From the Guidelines
Yes, ciprofloxacin can be administered via a percutaneous endoscopic gastrostomy (PEG) tube, with consideration of the type of formulation and potential interactions with enteral formula. When administering ciprofloxacin through a PEG tube, it is essential to follow specific guidelines to ensure the drug's efficacy and prevent tube clogging. The immediate-release tablet can be crushed and mixed with 20-30 mL of water, or the oral suspension can be used directly 1. After administration, flush the tube with at least 30 mL of water to ensure the complete dose is delivered and to prevent tube clogging, as recommended by the ESPEN practical guideline on home enteral nutrition 1.
It's crucial to note that the extended-release formulations (Cipro XR) should not be crushed or administered via PEG tube as this would alter the drug's release characteristics. When administering ciprofloxacin through a PEG tube, temporarily stop enteral nutrition feeds for 1-2 hours before and after administration, as certain nutrients can bind to ciprofloxacin and reduce its absorption. The choice between bolus and continuous feeding could affect the practical administration of particular medicines, such as medicines which bind to enteral formula, and some medicines administered through an enteral feeding tube may need to be administered apart from enteral formula 1.
Key considerations for administration include:
- Using polyurethane PEGs, which are preferable to silicone PEGs due to higher retention of patency and subsequent ability to continue to use the tube 1
- Flushing the tube with 30 mL of water before, between, and after each drug administration to prevent tube blockage 1
- Administering drugs individually through the enteral feeding tube to minimize interactions and ensure efficacy 1
From the Research
Administration of Ciprofloxacin via PEG
- Ciprofloxacin can be administered through a nasogastric tube with continuous enteral feeding to critically ill patients, but its bioavailability may be reduced due to interactions with enteral feedings 2.
- Studies have shown that enteral feedings can decrease the oral bioavailability of ciprofloxacin by 27 to 67% when given orally or via gastrostomy or jejunostomy tubes 3.
- A systematic review found that ciprofloxacin 750 mg given enterally yielded an AUC similar to that achieved with 400 mg given parentally, but the C(max) was lower, suggesting that higher doses of oral ciprofloxacin may be needed to compensate for reduced bioavailability 4.
- The pharmacokinetics and absolute bioavailability of ciprofloxacin administered through a nasogastric tube with continuous enteral feeding have been studied, and the results suggest that ciprofloxacin bioavailability ranges from 31 to 82% (median, 44%) in tube-fed critically ill patients 2.
Considerations for Administration
- The manufacturer recommends holding enteral feeds for a total of 8 h after ciprofloxacin is given, but this may not be feasible for patients receiving continuous enteral feeding 4.
- Ciprofloxacin should be used with caution in patients with known or suspected CNS disorders that predispose to seizures, and patients should be monitored carefully for CNS excitatory effects 5.
- The specific adverse-effect profile of quinolones, including ciprofloxacin, must be considered when they are chosen for treatment of bacterial infections, especially in elderly patients or those with certain co-morbidities 5.