Table of Contents
What is Ciprofloxacin?
Ciprofloxacin (Ciprofloxacino) is a drug used to treat various infections: prostatitis, gastrointestinal, urethritis, cystitis, pyelonephritis. The product ingredient is Ciprofloxacin hydrochloride (hcl).
The brand name of Ciprofloxacin in the United States is Cipro.
Mechanism of action (MOA) of Ciprofloxacin
As an antibacterial agent belonging to the group of fluoroquinolones, the bactericidal action of ciprofloxacin is due to the inhibition of both type II topoisomerase (DNA-girase) and type IV topoisomerase, necessary for replication, transcription, repair and recombination of bacterial DNA.
Therapeutic indications, uses and benefits of Ciprofloxacin
- Post-exposure prophylaxis and curative treatment of anthrax by inhalation.
- In adults: Gram- lower respiratory tract infection (exacerbation of COPD, bronchopulmonary infection in cystic fibrosis or bronchiectasis, pneumonia).
- Chronic suppurative and external malignant otitis media.
- Acute exacerbation of chronic sinusitis (Gram-).
- Urinary infections.
- Urethritis and gonococcal cervicitis caused by N. gonorrhoeae.
- Orquiepididimitis and PID, including those caused by N. gonorrhoeae.
- Infections of the gastrointestinal tract (e.g. traveler’s diarrhea), intra-abdominal, skin and soft tissue (Gram-), bones and joints.
- Treatment and prophylaxis of infections in patients with neutropenia.
- Prophylaxis of invasive infections by N. meningitidis.
- In children and adolescents: bronchopulmonary infections in cystic fibrosis by P. aeruginosa, complicated urinary tract, pyelonephritis and serious infections when necessary.
Dosage of Ciprofloxacin
Intravenous, slow infusion 60 min: 400 mg, 2-3 times/day.
Oral. Duration of treatments includes possible start intravenously.
Adults.
– Lower respiratory tract infection by gram- (exacerbation of COPD, bronchopulmonary infection in cystic fibrosis or in bronchiectasis, pneumonia): 500-750 mg, 2 times/day, 7-14 days.
– Acute exacerbation of chronic sinusitis by gram- and chronic suppurative otitis media: 500-750 mg, 2 times/day, 7-14 days.
– External malignant otitis: 750 mg, 2 times/day, 28 days-3 months.
– Uncomplicated cystitis: 250-500 mg, 2 times/day, 3 days. In pre-menopause, a single dose of 500 mg may be administered.
– Complicated cystitis, uncomplicated pyelonephritis: 500 mg, 2 times/day, 7 days.
– Complicated pyelonephritis: 500-750 mg, 2 times/day, min. 10 days (more than 21 days in specific cases such as abscesses).
– Prostatitis: 500-750 mg, 2 times/day, 2-4 weeks (acute) and 4-6 weeks chronic.
– Urethritis and gonococcal cervicitis sensitive to fluoroquinolones: single dose 500 mg.
– Orquiepididimitis and PID: 500-750 mg, 2 times/day, min. 14 days.
– Gastrointestinal infection: 500 mg, 2 times/day. Duration of treatment: 1 day in bacterial diarrhea, including Shigella spp. other than Shigella dysenteriae type 1 and empirical treatment of severe traveler’s diarrhea; 5 days in diarrhea caused by Shigella dysenteriae type 1; 3 days in diarrhea caused by Vibrio cholerae; 7 days in typhoid fever.
– Intra-abdominal infection by gram: 500-750 mg, 2 times/day, 5-14 days.
– Infection of skin and soft tissues: 500-750 mg, 2 times/day, 7-14 days.
– Infection of bones and joints: 500-750 mg, 2 times/day, max. 3 months.
– Treatment and prophylaxis of infections in patients with neutropenia (co-administered with appropriate antibacterial according to official recommendations): 500-750 mg, 2 times/day, during neutropenia.
– Prophylaxis of invasive infection by N. meningitidis: single dose 500 mg.
– Post-exposure prophylaxis and curative treatment of anthrax by inhalation. Oral: single dose 500 mg or 500 mg 2 times/day; Intravenous: 400 mg, 2 times/day, switch to oral as soon as possible. Administer as soon as suspected or confirmed, 60 days from confirmation.
Children and adolescents.
– Bronchopulmonary infection in cystic fibrosis by P. aeruginosa: 20 mg/kg, 2 times/day (max. 750 mg/dose), 10-14 days. IV (infusion 60 min): 10 mg/kg/8 h, max. 400 mg/dose. Sequential therapy may be used.
– Complicated urinary tract infection, pyelonephritis: 10-20 mg/kg, 2 times/day (max. 750 mg/dose), 10-21 days. IV: 6-10 mg/kg/8 h, max. 400 mg/dose.
