Pharmacokinetics of ciprofloxacin in the elderly: Increased oral bioavailability and reduced renal clearance

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Abstract
The pharmacokinetics of ciprofloxacin was studied after single intravenous and oral doses of 250 mg and during and after a five-day oral regimen of 500 mg twice daily in eight young (22–34 years) and eight elderly (63–76 years), healthy male volunteers. The absolute bioavailability of an oral dose was greater in the elderly than in the young subjects at both 250 mg (72 versus 58 %; p<0.05) and 500 mg (79 versus 63 %; p<0.05). Distribution was unaffected by age. The physiological aging of the kidneys resulted in a reduced renal clearance, while no significant changes in non-renal clearance, total clearance and terminal half-life were found in the elderly. The age-related increase in the bioavailability of ciprofloxacin, whether due to facilitated absorption and/or reduced first-pass elimination, is a hitherto unique finding for antibiotics. As a consequence, reduction of orally administered doses of ciprofloxacin should be considered for elderly patients.

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