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Concentration of the quinolon ofloxacin in the cerebrospinal fluid
LETTERS TO THE EDITOR
the 20th gestation week, and the level of prolactin, especially low for this woman during her puerperium. Prolactinoma infarction may, therefore, result in improvement of the endocrinopathy without impairing other pituitary hormones, and spontaneous disappearance of galactorrhea and headaches may be the only clinical manifestations during pregnancy.
Acknowledgment: We would like to thank Dr. L. Essers, MQhlheim, Federal Republic of Germany, for performing the high-pressure liquid chromatography. C. U. ANDERS, H. H~FELER, M.D., C. G. SCHMIDT,
Submitted
Notre-Dame Hospital University of Montreal Montreal, Quebec, Canada
2. 3. 4.
OSTEOMYELlTlS COMPLICATION CATHETER
Molitch M: Pregnancy and the hyperprolactinemic woman. N Engl J Med 1985; 312: 1364-1370. Mohr G, Hardy J: Hemorrhage, necrosis and apoplexy in pituitary adenomas. Surg Neurol 1982; 18: 181-189. Rjosk H-K, Fahlbusch R, von Werder K: Influence of pregnancies on prolactinomas. Acta Endocrinol 1982; 100: 337-346. Tucker AH: Endocrinology of lactation. Perinatalogy 1979; 3: 199. Submitted
August
6, 1987,
and accepted
CONCENTRATION OF THE QUINOLON IN THE CEREBROSPINAL FLUID
August
November
1987
The
American
26, 1987
OFLOXACIN
Journal
of Medicine
July 28, 1987, and accepted
August
OF THE CLAVICLE AS OF INFECTED SUBCLAVIAN
26, 1987
VEIN
To the Editor: In a recent article of the journal (Am J Med 1986; 80: 753754), Dr. Watanakunakorn reported on a patient with osteomyelitis of the clavicle and sternoclavicular arthritis compiieating infected indwelling subclavian vein catheter. The author stated that there have been only three previously reported cases of osteomyelitis of the clavicle following subclavian vein catheterization [l-3]. We wish to point out that in 1983, we described a 69-year-old patient with osteomyelitis of both clavicles as a complication of subciavian venipuncture followed by insertion of the catheter into the left subclavian vein [4]. The catheter was in place for four days. Of interest is the fact that in the three cases of osteomyelitis of the clavicle reported in the literature [l-3], the patients underwent abdominal surgery, and in two cases, fever and sepsis developed before the insertion of the catheter. Therefore the question can be raised whether the infection was due to the catheter or to generalized sepsis. On the other hand, in our patient, no surgery was performed except for the subclavian catheterization. in distinction from the reported cases, both clavicles were involved by osteomyelitis in our patient.
To the Editor: We read with interest the article of Wise and Donovan (Am J Med 1987; 82 [suppl 4A]: 103-107) on tissue penetration and metabolism of ciprofloxacin, in which they reported some data on concentrations in the cerebrospinai fluid. In 30 patients without meningeal infection, we investigated the concentration of ofloxacin in the cerebrospinal fluid by means of reverse-phase high-pressure liquid chromatography. Cerebrospinal fluid samples were taken routinely from patients with acute lymphobiastic leukemia before and during treatment. Eighteen patients received 200 mg ofloxacin orally two times a day for selective bowel decontamination. Cerebrospinal fluid samples from 12 patients receiving different selective bowel decontaminants were used as controls. Concentration of ofloxacin in the 18 treated patients was determined to be 0.33 f 0.12 mg/liter (mean f SD), whereas control samples contained less than 0.03 mg/iiter. Treatment with orally administered ofloxacin led to concentrations higher than MiC& for several gramnegative organisms like Escherichia coli (MICs0 less than 0.06 mg/liter), Kiebsielia pneumoniae (0.25 mg/liter), Enterobacter (0.12 mg/.iter), Proteus mirabilis (0.12 mg/iiter), Proteus vulgaris (0.12 mg/liter), and Salmonella species (less than 0.06 mg/iiter). Wise and Donovan reported maximum concentrations of ciprofioxacin of 0.14 mg/liter in non-inflamed cerebrospinal fluid. The higher concentration of ofioxacin may be responsible for the increased frequency of central nervous system side effects caused by ofioxacin compared with ciprofloxacin.
1006
M.D.
West German Tumor Center University of Essen 4300 Essen, Federal Republic of Germany
RONALD COMTOIS, M.D. SYLVIE BERTRAND, M.D. HUGUES BEAUREGARD, M.D. JEAN-LOUIS LUGER, M.D. OMAR SERRI, M.D., Ph.D.
1.
M.D.
Ph.D.
B. KLEIN, M. MITTELMAN, R. KATZ, M. DJALDETTI,
M.D. M.D.
M.D. M.D.
Hasharon Hospital Tel Aviv University Medical School Petah-Tiqva, Israel 1.
2.
3.
4.
Lee Y-H, Kerstein MD: Osteomyelitis and septic arthritis. A complication of subclavian venous catheterization. N Engl J Med 1971; 285: 1179-1180. Manny J, Haruzi I, Yosipovitch Z: Osteomyelitis of the clavicle following subclavian vein catheterization. Arch Surg 1973; 106: 342-343. Steen J, Pedersen H: Osteomyelitis of clavicle following percutaneous subclavian vein catheterization. Dan Med Bull 1978; 25: 260-261. Klein B, Mktelman M, Katz R, Djaldetti M: Osteomyelitis of both clavicles as a complication of subclavian venipuncture. Chest 1983; 83: 143-144. Submitted
Volume
83
July 24, 1987,
and accepted
August
26, 1987
the 20th gestation week, and the level of prolactin, especially low for this woman during her puerperium. Prolactinoma infarction may, therefore, result in improvement of the endocrinopathy without impairing other pituitary hormones, and spontaneous disappearance of galactorrhea and headaches may be the only clinical manifestations during pregnancy.