– Other serious infections: 20 mg/kg, 2 times/day (max. 750 mg/dose), duration of treatment according to type of infection. IV. 10 mg/kg/8 h, max. 400 mg/dose.
– Post-exposure prophylaxis and curative treatment of anthrax by inhalation. Oral: 10-15 mg/kg, 2 times/day (max. 500 mg/dose); IV same dose (max. 400 mg/dose), to be taken orally as soon as possible. Administer as soon as suspected or confirmed, 60 days from confirmation.
Kidney failure, adults:
– Oral. Clcr 30-60 ml/min: 250-500 mg/12 h; Clcr < 30 and peritoneal dialysis: 250-500 mg/24 h; haemodialised: 250-500 mg/24 h after dialysis.
– Clcr 31-60 ml/min: max. 800 mg/day; Clcr ≤ 30: max. 400 mg/day; haemodialised: 400 mg/day on and after dialysis; DPAC: 50 mg/l dialysed/6 h.
Some infections may require the association of another suitable antibacterial, such as those caused by bacteria Pseudomonas aeruginosa, Acinetobacter or Staphylococcus, and intraabd infections.
Mode of administration of Ciprofloxacin
In oral administration, it can be taken independently of mealtimes.
The tablets should be swallowed whole without chewing and with liquid.
If taken on an empty stomach, it is absorbed more quickly.
It should not be taken with dairy products (e.g. milk or yoghurt) or with fruit juice enriched in minerals (e.g. orange juice enriched in Ca).
Calcium in the diet does not significantly affect the absorption of ciprofloxacin.
In severe cases or if the patient is unable to take comp. (e.g. patients in enteric nutrition), start IV treatment until a switch to oral administration is possible.
Contraindications for Ciprofloxacin
Hypersensitivity to quinolones; do not administer with tizanidine.
Warnings and Cautions with Ciprofloxacin
Warnings
Kidney failure to adjust doses; avoid in patients who have previously experienced serious adverse reactions with the use of drugs containing quinolones or fluoroquinolones; associate with appropriate antibacterial treatment for: severe infections caused by gram+, anaerobes or N. gonorrhoeae.
Not recommended for streptococcal infections (insufficient efficacy), limited efficacy data for post-surgical intra-abdominal infection; for traveler’s diarrhoea: consult information on ciprofloxacin resistance of relevant pathogens in the countries visited.
Inhalational anthrax, consult national and/or international consensus documents on its treatment.
In children/adolescents, assess benefit/risk from possible adverse effects on joints and/or surrounding tissues; bronchopulmonary infection in cystic fibrosis in children 1-5 years, limited experience.
According to official recommendations, its use to treat other serious infections may be justified after evaluating benefit/risk, if other treatments cannot be used or if conventional treatment fails, always after microbiological verification (advisable caution).
Risk of: hypersensitivity, tendinitis and tendon rupture (greater risk in the elderly or in concomitant treatment with corticosteroids).
Suspend treatment for any sign of tendinitis (painful swelling, inflammation) and keep the affected limb at rest; do not administer in case of: history of disease or tendon disorder related to treatment with quinolones.
Cautions
Myasthenia gravis, CNS disorders predisposing to convulsions, arrhythmia of the Torsades de Pointes type; discontinue treatment if necessary: hypersensitivity (possible high-risk anaphylactic reaction), signs of tendinopathy (increased risk in the elderly or treated with corticosteroids, and possible up to several months after discontinuation of treatment), convulsions, psychiatric reactions, symptoms of neuropathy, antibiotic-associated colitis (may be life-threatening, with possible result of death), signs of hepatopathy (described hepatic necrosis and liver failure with risk of death).
Notified cases of polyneuropathy; monitor hydration and avoid excess alkalinity of urine, described crystalluria; avoid sun exposure and UV radiation during treatment; consult ophthalmologist if vision deteriorates.
Avoid family history or G6PDH deficit due to risk of hemolysis (assess benefit/risk and monitor); risk of resistance in prolonged treatment; concomitance with: theophylline, clozapine, ropinirole, tizanidine (clinical surveillance for increased concentrations, control of theophylline and dose adjustment).
Not recommended for concomitant treatment with methotrexate; do not prescribe quinolones or fluoroquinolones for: treatment of self-limited or mild infections (such as pharyngitis, tonsillitis, and acute bronchitis), prophylaxis of traveler’s diarrhea or recurrent lower urinary tract infections, nonbacterial infections, or for mild to moderate infections (including uncomplicated cystitis), acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease, acute bacterial rhinosinusitis and acute otitis media), unless other antibiotics commonly recommended for these infections are considered inadequate and should not be prescribed in patients with a history of serious adverse reactions following administration of this type of antibiotics.
