최근 2년간 전라남도 및 광주지역의 지역사회 획득성 요로감염에 이환된 여성 환자에서 동정된 Escherichia coli의 Ciprofloxacin 내성패턴

김경영,김철성,임동훈 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.6

Purpose: The overuse of ciprofloxacin has recently increased the resistance of the Escherichia coli(E. coli). We studied the prevalence od the ciprofloxacin-resistant(CR) E. coli that were isolated from female patients with community-acquired urinary tract infection(CAUTI), and we demonstrated the resistant rate to other antibiotics to help physicians choose the suitable antibiotics to properly treat CAUTI. Materials and Methods: From January 2006 to December 2007, we retrospectively analyzed 910 female patients with CAUTI. Among them, we chose 387 patients infected by E. coli and we evaluated the resistance rate to ciprofloxacin and its relationship with age, the disease causing the UTI and the previous antibiotics. We also compared the resistance to ciprofloxacin with that of other antibiotics, including cephalosporin and the other antibiotics recommended by the guidelines of the Infectious Diseases Society of America(IDSA). Results: The incidence of UTI by E. coli increased with age(p<0.001), and it was highest in the 7th decade (59.0%). One hundred seventeen (30.2%) patients showed ciprofloxacin resistance. It was significantly related to an increased age(p=0.034), complicated UTI(p=0.04) and a previous history of antibiotic use(p=0.023). Trimethoprim/sulfamethoxazole(TMP/SMX) and fosfomycin showed similar resistance rates like ciprofloxacin; 31.8 and 28.2%, respectively. On the other hand, nitrofurantoin showed a low resistant rate of 5.7%. The resistance to cephalosporin was low in general; the lowest was cefepime(5.9%). Conclusions: Our results imply that the empirical use of ciprofloxacin for female patients with CAUTI is questionable, and especially for patients older than 40 years old, patients with complicated UTI and patients with a previous history of antibiotic use. Nitrofurantoin and cephalosporin can be useful agents for the treatment of female CAUTI. (Korean J Urol 2008; 49:540-548) Purpose: The overuse of ciprofloxacin has recently increased the resistance of the Escherichia coli(E. coli). We studied the prevalence od the ciprofloxacin-resistant(CR) E. coli that were isolated from female patients with community-acquired urinary tract infection(CAUTI), and we demonstrated the resistant rate to other antibiotics to help physicians choose the suitable antibiotics to properly treat CAUTI. Materials and Methods: From January 2006 to December 2007, we retrospectively analyzed 910 female patients with CAUTI. Among them, we chose 387 patients infected by E. coli and we evaluated the resistance rate to ciprofloxacin and its relationship with age, the disease causing the UTI and the previous antibiotics. We also compared the resistance to ciprofloxacin with that of other antibiotics, including cephalosporin and the other antibiotics recommended by the guidelines of the Infectious Diseases Society of America(IDSA). Results: The incidence of UTI by E. coli increased with age(p<0.001), and it was highest in the 7th decade (59.0%). One hundred seventeen (30.2%) patients showed ciprofloxacin resistance. It was significantly related to an increased age(p=0.034), complicated UTI(p=0.04) and a previous history of antibiotic use(p=0.023). Trimethoprim/sulfamethoxazole(TMP/SMX) and fosfomycin showed similar resistance rates like ciprofloxacin; 31.8 and 28.2%, respectively. On the other hand, nitrofurantoin showed a low resistant rate of 5.7%. The resistance to cephalosporin was low in general; the lowest was cefepime(5.9%). Conclusions: Our results imply that the empirical use of ciprofloxacin for female patients with CAUTI is questionable, and especially for patients older than 40 years old, patients with complicated UTI and patients with a previous history of antibiotic use. Nitrofurantoin and cephalosporin can be useful agents for the treatment of female CAUTI. (Korean J Urol 2008; 49:540-548)

Acute Pancreatitis Secondary to Ciprofloxacin Therapy in Patients with Infectious Colitis

안지원,이현정,성혜영,정대영,김진일,조세현,박수헌,한준열,김재광 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

