Gea-Bancloche and Metcalfe developed a protocol for the intravenous desensitization of a patient with an allergy to ciprofloxacin. The authors are from the National Institute of Allergy and Infectious Diseases and the Universidad Autonoma de Madrid.
Target dose of ciprofloxacin for IV dosing: 400 mg
Working solutions of ciprofloxacin:
(1) 0.1 mg per mL
(2) 1.0 mg per mL
(3) 2.0 mg per mL
|
Step |
Solution in mg/mL |
Amount in mL |
Saline to Add |
Dose in mg |
Cumulative Dose in mg |
|
1 |
0.1 |
0.1 mL |
2.9 mL: |
0.01 |
0.01 |
|
2 |
0.1 |
0.2 mL |
2.8 mL |
0.02 |
0.03 |
|
3 |
0.1 |
0.4 mL |
2.6 mL |
0.04 |
0.07 |
|
4 |
0.1 |
0.8 mL |
2.2 mL |
0.08 |
0.15 |
|
5 |
1.0 |
0.16 mL |
2.84 mL |
0.16 |
0.31 |
|
6 |
1.0 |
0.32 mL |
2.68 mL |
0.32 |
0.63 |
|
7 |
1.0 |
0.64 mL |
2.36 mL |
0.64 |
1.27 |
|
8 |
2.0 |
0.6 mL |
2.4 mL |
1.2 |
2.47 |
|
9 |
2.0 |
1.2 mL |
1.8 mL |
2.4 |
4.87 |
|
10 |
2.0 |
2.4 mL |
|
4.8 |
9.67 |
|
11 |
2.0 |
5.0 mL |
|
10 |
19.67 |
|
12 |
2.0 |
10 mL |
|
20 |
39.67 |
|
13 |
2.0 |
20 mL |
|
40 |
79.67 |
|
14 |
2.0 |
40 mL |
|
80 |
159.67 |
|
15 |
2.0 |
120 ml |
|
240 |
399.67 |
Premedication: 10 mg prednisone and 50 mg diphenhydramine HCl IV 1 hour before desensitization.
Administration of ciprofloxacin solutions:
(1) Each dose that is less than 1 mL in volume is diluted with normal saline to a final volume of 3 mL. (This was also done for the 1.2 mL dose for consistency.)
(2) The doses are slowly infused intravenously.
(2a) The first 9 doses are slowly infused with no time limit.
(2b) The 10th to 14th dose are infused slowly over 10 minutes.
(2c) The final dose is infused slowly over 20 minutes using an infusion pump.
(3) The interval between each dose is 15 minutes (I assume this is the interval after the dose is complete). Assuming 5 minutes for the first 9 doses, this should take 3.5 hours to complete.
Monitoring during the administration:
(1) The patient should be closely observed throughout the procedure.
(2) Emergency supplies for treatment of anaphylaxis should be readily available.
(3) The patient is observed for rash, urticaria, hypotension and wheezing.
(4) If any sign of reaction is observed then the process is discontinued.
If the patient completes the protocol successfully then:
(1) a second intravenous dose of 400 mg is given in 4 hours
(2) further doses are given every 12 hours until the regimen is complete
(3) booster doses are 25 mg are given IV at 6 hours after each dose to maintain drug levels in the blood.
Specialty: Infectious Diseases, Pharmacology, clinical
ICD-10: ,