Increased risk of tendon lesions following administration of quinolones and fluoroquinolones in the elderly, transplant recipients, or corticosteroid patients.
Interrupt treatment if symptoms affecting the musculoskeletal system (tendonitis, tendon rupture, myalgia, muscle weakness, arthralgia and joint edema) or the nervous system (peripheral neuropathy, psychosis, anxiety, insomnia, depression, hallucinations, autolytic thoughts, confusion, alterations of hearing or vision, or of the senses of taste and smell) appear; increased risk of aneurysm and aortic dissection (especially in the elderly).
Assess risk/benefit in: patients with a family history of aneurysm, diagnosed with pre-existing aortic aneurysm and/or aortic dissection or in the presence of other risk factors or disorders predisposing to aortic aneurysm and dissection (Marfan syndrome, Ehlers-Danlos vascular syndrome, Takayasu arteritis, giant cell arteritis, BehÇet disease, hypertension, known atherosclerosis).
Monitor blood glucose for risk of hypoglycaemia, hyperglycaemia and diabetic coma usually in diabetic patients who receive concomitant treatment with an oral hypoglycaemic (p.). e.g, glibenclamide) or insulin.
Very rare cases of serious disabling, long-lasting (persistent for months or years), and potentially irreversible adverse reactions affecting different and sometimes multiple body systems (musculoskeletal, nervous, psychiatric, and sensory) were reported in patients receiving quinolones and fluoroquinolones, regardless of their age and pre-existing risk factors (discontinuation of treatment if they occur).
In patients treated with quinolones and fluoroquinolones, cases of sensitive polyneuropathy or sensory-motor polyneuropathy have been reported, resulting in paresthesia, hypoanesthesia, dysesthesia or weakness.
Renal insufficiency
Caution.
Adjust dose (not studied in children).
Adults. Oral: Clcr 30-60 ml/min, 250-500 mg/12 h; Clcr < 30 and peritoneal dialysis, 250-500 mg/24 h; hemodialized, 250-500 mg/24 h after dialysis.
I.V.: Clcr 31-60 ml/min, max. 800 mg/day; Clcr ≤ 30, max. 400 mg/day; haemodialised, 400 mg/day on and after dialysis; DPAC, 50 mg/l dialysed/6 h.
Interactions with Ciprofloxacin
- Contraindicated with: tizanidine.
- Reduced absorption by: mineral drugs and supplements with multivalent cations (Ca, Mg, Al, Fe), polymeric phosphate fixatives (sevelamer), sucralfate or antacids, very buffered drugs (didanosine) containing Mg, Ca or Al, dairy and mineral enriched beverages. Administer 1-2 h before or min. 4 h after these products.
- Avoid with: dairy products or mineral-enriched drinks (e.g. milk, yoghurt, Ca-enriched orange juice).
- Plasma concentration increased by: probenecid.
- Not recommended with: methotrexate, zolpidem.
- Increases serum concentration of: theophylline (control concentration and adjust dose); other xanthine derivatives (caffeine, pentoxifylline).
- Increases or decreases serum levels of: phenytoin (monitor).
- Potency effect of: oral anticoagulants (warfarin). To control the normalized international index.
- Monitor and adjust doses with: ropinirole, clozapine.
- Lab: false- bacteriological analysis Mycobacterium tuberculosis.
Pregnancy
Data available in pregnant women do not show toxicity. Animal studies do not show harmful effects; in juvenile and prenatal animals exposed to quinolones observed effects on immature cartilage, damage to fetal articular cartilage cannot be excluded. Avoid.
Breastfeeding
Ciprofloxacin is excreted in breast milk. Due to the possible risk of joint injury, ciprofloxacin should not be used during lactation.
Effects on driving ability
Due to its neurological effects, ciprofloxacin can affect reaction time. Therefore, the ability to drive or use machines may be impaired.
Adverse reactions and side effects of Ciprofloxacin
Nausea, diarrhea. In addition IV: vomiting, reactions at the site of perfus, transient increase in transaminases, skin rash. In children arthropathy also occurs frequently.
⭐⭐⭐⭐⭐ VIDEO OF CIPROFLOXACIN/CIPRO (DRUG)
Source: The content of this active ingredient has been written taking into account the clinical and molecular information of all medicines authorised and marketed in the United States under the Unique Ingredient Identifier (UNII) by the Substance Registration System (SRS) of the Food and Drug Administration (FDA) and the United States Pharmacopeia (USP).
In order to know in detail the information authorized by the FDA for each drug, you should consult the corresponding medication guide authorized by the FDA.
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