Pharmacokinetics of intravenous ciprofloxacin for Legionella pneumonia during prolonged intermittent kidney replacement therapy: a case report and literature review
Abstract
Background: Legionella pneumophila is a gram-negative intracellular bacteria that causes pneumonia. In severe cases, combination antimicrobial therapy using azithromycin and ciprofloxacin is recommended and critical care management may be required. Ciprofloxacin requires dose adjustment during kidney replacement therapy; however, dosing guidance during prolonged intermittent kidney replacement therapy (PIKRT) is limited. A population pharmacokinetic (PK) study based on in vitro data suggested high doses would be required to meet pharmacokinetic/pharmacodynamic (PK/PD) targets. Case presentation: We describe the PK of intravenous ciprofloxacin in a 71-year-old male with L. pneumophila pneumonia requiring PIKRT. Ciprofloxacin was administered at 400 mg IV every 12 h, in addition to azithromycin. Ciprofloxacin PK modelling described a terminal half-life of 10.7 h and an area under the curve over 24 h (AUC0-24) of 130 mg·h/L. While PK/PD targets specific to L. pneumophila are not established, applying the reported median minimum inhibitory concentration (MIC) for Legionella (0.5 mg/L), and the gram-negative organism PK/PD target AUC1–24/MIC > 125, our data supports ciprofloxacin dosing of 400 mg IV every 12 h during PIKRT. Contrary to the prior PK study based on in vitro data, PIKRT did not contribute additional clearance of ciprofloxacin. Conclusions: Ciprofloxacin 400 mg IV every 12 h achieved adequate exposure during PIKRT, supporting this dosing regimen for treating L. pneumophila pneumonia. Further studies are needed to establish definitive dosing guidelines in this setting.
Related
- Pharmacokinetics and Tissue Distribution of Enrofloxacin and Its Metabolite Ciprofloxacin After a Single Intraperitoneal Administration in Black Rockfish (Sebastes schlegelii) at Two Water Temperatures.
- Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury
- Dynamics and activation of the Legionella Type IV secretion system
- Genetic diversity of Legionella species in culture-negative clinical and environmental specimens by sequencing the 23S-5S ribosomal intergenic spacer region
- pH-Dependent Evolution of Delafloxacin and Ciprofloxacin Resistance in Pseudomonas aeruginosa from cystic fibrosis (CF) and non-CF-patients
BibTeX
@article{scott2026pharmacokinetics,
title = {{Pharmacokinetics of intravenous ciprofloxacin for Legionella pneumonia during prolonged intermittent kidney replacement therapy: a case report and literature review}},
author = {Donna Scott and Sam Salman and Paul Ingram and Brett Mcwhinney and Jacobus Ungerer and David Morgan and Jason A. Roberts and Matthew Rawlins},
journal = {Advances in Renal Replacement Therapy},
year = {2026},
month = jun,
doi = {10.1186/s41100-026-00738-8},
url = {https://hal.science/hal-05825574v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Pharmacokinetics of intravenous ciprofloxacin for Legionella pneumonia during prolonged intermittent kidney replacement therapy: a case report and literature review
AU - Donna Scott
AU - Sam Salman
AU - Paul Ingram
AU - Brett Mcwhinney
AU - Jacobus Ungerer
AU - David Morgan
AU - Jason A. Roberts
AU - Matthew Rawlins
PY - 2026
DA - 2026/06/29
JO - Advances in Renal Replacement Therapy
DO - 10.1186/s41100-026-00738-8
UR - https://hal.science/hal-05825574v1
AB - Background: Legionella pneumophila is a gram-negative intracellular bacteria that causes pneumonia. In severe cases, combination antimicrobial therapy using azithromycin and ciprofloxacin is recommended and critical care management may be required. Ciprofloxacin requires dose adjustment during kidney replacement therapy; however, dosing guidance during prolonged intermittent kidney replacement therapy (PIKRT) is limited. A population pharmacokinetic (PK) study based on in vitro data suggested high doses would be required to meet pharmacokinetic/pharmacodynamic (PK/PD) targets. Case presentation: We describe the PK of intravenous ciprofloxacin in a 71-year-old male with L. pneumophila pneumonia requiring PIKRT. Ciprofloxacin was administered at 400 mg IV every 12 h, in addition to azithromycin. Ciprofloxacin PK modelling described a terminal half-life of 10.7 h and an area under the curve over 24 h (AUC0-24) of 130 mg·h/L. While PK/PD targets specific to L. pneumophila are not established, applying the reported median minimum inhibitory concentration (MIC) for Legionella (0.5 mg/L), and the gram-negative organism PK/PD target AUC1–24/MIC > 125, our data supports ciprofloxacin dosing of 400 mg IV every 12 h during PIKRT. Contrary to the prior PK study based on in vitro data, PIKRT did not contribute additional clearance of ciprofloxacin. Conclusions: Ciprofloxacin 400 mg IV every 12 h achieved adequate exposure during PIKRT, supporting this dosing regimen for treating L. pneumophila pneumonia. Further studies are needed to establish definitive dosing guidelines in this setting.
SN - 1073-4449
SN - 1528-8455
ER -