Ciprofloxacin is considered to be a safe and effective treatment of acute infectious colitis. However, this drug, albeit rarely, may cause drug-induced pancreatitis. This study was conducted to analyze the clinical features of pancreatitis caused by ciprofloxacin. Method: From January 2007 to March 2011, we registered 227 patients who were hospitalized infectious colitis at St. Mary`s hospital, Seoul, Korea. All the patients received ciprofloxacin therapy for a treatment of infectious colitis. We observed a few cases of rare adverse events; ciprofloxacin-induced acute pancreatitis diagnosed by the Naranjo algorithm. Results: During ciprofloxacin therapy, 7 of 227 patients (3.1%) were met rare adverse events (4 males and 3 females with a mean age of 46.9±17.4 years; range: 24-71). They were diagnosed to probable pancreatitis secondary to ciprofloxacin by the Naranjo algorithm; pancreatic enzyme was sporadically elevated with ciprofloxacin use. After ciprofloxacin administration, the average time interval until development of pancreatitis was 5.5 days (range: 4-7). In abdominal computed tomography, pancreatic swelling and homogenous enhancement was noted in 3 of 7 patients. Complicating acute pancreatitis was completely resolved gradually after the cessation of ciprofloxacin administration. Mean recovery time was 11.3 days (range: 8-15). Conclusion: We observed that ciprofloxacin-induced pancreatitis may occur with an incidence of approximately 3%. Drug-induced pancreatitis by ciprofloxacin displays a short latency, suggesting an idiosyncratic hypersensitivity reaction. If pancreatitis was detected early, the prognosis was very good. During ciprofloxacin use, practitioners should be aware that drug-induced pancreatitis can occur during ciprofloxacin therapy. And regular screening of chemical profiles is warranted.

Ciprofloxacin 약제에 내성을 보이는 대장균에 의한 소아 요로감염: 위험 인자 분석

홍주형,유지숙,이길호 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.12

urpose: Previous exposure to fluoroquinolone is an important risk factor for acquiring resistant strains of microorganisms. However, the mechanisms of fluoroquinolone resistance in Escherichia coli from pediatric patients with urinary tract infection (UTI) are not well defined because fluoroquinolone prescription for children is not permitted around the world. We investigated the risk factors for ciprofloxacin-resistant E. coli isolates from the urine of pediatric patients with UTI. Materials and Methods: Data from 72 patients who showed ≥105 E. coli colony-forming units in urine culture were retrospectively collected from a university hospital between June 2006 and June 2009. The minimum inhibitory concentration of ciprofloxacin resistance was determined by the agar dilution method on Mueller-Hinton agar. Results: The rates of E. coli resistance to ciprofloxacin, cefazolin, ampicillin, co-trimoxazole, and fosfomycin were 8.3%, 20.8%, 77.7%, 25%, and 0%, respectively. Differences in sex, age intervals, and previous antimicrobial use in recent years were significantly associated with ciprofloxacin resistance, whereas admission level, the presence of fever, and the type of UTI were not. In addition, female gender, previous antimicrobial use, and older age significantly increased the risk for ciprofloxacin resistance in a univariate analysis. Only co-trimoxazole resistance was positively associated with ciprofloxacin resistance, whereas resistance to other antimicrobials was not. Conclusions: Even though the incidence was not high, ciprofloxacin resistance was found in E. coli from pediatric UTIs. Because the characteristics of ciprofloxacin resistance in pediatric patients are not well defined, further study of the mechanism of acquiring ciprofloxacin resistance in children is needed. urpose: Previous exposure to fluoroquinolone is an important risk factor for acquiring resistant strains of microorganisms. However, the mechanisms of fluoroquinolone resistance in Escherichia coli from pediatric patients with urinary tract infection (UTI) are not well defined because fluoroquinolone prescription for children is not permitted around the world. We investigated the risk factors for ciprofloxacin-resistant E. coli isolates from the urine of pediatric patients with UTI. Materials and Methods: Data from 72 patients who showed ≥105 E. coli colony-forming units in urine culture were retrospectively collected from a university hospital between June 2006 and June 2009. The minimum inhibitory concentration of ciprofloxacin resistance was determined by the agar dilution method on Mueller-Hinton agar. Results: The rates of E. coli resistance to ciprofloxacin, cefazolin, ampicillin, co-trimoxazole, and fosfomycin were 8.3%, 20.8%, 77.7%, 25%, and 0%, respectively. Differences in sex, age intervals, and previous antimicrobial use in recent years were significantly associated with ciprofloxacin resistance, whereas admission level, the presence of fever, and the type of UTI were not. In addition, female gender, previous antimicrobial use, and older age significantly increased the risk for ciprofloxacin resistance in a univariate analysis. Only co-trimoxazole resistance was positively associated with ciprofloxacin resistance, whereas resistance to other antimicrobials was not. Conclusions: Even though the incidence was not high, ciprofloxacin resistance was found in E. coli from pediatric UTIs. Because the characteristics of ciprofloxacin resistance in pediatric patients are not well defined, further study of the mechanism of acquiring ciprofloxacin resistance in children is needed.

