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Ciprofloxacin Nephrotoxicity-Reply

Kenneth V. I. Rolston, MD; Edward B. Rubenstein, MD
Arch Intern Med. 1993;153(23):2706. doi:10.1001/archinte.1993.00410230129018.
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We appreciate the comments of Anand with respect to the nephrotoxic potential of ciprofloxacin. In our first trial of outpatient antibiotic therapy in low-risk, neutropenic cancer patients, we used a higher-than-usual dose of ciprofloxacin (750 mg orally every 8 hours), based on data indicating reduced absorption of orally administered ciprofloxacin after antineoplastic chemotherapy.1 The study by Ljungberg and Nilsson-Ehle,2 demonstrating increased oral bioavailability and reduced renal clearance of ciprofloxacin in elderly patients is of interest, and may in part explain our experience in elderly oncologic patients. Although acute renal failure has been associated with ciprofloxacin administered at much lower doses (200 mg every 12 hours), in our second study of outpatient antibiotic therapy of low-risk neutropenic patients we have reduced the dose of ciprofloxacin to 500 mg orally every 8 hours. Also, we have substituted amoxicillin/clavulanate for clindamycin in the oral regimen of our second trial, although, as


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