Acknowledgment: We would like to thank Dr. L. Essers, MQhlheim, Federal Republic of Germany, for performing the high-pressure liquid chromatography. C. U. ANDERS, H. H~FELER, M.D., C. G. SCHMIDT,
Submitted
Notre-Dame Hospital University of Montreal Montreal, Quebec, Canada
2. 3. 4.
OSTEOMYELlTlS COMPLICATION CATHETER
Molitch M: Pregnancy and the hyperprolactinemic woman. N Engl J Med 1985; 312: 1364-1370. Mohr G, Hardy J: Hemorrhage, necrosis and apoplexy in pituitary adenomas. Surg Neurol 1982; 18: 181-189. Rjosk H-K, Fahlbusch R, von Werder K: Influence of pregnancies on prolactinomas. Acta Endocrinol 1982; 100: 337-346. Tucker AH: Endocrinology of lactation. Perinatalogy 1979; 3: 199. Submitted
August
6, 1987,
and accepted
CONCENTRATION OF THE QUINOLON IN THE CEREBROSPINAL FLUID
August
November
1987
The
American
26, 1987
OFLOXACIN
Journal
of Medicine
July 28, 1987, and accepted
August
OF THE CLAVICLE AS OF INFECTED SUBCLAVIAN
26, 1987
VEIN
To the Editor: In a recent article of the journal (Am J Med 1986; 80: 753754), Dr. Watanakunakorn reported on a patient with osteomyelitis of the clavicle and sternoclavicular arthritis compiieating infected indwelling subclavian vein catheter. The author stated that there have been only three previously reported cases of osteomyelitis of the clavicle following subclavian vein catheterization [l-3]. We wish to point out that in 1983, we described a 69-year-old patient with osteomyelitis of both clavicles as a complication of subciavian venipuncture followed by insertion of the catheter into the left subclavian vein [4]. The catheter was in place for four days. Of interest is the fact that in the three cases of osteomyelitis of the clavicle reported in the literature [l-3], the patients underwent abdominal surgery, and in two cases, fever and sepsis developed before the insertion of the catheter. Therefore the question can be raised whether the infection was due to the catheter or to generalized sepsis. On the other hand, in our patient, no surgery was performed except for the subclavian catheterization. in distinction from the reported cases, both clavicles were involved by osteomyelitis in our patient.
To the Editor: We read with interest the article of Wise and Donovan (Am J Med 1987; 82 [suppl 4A]: 103-107) on tissue penetration and metabolism of ciprofloxacin, in which they reported some data on concentrations in the cerebrospinai fluid. In 30 patients without meningeal infection, we investigated the concentration of ofloxacin in the cerebrospinal fluid by means of reverse-phase high-pressure liquid chromatography. Cerebrospinal fluid samples were taken routinely from patients with acute lymphobiastic leukemia before and during treatment. Eighteen patients received 200 mg ofloxacin orally two times a day for selective bowel decontamination. Cerebrospinal fluid samples from 12 patients receiving different selective bowel decontaminants were used as controls. Concentration of ofloxacin in the 18 treated patients was determined to be 0.33 f 0.12 mg/liter (mean f SD), whereas control samples contained less than 0.03 mg/iiter. Treatment with orally administered ofloxacin led to concentrations higher than MiC& for several gramnegative organisms like Escherichia coli (MICs0 less than 0.06 mg/liter), Kiebsielia pneumoniae (0.25 mg/liter), Enterobacter (0.12 mg/.iter), Proteus mirabilis (0.12 mg/iiter), Proteus vulgaris (0.12 mg/liter), and Salmonella species (less than 0.06 mg/iiter). Wise and Donovan reported maximum concentrations of ciprofioxacin of 0.14 mg/liter in non-inflamed cerebrospinal fluid. The higher concentration of ofioxacin may be responsible for the increased frequency of central nervous system side effects caused by ofioxacin compared with ciprofloxacin.
1006
M.D.
West German Tumor Center University of Essen 4300 Essen, Federal Republic of Germany
RONALD COMTOIS, M.D. SYLVIE BERTRAND, M.D. HUGUES BEAUREGARD, M.D. JEAN-LOUIS LUGER, M.D. OMAR SERRI, M.D., Ph.D.
1.
M.D.
Ph.D.
B. KLEIN, M. MITTELMAN, R. KATZ, M. DJALDETTI,
M.D. M.D.
M.D. M.D.
Hasharon Hospital Tel Aviv University Medical School Petah-Tiqva, Israel 1.
2.
3.
4.
Lee Y-H, Kerstein MD: Osteomyelitis and septic arthritis. A complication of subclavian venous catheterization. N Engl J Med 1971; 285: 1179-1180. Manny J, Haruzi I, Yosipovitch Z: Osteomyelitis of the clavicle following subclavian vein catheterization. Arch Surg 1973; 106: 342-343. Steen J, Pedersen H: Osteomyelitis of clavicle following percutaneous subclavian vein catheterization. Dan Med Bull 1978; 25: 260-261. Klein B, Mktelman M, Katz R, Djaldetti M: Osteomyelitis of both clavicles as a complication of subclavian venipuncture. Chest 1983; 83: 143-144. Submitted
Volume
83
July 24, 1987,
and accepted
August
26, 1987