주요 임상분리센균에 대한 moxifloxacin과 ciprofloxacin의 최소억제농도

김의종,김하영,이상원 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.4

목적 : Moxifloxacin에 대한 국내 임상 분리 균주의 감수성 여부를 팡가하기 위하여 임상 환자에서 흔히 분리되는 통성 혐기성 세균을 대상으로 최소억제농도를 측정하였으며, 대조 항생제로는 ciprofloxacin을 사용하여 그 결과와 서로 비교하였다. 방법 : 시험 균종은 1999년 서울대학교병원 임상병리과로 세균배양이 의뢰된 혈액, 객담, 소변 등 임상 검체에서 분리한 균주로서 임상 환자에서 흔히 분리되는 통성 혐기성 세균 총 507주를 대상으로 하였다. 미국임상검사표준화협회(NCCLS)에서 권장하는 방법에 따라 S. pneumoniae와 H. influenzae를 제외한 모든 균종은 한천희석법으로 MIC를 측정하였으며, S. pneumoniae와 H. influenzae는 microdilution broth법으로 MIC를 측정하였다. 결과 : Staphylococcus spp.와 Enterococcus spp.에서 moxifloxacin에 대한 MIC가 ciprofloxacin에 대한 MIC보다 전반적으로 낮았다. PSSP의 경우 moxifloxacin에 대한 MIC가 cirpofloxacin의 MIC보다 4-8배 낮았다. PRSP의 경우 moxifloxacin에 대한 MIC는 2㎍/㎖인 한 균주를 제외하고는 모든 균주가 0.06-0.125㎍/㎖으로 감수성이었다. Ciprofloxacin에 대해 감수성을 보인 PRSP의 moxifloxacin에 대한 MIC는 ciprofloxacin의 MIC보다 4-8배 낮았다. E. coli, K. pneumoniae와 E. cloacae에서는 ciprofloxacin의 MIC가 moxifloxacin보다 낮았다. P. aeruginosa의 moxifloxacin에 대한 MIC가 ciprofloxacin의 경우보다 4-8배 높았다. A. baumanii와 S. maltophilia의 moxifloxacin에 대한 MIC가 ciprofloxacin의 경우보다 2-8배 낮았다. H. influenzae의 moxifloxacin에 대한 MIC_(90)는 0.015㎍/㎖ 이하이었고, ciprofloxacin에 대한 MIC도 이하 동일한 결과가 관찰되었다. 결론 : Ciprofloxacin은 Enterobacteriaceae와 Pseudomonas spp.에 대하여 항균력이 높고, moxifloxacin은 페니실린 내성 유무에 관계없이 S. pneumoniae에 대하여 항균력이 뛰어나다. 우리 나라에서 moxifloxacin을 사용한 후, S. pneumoniae에 대한 moxifloxacin의 MIC 분포가 내성 쪽으로 기울어지는 지를 계속적으로 모니터링해야 할 것이다. Background: Minimal inhibitory concentrations (MICs) of facultative anaerobic bacteria isolated from patients were determined for the in vitro susceptibility of Korean clinical isolates against moxifloxacin and compared with MICs of ciprofloxacin. Methods: Total 507 strains isolated from blood, sputum, or urine of patients at Seoul National University Hospital in 1999 were examined by agar dilution or microdilution broth method according to the recommendations of National Committee for Clinical Laboratory Standards. Results: The MICs of moxifloxacin against Staphylococcus spp. and Enterococcus spp. were lower than those of ciprofloxacin. For penicillin-susceptible S. pneumoniae moxifloxacin showed 4 to 8-fold lower MIC than ciprofloxacin. All of penicillin-resistant S. pneumoniae were susceptible to moxifloxacin (MICs 0.06-0.125 ㎍/㎖). except one strain (MIC 2 ㎍/㎖). The MICs of moxifloxacin against ciprofloxacin-susceptible. penicillin-resistant S. pneumoniae were 4 to 8-fold lower than those of ciprofloxacin. Against E. coil. K. pneumoniae. and E. cloacae. MICs of ciprofloxacin were lower than those of moxifloxacin. Against P. aeruginosa, moxifloxacin was less active than ciprofloxacin. Moxifloxacin was 2 to 8-fold more active than ciprofloxacin against A. baumanii and S. maltophilia. Against H. influenzae. moxifloxacin (MIG_(90) ≤0.015㎍/㎖) was moxifloxacin was as active as ciprofloxacin. Conclusion: Moxifloxacin was more active against gram-positive bacteria, especially penicillin-resistant S. pneumoniae. Ciprofloxacin was more active against Enterobacteriaceae and P. aeniginosa. The continuous monitoring for the change of susceptibility of moxifloxacin against S. pneumoniae is needed after using moxifloxacin in Korea.

