Ciprofloxacin was used as an antituberculous drug in adult patients who could not tolerate standard regimens or had to be treated with alternative combinations for resistance problems. During October 1986 to December 1991, 241 patients received ciprofloxacin in two daily 500 mg doses administered under supervision at 8.30 a.m. and 5 p.m., respectively. This group of patients was submitted to retrospective analysis for tolerability and clinical as well as microbiological efficacy. In January 1992, a once daily regimen with 1,000 mg of ciprofloxacin was introduced in order to simplify drug administration together with the other combination partners and to take advantage of higher drug levels at the site of infection. These patients were followed prospectively for safety and efficacy. Until July 1993, 227 patients with smear-positive pulmonary tuberculosis were included in this open study. Comparative analysis was carried out for a selected group of patients who had remained smear and culture positive for more than 27 days after start of treatment. Fifty-four patients who had received ciprofloxacin twice daily and 35 patients on the once daily regimen were evaluable. Both regimens were equally well tolerated. The once daily regimen was associated with a trend towards earlier conversion to smear negativity and a significantly shorter time to culture negativity. Smears became negative on average within 84 days with the once daily and in 94 days with the twice daily schedule (p=0.19). Culture negativity occurred at 60 and 76 days in the respective groups (p=0.0013; log Rank test). Of the patients who received ciprofloxacin twice daily, 33% were still smear and culture positive 90 days after start of treatment compared to only 15% of the patients treated with the once daily schedule. We conclude that ciprofloxacin, given as a single daily dose of 1,000 mg is as safe as two 500 mg doses, more convenient to apply and probably more efficacious.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Raviglione, M. C., Snider, D. E., Jr., Kochi, A. Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic. JAMA 272 (1995) 220–226.
Raviglione, M. C., Rieder, H. L., Styblo, K., Khomenko, A. G., Esteves, K., Kochi, A. Tuberculosis trends in eastern Europe and the former USSR. Tubercle Lung Dis. 75 (1994) 400–416.
Zafran, N., Heidal, E., Pavlovic, S., Vuckovic, D., Boe, J. Why do our patients die of active tuberculosis in the era of effective therapy? Tubercle Lung Dis. 75 (1994) 329–333.
Neville, K., Bromberg, A., Bromberg, R., Bong, S., Hanna, B. A., Rom, W. N. The third epidemic multidrug-resistant tuberculosis. Chest 105 (1994) 45–48.
Laszlo, A., de Kantor, I. A random sample survey of initial drug resistance among tuberculosis cases in Latin America. Bull. World Health Organ. 72 (1994) 603–610.
Bloch, A. B., Cauthen, G. M., Onorato, I. M., Dansbury, K. G., Kelly, G. D., Driver, C. R., Snider, D. E. Nationwide survey of drug-resistant tuberculosis in the United States. JAMA 271 (1994) 665–671.
Plum, G., Wenzel, R. P. Die Epidemiologie der multiresistenten Tuberkulose in den Vereinigten Staaten von Amerika. Internist 36 (1995) 980–986.
Jarvis, W. R. Nosocomial transmission of multidrug-resistantMycobacterium tuberculosis. Am. J. Infect. Control 23 (1995) 146–151.
Centers for Disease Control Essential components of a tuberculosis prevention and control program. MMWR Morb. Mortal. Wkly. Rep. 44 (1995) 1–16.
Brodt, H. T. R., Staszewski, S., Enzensberger, R., Keul, H. G., Buhl, R., Hübner, K., Helm, E. B. Epidemiologie der Tuberkulose bei Patienten mit HIV-Infektion der Universitätsklinik Frankfurt. Med. Klin. 88 (1993) 279–286.
Arbeitskreis Mykobakterien Erhebung zur Resistenzlage der Tuberkulosebakterien in Deutschland für das Jahr 1991 und 1992. Pneumologie 48 (1994) 28–29.
Schneider, C., Lasch, C., Brade, V. Haben Inzidenz und Resistenz der Tuberkulose zugenommen? Verlaufsbeobachtungen anhand kulturell gesicherter Erkrankungen. Pneumologie 48 (1994) 803–808.
Schaberg, T., Gloger, G., Reichert, B., Mauch, H., Lode, H. Drugresistant tuberculosis in Berlin, Germany. Eur. Respir. J. 8 (1995) 278–284.
