycillin and ciprofloxacin. J Antimicrob Chemother1990; 26 (Suppl F): 19–24.
44.
DaviesBIMaesenFPVBaurCCiprofloxacin in the treatment of acute exacerbations of chronic bronchitis. Eur J Microbiol1986; 5: 226–231.
45.
CantonPHoenBRichetHBrief report: comparative efficacy of ciprofloxacin versus josamycin in the treatment of acute, recurrent or exacerbated bronchitis. Am J Med1989; 87 (Suppl 5A): 121–122.
46.
FassRJEfficacy and safety of oral ciprofloxacin in the treatment of serious respiratory infections. Am J Med1987; 82 (Suppl 4A): 202–207.
47.
WollschlangerCMRaoofSKhanFAControlled, comparative study of ciprofloxacin versus ampicillin in treatment of bacterial respiratory tract infections. Am J Med1987; 82 (Suppl 4A): 164–168.
48.
HaddowAGreeneSHeinzGCiprofloxacin (intravenous/oral) versus ceftazidime in lower respiratory tract infections. Am J Med1989; 87 (Suppl 5A: 113S–115S.
49.
ChrysanthopoulosCJBassarisHPUse of oral ciprofloxacin in community acquired pneumonia. J Chemother1989; 1: 103–106.
50.
ErnstJASyERColon-LuccaHCiprofloxacin in the treatment of pneumonia. Antimicrob Agents Chemother1986; 29: 1088–1089.
51.
TrenholmeGSchmittBASpearJRandomized study of intravenous/oral ciprofloxacin versus ceftazidime in the treatment of hospital and nursing home patients with lower respiratory tract infections. Am J Med1989; 87 (Suppl 5A: 116s–118s.
52.
KhanFABasirRSequential intravenous–oral administration of ciprofloxacin vs ceftazidime in serious bacterial respiratory tract infections. Chest1989; 96: 528–537.
53.
JohnsonRLevineSTraubS Prospective, multicenter study comparing the efficacy and safety of sequential intravenous/oral ciprofloxacin with parenteral ceftriaxone in the treatment of patients with community-acquired pneumonia [Abstract]. Fifth International Symposium on New Quinolones. Singapore: 1994; Abstr. 143.
54.
CaballeroMBonoarVCalabuigJR Clinical and microbiological comparison of sequential IV/PO ciprofloxacin vs parenteral cefotaxime in patients with sepsis [Abstract]. Seventh European Congress on Clinical Microbiology and Infectious Disease. Vienna: 1995; Abstr. 1123.
55.
FinkMPSnydmanDRNiedermanMSTreatment of severe pneumonia in hospitalized patients: results of a multicentre, randomized, double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastatin. Antimicrob Agents Chemother1994; 38: 547–557.