병원획득 Klebsiella pneumoniae 균혈증 분석을 통해 본 Ciprofloxacin 내성과 Extended-Spectrum β-Lactamase생성 간의 연관성

김미영,추은주,곽이경,송문희,나성수,송태준,김성혜,전재범,최상호,정진용,김남중,김양수,우준희,류지소 대한감염학회 2004 감염과 화학요법 Vol.36 No.5

목적 : K. pneumoniae는 ciprofloxacin내성 증가가 전세계적으로 문제가 되고있는 extended-spectrum beta-lactamase (ESBL)를 생성하는 대표적인 세균으로 최근 외국에서 ciprofloxacin 내성과 ESBL 생성사이에 관련이 있다는 2-3편의 보고들이 있었다. 본 연구에서는 병원획득 K. pneumoniae 패혈증이 있었던 환자들을 대상으로 ciprofloxacin 내성과 관련된 인자를 알아보고자 하였다. 재료 및 방법 : 2001년 1월 부터 2002년 12월 사이에 2200병상의 3차 의료기관인 한 대학병원에서 입원 후 72시간 이후에 나간 혈액배양에서 K. pneumoniae가 배양된 입원환자를 대상으로 의무기록과 전산기록을 분석하여 환자의 성별, 나이, 병동, 기저질환, 이전의 항생제 사용력, 패혈증 발생당시까지의 재원기간, 이전 입원력, 원인균의ESBL 생성유무 등을 파악하였고 이들 변수가 ciprofloxacin 내성과 관련이 있는지를 분석하였다. 재발성 패혈증의 경우는 첫 번째 경우만을 분석에 포함하였다. 결과 : 연구대상 환자는 총154명이었고 K. pneumoniae의 ciprofloxacin에 대한 내성률은 28.6% (44/154)였다. Ciprofloxacin 내성균주 중 ESBL 생성균주의 비율은 95.5% (42/44)였고 ciprofloxacin 감수성균주에서 ESBL 생성균주의 비율은 24.5% (27/110)였다(P<0.001). ESBL생성외에 단변량 분석에서 유의한 관련을 보인 변수로는 남자, 나이가 많은 경우, 패혈증 당시 중환자실 재원, 기저질환이 고형암, 혈액암, 담도계 질환인 경우, 패혈증 발생이전 1달 이내의 항생제 사용력, 3세대 cephalosporin, metronidazole, fluroquinolone, carbapenem 투여력이 있었다. 다변량 로지스틱 분석을 시행 하였을 때는 나이가 많은 경우(Adjusted odds ratio[A0R]; 1.04, 95%confidence interval[CI]; 1.01-1.06)와 ESBL 생성(AOR; 81.35, 95% CI; 17.76-372.53)이 유의하게 ciprofloxacin 내성과 관련이 있었다. 결론 : 패혈증을 일으킨 병원획득 K. pneumonias에서의 ciprofloxacin 내성은 ESBL 생성과 유의한 관련을 보였고 향후 이에 관련된 원인이나 기전을 분석하기위한 분자역학적·분자생물학적 연구가 필요하겠다. Background : Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. Materials and Methods : Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. Results : The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3^(rd)-generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). Conclusion : The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.