Snider, D. E., Graczyk, J., Bek, E., Rogowsi, J. Supervised six-month treatment of newly diagnosed pulmonary tuberculosis using isoniacid, rifampin and pyrazinamide with and without streptomycin. Am. Rev. Respir. Dis. 130 (1984) 1091–1094.
Grosset, J. H. Present status of chemotherapy for tuberculosis. Rev. Infect. Dis. 11 (1989) (Suppl. 2) S347-S352.
American Thoracic Society Treatment of tuberculosis and tuberculosis infection in adults and children. Am. J. Respir. Dis. 129 (1984) 573–579.
Isemann, M. D. Treatment of multidrug-resistant tuberculosis. N. Engl. J. Med. 329 (1993) 784–791.
Tsukamura, M., Nakamura, E., Yoshii, S., Amano, H. Therapeutic effect of a new antibacterial substance ofloxacin (DL81280) on pulmonary tuberculosis. Am. Rev. Respir. Dis. 131 (1985) 353–356.
Collins, C. H., Uttley, A. In-vitro activity of seventeen antimicrobial compounds against seven species of mycobacteria. J. Antimicrob. Chemother. 22 (1988) 857–961.
Rastogi, N., Goh, K. S. In vitro activity of the new difluorinated quinolone sparfloxacin (AT-4140) againstMycobacterium tuberculosis compared with activities of ofloxacin and ciprofloxacin. Antimicrob. Agents Chemother. 35 (1991) 1933–1936.
Bergstermann, H., Seifert, S., Bauer, M., Rifai, M.: Quinolones for the treatment of tuberculosis. Eur. J. Clin. Microbiol. Infect. Dis. 1991 spec. issue 301–302.
Weis, S. E., Slocum, P. C., Blais, F. X., King, B., Nunn, M., Matney, G., Gomez, E., Foresman, B. H. The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis. N. Engl. J. Med. 330 (1994) 1179–1184.
Genevois, E., Lelouer, V., Vercken, J.-B., Caillon, R. Study design, methodology and statistical analysis in the clinical development of sparfloxacin. J. Antimicrob. Chemother. 37 (1996) (Suppl. A) 65–72.
Rifai, M., Bergstermann, H., Sültz, J., Bauer, M., Feldmann, K. Kombinationstherapie der Lungentuberkulose mit Gyrasehemmern. Resistenzbestimmung und klinische Erfahrungen. Prax. Klin. Pneumol. 41 (1987) 899–900.
Mohanty, K. C., Dhamgaye, T. M. Controlled trial of ciprofloxacin in short-term chemotherapy for pulmonary tuberculosis. Chest 104 (1993) 1194–1198.
Yew, W. W., Kwan, S. Y., Ma, W. K., Khin, M. A., Chau, P. Y. In vitro activity of ofloxacin againstMycobacterium tuberculosis and its clinical efficacy in multiple resistant tuberculosis. J. Antimicrob. Chemother. 26 (1990) 227–236.
Kennedy, N., Fox, R., Kisyombe, G. M., Saruni, A. O. S., Uiso, L. O., Ramsay, A. R. C., Ngowi, F. I., Gillespie, S. H. Early bactericidal and sterilizing activities of ciprofloxacin in pulmonary tuberculosis. Am. Rev. Respir. Dis. 148 (1993) 1547–1551.
Craig, W. A., Ebert, S. C. Killing and regrowth of bacteriain vitro: a review. Scand. J. Infect. Dis. (Suppl. 74) (1991) 63–70.
Reid, T. M. S., Gould, I. M., Golder, D., Legge, J. S., Douglas, J. G., Friend, J. A. R., Watt, S. J. Brief report: respiratory tract penetration of ciprofloxacin. Am. J. Med. 87 (1989) (Suppl. 5a) 60s-61.
Baal, P., Tillotson, G. Tolerability of fluoroquinolone antibiotics. Drug Safety 13 (1995) 343–358.
About this article
Cite this article
Bergstermann, H., Rüchardt, A. Ciprofloxacin once daily versus twice daily for the treatment of pulmonary tuberculosis. Infection 25, 227–232 (1997). https://doi.org/10.1007/BF01713149
- Drug Level
- Pulmonary Tuberculosis
- High Drug
- Respective Group