Pharmacokinetics of ciprofloxacin in hospitalized geriatric patients: Comparison between nasogastric tube and oral administration

OBJECTIVES:: Drug administration to debilitated elderly patients on enteral feeding through a nasogastric tube (NGT) can modify the pharmacokinetic characteristics of the drug and influence its therapeutic blood concentration. The aim of this study was to evaluate the pharmacokinetics of ciprofloxacin administered through an NGT and to compare it with those of a group of patients receiving the drug orally. METHODS:: Twenty patients in stable clinical and hemodynamic condition from the long-term care ward of a geriatric multilevel hospital were studied. Patients in group 1 (n = 10) had oropharyngeal dysphagia and received food and medications, including ciprofloxacin, by NGT. Group 2 (n = 10) included age- and disease-matched orally fed patients from the same department receiving ciprofloxacin orally. Blood samples for ciprofloxacin concentration were taken at steady state, before drug administration, time 0, and at 1, 2, 3, 4, 6, 8, and 10 hours after drug administration. Ciprofloxacin was measured using liquid chromatography with tandem mass spectrometric detection. The mean daily dose was the same in both the groups: 1000 mg (500 mg twice daily). RESULTS:: Pharmacokinetic parameters of ciprofloxacin were not significantly different between the 2 groups: trough concentrations were 1.24 ± 0.95 μg/mL (0.25-3.67 μg/mL) versus 1.30 ± 0.61 μg/mL (0.21-2.36 μg/mL) (P = 0.76); Cmax 3.30 ± 2.16 μg/mL (1.54-8.62 μg/mL) versus 4.24 ± 1.99 μg/mL (2.24-9.02 μg/mL) (P = 0.356); tmax 2.8 ± 1.5 versus 3.1 ± 2.8 hours (P = 0.799); and AUC0-10 20.2 ± 12.1 μg·h·mL (9-51.07 μg·h·mL) versus 24.4 ± 13.0 μg·h·mL (5.57-52.48 μg·h·mL) (P = 0.493), in the oral fed versus NGT, respectively. CONCLUSIONS:: Ciprofloxacin pharmacokinetic parameters are not significantly different between patients receiving the drug through NGT compared with those who received it orally, and therefore, in frail elderly patients, this route of administration can be considered.