Ciprofloxacin 치료에 실패한 국내에서감염된 장티푸스 1예

이광선,이하연,전은주,정진원 대한감염학회 2008 Infection and Chemotherapy Vol.40 No.3

Typhoid fever caused by Salmonella enterica serovar Typhi (S. typhi) and usually ciprofloxacin is first used for treatment. However, the incidence of fluoroquinolone resistance or reduced susceptibility in S. typhi has been increased in Asia over the past decade and there have been reports of failed treatment with ciprofloxacin. Recently, if typhoid fever does not improved with ciprofloxacin treatment, S. typhi with reduced susceptibility to ciprofloxacin should be considered. We experienced a case of nalidixic acid-resistant S. typhi infection that was refractory to treatment with ciprofloxacin in Korea. A 47-year-old woman presented with fever and headache for 14 days. Blood culture revealed the presence of S. typhi that was susceptible to ciprofloxacin. However, she remained feverish and new symptoms of abdominal pain and bloody diarrhea developed after 5 days treatment with ciprofloxacin and subsequent testing showed that isolate was resistant to nalidixic acid. 장티푸스의 경험적 1차 치료 항생제는 현재 ciprofloxacin이 가장 많이 사용되고 있다. 하지만 최근 아시아의 여러 개발도상국에서 내성이 문제되고 있다. 국내에서도 약제내성균이 증가되고 있어서 임상적 치료에 반응이 없는 경우 nalidixic acid 내성균에 의한 장티푸스를 고려해야 한다. 저자들은 국내에서 내국인이 감염된 장티푸스가 ciprofloxacin 치료에 실패한 예를 경험하였기에 문헌 고찰과 함께 보고한다. 47세 여성은 발열과 두통을 주소로 입원하였다. 입원 4일 뒤 혈액 배양 검사에서 Salmonella enterica serovar Typhi 가 동정되어서 감수성을 보인 ciprofloxacin을 4일간 투여하였으나 39℃ 이상의 발열과 혈성 설사가 동반되고, 균혈증이 지속되었고 nalidixic acid 내성으로 나타나서 ampicillin/sulbactam으로 변경 치료 후 호전되었다.

쯔쯔가무시병에서 Ciprofloxacin, Pefloxacin, Doxycycline의 치료 효과 비교

오수용,정문현,오세진,손민수,안승운 대한감염학회 1995 감염 Vol.27 No.2

목적: 리케치아 감염증과 장티푸스는 국내에서 모두 발생하며 임상적으로 비슷하다. 경험적 항균제는 이 두 질환에 모두 효과적이어야 하며 chloram phenicol이 효과가 있으나 부작용이 문제가 되므로 새로운 항균제에 대한 연구가 필요하다. 새로운 quinolone은 장티푸스에 치료 효과가 있으며, 일부 리케치아 질환에 효과가 있다는 보고가 있다. 쯔쯔가무시병에 대해서는 증례 보고만이 있을 뿐이며 doxycycline과 비교한 연구가 없다. 이 연구는 fluoroquinolone제제인 ciprofloxacin과 pefloxacin의 쯔쯔가무시병 치료에 대한 효과를 조사한 것이다. 방법: 입원한 환자 중 발열을 포함하여 임상 소견이 있고 간접면역형광항체법으로 증명된 쯔쯔가무시병 환자 18명을 대상으로 3군으로 나누어 ciprofloxacin, pefloxacin, doxycycline중 하나를 투여하고 해열까지 투여한 횟수를 비교하였다. 각 치료제로 배정은 담당의의 판단에 따랐으며 무작위 배정은 아니었다. 결과: Ciprofloxacin을 투여한 5명 중 4명은 중앙값 6.5회 투여 후 해열되었으며 한 명은 7회 투여후에도 증상이나 이학 소견이 호전되지 않아 doxycycline으로 바꾸었다. Pefloxacin을 투여한 5명중에서도 4명은 중앙값 6.5회 투여 후 해열 되었고 한 명은 11회 투여 후에도 호전되지 않았다. Doxycycline은 8명에서 사용하였고 해열까지 중앙값 4.0회 투여하였으며 치료 실패는 없었다. 결론: Ciprofloxacin이나 pefloxacin은 단독으로 사용 시 쯔쯔가무시병 치료 효과가 있으나, doxycycline에 비해 해열까지 시간이 더 걸리는 듯하고, 일부 환자는 6번 투여 후에도 증상이나 이학 소견이 좋아지지 않았다. 모든 환자에서 효과가 있는 것은 아니므로 빠른 치료를 요하는 중증 환자에게는 사용하지 않는 것이 좋다. Background: Although doxycyline is the antimicrobial drug of choice for the treatment of scrub typhus, it has no role in the treatment of typhoid fever. Typhoid fever and rickettsial infections are similar in many clinical features. For the empirical treatment of suspected rickettsial infections in areas where typhoid fever and rickettsial infections are endemic, it is preferable to use an agent which has an additional antimicrobial activity against salmonella species. Fluoroquinolones are effective against typhoid fever, and recent studies revealed that quinolones might be effective against several rickettsial infections. Methods: We conducted an open clinical study of patients with scrub typhus who were admitted to the Chungan Gil hospital during the period from 1992 through 1994. Patients were assigned to ciprofloxacin(200mg intravenously every 12 hours), pefloxacin(400mg every 12 hours), or doxycycline (100mg every 12 hours). If no clinical improvement was a chieved within doses of medications, we defined it as treatment failure. Results: Of the eighteen patients, five were in the ciprofloxacin, five in the pefloxacin, and eight in the doxycycline group. There were two patients of treatment failure, one(20%) in the ciprofloxacin and one(20%) in the pefloxacin group. There was no case of treatment failure in the doxycycline group. Doses, administered to the remaining patients until defervescence, were 3,6,7,9(median 6.5) in the ciprofloxacin group;4,5,8,11(median 6.5) in the pefloxacin group;2,3,4,4,4,5,5,7(median 4.0) in the doxycycline group. Conclusions: Ciprofloxacin and pefloxacin have efficacy against scrub typhus. However, some patients were not improved clinically within 6 doses of ciprofloxacin or pefloxacin, and fluoroquinolones might show slowere responses than doxycycline. Therefore, it would be prudent not to use ciprofloxacin or pefloxacin for the treatment of severe scrub typhus.

