Interaction entre la phénytoïne et la ciprofloxacine chez une patiente âgée de 20 ans
Bibliographic record
Abstract
Resume Objectif : Decrire une interaction possible entre la ciprofloxacine et la phenytoine chez une patiente agee de 20 ans et discuter de la gestion de cette interaction. Resume du cas : Une patiente de 20 ans a ete hospitalisee pour un status epilepticus refractaire au lorazepam. Apres la stabilisation de son traitement antiepileptique, la patiente a recu de la ciprofloxacine et de la piperacilline-tazobactam pour une pneumonie, ce qui a possiblement cause une diminution des dosages seriques de la phenytoine a des niveaux soustherapeutiques. A la suite de l’arret des deux antibiotiques, les dosages seriques de phenytoine sont retournes a la normale. Discussion : De nombreuses interactions medicamenteuses ont ete rapportees en presence de phenytoine. Quelques cas ont ete decrits dans la documentation scientifique en relation avec l’utilisation a long terme de la phenytoine et de la ciprofloxacine. Le mecanisme d’action n’est pas clairement elucide. Certains auteurs rapportent que la ciprofloxacine pourrait influencer le cycle entero-hepatique de la phenytoine, qu’elle pourrait egalement diminuer la liaison de la phenytoine aux proteines plasmatiques ou affecter les enzymes hepatiques responsables du metabolisme de la phenytoine. Conclusion : La diminution des dosages seriques de phenytoine chez cette patiente serait possiblement due a l’ajout de la ciprofloxacine. Il faudrait recommander un suivi des dosages seriques de phenytoine dans les trois jours apres le debut du traitement a la ciprofloxacine et egalement a la suite de l’arret du traitement. Abstract Objectives: To describe a possible interaction between ciprofloxacin and phenytoin and to discuss its management in a 20-year-old patient. Case summary: A 20-year-old female patient was hospitalized with status epilepticus. After her antiepileptic therapy was stabilized, the patient received ciprofloxacin and piperacillin-tazobactam for pneumonia, which possibly caused a decrease in her serum phenytoin concentrations to subtherapeutic levels. After the two antibiotics were stopped, the serum phenytoin levels returned to normal. Discussion: A few cases involving the chronic use of phenytoin and ciprofloxacin have been described in the scientific literature. The mechanism of the interaction has not been clearly elucidated. Some authors report that ciprofloxacin might have an effect on the enterohepatic cycle of phenytoin and that it might also decrease the binding of phenytoin to plasma proteins or affect its metabolism. Conclusion: The decrease in this patient’s serum phenytoin levels was possibly due to the addition of ciprofloxacin. Monitoring serum phenytoin levels one to three days after treatment with ciprofloxacin is started, as well as after it is stopped, should be recommended. Key words: Ciprofloxacin, drug interaction, phenytoin, serum concentration
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".