Active Ingredients: Ciprofloxacin
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Despite the development of bacterial resistance, which was noted shortly after the penicillins were introduced, these drugs are still widely used, and new penicillin derivatives are being developed.
Penicillin G is not as well absorbed and is therefore less useful for oral therapy.
Penicillin V is indicated for the treatment of mild gram-positive infections of the throat, respiratory tract and soft tissues. This natural penicillin is still the drug of choice for the treatment of group A streptococcal pharyngitis in patients who are not allergic to penicillin.
Therefore we would suggest that each concentration of antibiotic, or antibiotic combination, and anticoagulant requires specific testing in vitro. The prevalence of MRSA in hospitalized patients has increased dramatically in the past decade; 7 that of VRE has also increased, but more modestly.
It is therefore advisable to consider an infection with multiresistant bacteria early in any catheter-related septicaemia and to initiate empirical systemic antibiotic treatment with activity against a broad spectrum of microorganisms until the antibiogram is available.
A number of studies have described the allocation of patients to either systemic treatment alone, systemic treatment plus antibiotic locks or antibiotic locks alone, 8, 12, 14, 15 with better outcome being achieved when both antibiotic lock and systemic treatment were used.
The antibiotic lock combinations active against the broadest spectrum of bacteria in this study were the teicoplanin—ciprofloxacin—heparin solutions.
However, for directed treatment in cases where the pathogen is either known or suspected, of the agents we tested, we would suggest flucloxacillin—heparin combinations for MSSA, teicoplanin—heparin or teicoplanin—gentamicin—heparin combinations for MRSA, linezolid—heparin combinations for VRE and ciprofloxacin—heparin combinations for P.
Some centres use citrate dextrose in different strengths, or 3. Our studies do not suggest any major benefits of antibiotic-containing line-locks using citrate dextrose rather than heparin, although aminoglycoside solubility does appear to be improved.
In summary, we have shown that precipitate formation in antibiotic lock solutions is concentration dependent and that the stability of each antibiotic—anticoagulant combination needs to be assessed individually. We have identified a number of promising antibiotic lock solutions for empirical and directed treatment and prophylactic use in CVC-related infection.
Although there are insufficient data on the long-term effects of antibiotic lock solutions on catheter integrity and durability or selection of resistant isolates, we feel that the antibiotic lock solutions identified in this study warrant clinical trials to investigate their role in both the treatment and prophylaxis of catheter-related infection.
Acknowledgements Many thanks to the staff in the Quality Control Laboratory and the Renal Unit of the Lister Hospital for their enthusiastic support for the practical aspects of this study.
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