국내 대학병원에서 정주용 Ciprofloxacin 사용의 적정성 평가

김신우,박효정,오원섭,김연숙,장현하,정숙인,정두련,이혁,염준섭,기현균,손준성,백경란,우건조,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

목적 : 국내 병원에서의 정주 ciprofloxacin 사용의 적정성을 평가하고자 하였다. 재료 및 방법 : 2003년 9월 25일부터 8개의 대학병원에서 정주 ciprofloxacin을 받았던 290명의 연속적으로 모집한 성인환자를 대상으로 약제사용 평가(DUE)를 전향적으로 수행하였다. 이 연구에 사용된 DUE 기준은 미국병원약사회의 기준을 국내 실정에 맡게 수정하여 사용하였으며 1) 사용의 정당성에 관한 항목, 2) 사용 시 준수되거나 시행되어야 할 사항에 대한 항목, 3) 부작용에 대한 항목, 4) 치료 효과에 대한 항목으로 나누어 조사하였다. 결과 : 환자의 평균 나이는 54세였다. 33예(26.9%)에서만 약제 사용의 적정성 측면에서 기준을 만족하였고 91예(73.1%)에서는 사용이 적절하지 않았다. 정주 cipro-floxacin의 부적절한 사용의 흔한 원인은 수술 전후의 예방약 사용, 비뇨기계 처치 전의 예방적 사용, 열성 질환에 대한 경험적 사용 등의 순이었다. 사용 시 준수사항 의 측면에서는 사용 전 배양검사(73.8%)와 사용 중 배양검사(68.6%)가 낮은 수행 정도를 보였으나 그 외는 비교적 높은 적정성(82.4-100%)을 보여주었다. 정주 ciprofloxacin사용의 합병증은 드물었다. 치료 효과의 면에서 치료반응은 93.3%였다. 결론 : 약제 사용의 정당성 기준에 따른 정주 cipro-floxacin의 부적절한 사용은 연구에 포함된 대학병원에서 매우 흔하였다(73.1%). 그러므로 적절한 항생제 사용에 대한 교육과 제도적 장치가 매우 필요한 것으로 판단되었다. Background : To evaluate the appropriateness of intravenous (IV) ciprofloxacin usage in university hospitals in Korea. Materials and Methods : We prospectively evaluated the appropriateness of drug usage in 290 consecutive adult patients who received IV ciprofloxacin in eight teaching hospitals during the period from September 25, 2003 to November 15, 2003. Drug use evaluation (DUE) in this study was based on the modified standard by the American Society of Hospital Pharmacy with regard to the justification of drug use, critical and process indications, complications, and outcome measures. Results : Average age of the patients was 54 years. The use of IV ciprofloxacin was appropriate only in 33 cases (26.9%). Common reasons for inappropriate use of IV ciprofloxacin include perioperative uses or prophylactic injection before urologic procedures, and empirical therapy for febrile episodes. Most of the "critical indications" and "process indications" showed high rate of appropriateness (82.4-100%). However, the rate of taking culture and sensitivity test before (73.8%) and during ciprofloxacin use (68.6%) were low. Complications with ciprofloxacin use were rare. In 93.3% of cases, ciprofloxacin treatment was clinically effective. Conclusion : Use of intravenous ciprofloxacin is frequently inappropriate in tertiary care hospitals in Korea. Implementation of education program and antibiotic control system is critical in improving the appropriateness of antimicrobial use.

Ciprofloxacin 치료에 실패한 국내에서 감염된 장티푸스 1예

이광선,이하연,전은주,정진원 대한감염학회 2008 감염과 화학요법 Vol.40 No.3

장티푸스의 경험적 1차 치료 항생제는 현재 Ciprofloxacin이 가장 많이 사용되고 있다. 하지만 최근 아시아의 여러 개발도상국에서 내성이 문제되고 있다. 국내에서도 약제내성균이 증가되고 있어서 임상적 치료에 반응이 없는 경우 nalidixic aci친 내성균에 의한 장티푸스를 고려해야 한다. 저자들은 국내에서 내국인이 감염된 장티푸스가 ciprofloxacin 치료에 실패한 예를 경험하였기에 문헌 고찰과 함께 보고한다. 47세 여성은 발열과 두통을 주소로 입원하였다. 입원 4일 뒤 혈액 배양 검사에서 Salmonella enterica serovar Typhi 가 동정 되 어서 감수성을 보인 ciprofloxacin을 4일간 투여하였으나 39'C 이상의 발열과 혈성 설사가 동반되고, 균혈증이 지속되었고 nalidixic acid 내성으로 나타나서 ampicillin/sulbactam으로 변경 치료 후 호전되었다. Typhoid fever caused by Salmonella enterica serovar Typhi (S. typhi) and usually ciprofloxacin is first used for treatment. However, the incidence of fluoroquinolone resistance or reduced susceptibility in S. typhi has been increased in Asia over the past decade and there have been reports of failed treatment with ciprofloxacin. Recently, if typhoid fever does not improved with ciprofloxacin treatment S. typhi with reduced susceptibility to ciprofloxacin should be considered. We experienced a case of nalidixic acid-resistant S. typhi infection that was refractory to treatment with ciprofloxacin in Korea. A 47-year-o1d woman presented with fever and headache for 14 days. Blood culture revealed the presence of S. typhi that was susceptible to ciprofloxacin. However she remained feverish and new symptoms of abdominal pain and bloody diarrhea developed after 5 days treatment with ciprofloxacin and subsequent testing showed that isolate was resistant to nalidixic acid.

Ciprofloxacin의 약물사용 평가

연은숙,박지원,김수자,장혜경,김옥녀 한국병원약사회 1999 병원약사회지 Vol.16 No.1

Ciprofloxacin is one of synthetic fluoroquinolone antibacterial agents which has great bactericidal activity against Gram negative aerobic organisms (especially, Enterobacteriaceae and Pseudomonas aeruginosa) and Gram positive bacteria (including Penicillinase-producing and Methicillin-sensitive Staphylococcus aureus). However, the appearance of ciprofloxacin resistant to many different microorganisms limits the use of ciprofloxacin for patients who are really needed it. This sudy was performed to analyzed the appropriateness for ciprofloxacin use in St. Mary's Hospital setting. Forty-one charts of patients who used ciprofloxacin (Ⅳ) (M/F 24/17, Jan.-Aug. of 1998) underwent drug utilization evaluation (DUE). The criterias of DUE used in this study were based on the standards by the American Society of Hospital Pharmacy which modified to be appropriate in our hospital setting : 1) Justification of drug use, 2) Critical & process indications, 3) Complications, 4) Outcome measures. Justification of use showed high appropriate rate (87.8%). Most of the critical & process indications also showed high appropriate rates (82.9 thru 97.5%) except C&S test during ciprofloxacin use (60.9%). Complications in ciprofloxacin use were usually minor symptoms such as pruritis (2.4%) and GI problems (39.0%). Also these study datas demonstrated other factors such as drug-drug interactions and co-disease could influence the complications. In case of outcome measures, the total therapeutic response showed high rate (95.1%). Only two patients (4.8%) had no response to ciprofloxacin at all. This study shows DUE analyzed for the appropriateness and problems of ciprofloxacin use. Therefore, DUE to a specific drug can apply to improve the efficacy of drug use and quality of medical service.