| Drug class /Antibacterial drug | |
| Pharmacologic class: Fluoroquinolone | |
| Overdose danger rating /Medium | |
| Dependence rating /Low | |
| Prescription needed /Yes | |
| Available as generic /Yes | |
| BLACK BOX ALERT /May increase the possibility of tendonitis and tendon rupture. Myasthenia gravis may be exacerbated. |
-Ciprofloxacin is a quinolone antibacterial, is used to treat infections caused by those bacteria that are resistant to other antibiotics. It is especially beneficial for infections of the lungs, intestines, and urinary tract.
-Ciprofloxacin is well absorbed by the body and works quickly and effectively when taken by mouth. However, in more severe systemic bacterial infections, the drug may be needed to be administered via injection.
-The most common ciprofloxacin side effect is a gastrointestinal disturbance. It can occasionally cause tendon inflammation and damage.
-Ciprofloxacin has antibacterial activity against both Gram-positive and Gram-negative bacteria. It is especially effective against Gram-negative bacteria, such as (Salmonella, Shigella, Campylobacter, Neisseria, and Pseudomonas).
-Ciprofloxacin has only moderate activity against Gram-positive bacteria like (Streptococcus pneumoniae and Enterococcus faecalis) and should not be used to treat pneumococcal pneumonia. It has antibacterial activity against Chlamydia and some mycobacteria. The majority of anaerobic organisms are not affected.
-Ciprofloxacin is effective against respiratory tract infections (but not pneumococcal pneumonia), gastrointestinal infections (including typhoid fever), bone and joint infections, gonorrhea, and septicemia caused by sensitive organisms.
Action
In susceptible bacteria, inhibits the enzyme DNA gyrase, interfering with bacterial cell replication. (Bactericidal effect).
Pharmacokinetics
-Well absorbed from GI tract
-Protein binding: 20%–40%
-Widely distributed including to CSF
-Metabolized in liver
-Primarily excreted in urine
-Minimal removal by hemodialysis
-3–5 hours is the half-life (increased in renal impairment, elderly)
Treatment of susceptible infections due to E. coli, K. pneumoniae, E. cloacae, P. mirabilis, P. vulgaris, P. aeruginosa, H. influenzae, M. catarrhalis, S. pneumonia, S. aureus (methicillin-susceptible), S. epidermidis, S. pyogenes, C. jejuni, Shigella spp., S. Typhi including intra-abdominal, bone, joint, lower respiratory tract, skin/skin structure infections; UTIs, infectious diarrhea, prostatitis, sinusitis, typhoid fever, febrile neutropenia.
Ophthalmic: Treatment of superficial ocular infections with ophthalmic drugs.
Otic: Treatment of acute otitis externa caused by susceptible strains of Pseudomonas aeruginosa or Staphylococcus aureus.
OFF-LABEL: Chancroid treatment. Acute cystic fibrosis pulmonary exacerbations, disseminated gonococcal infections, and Neisseria meningitidis prophylaxis following close contact with an infected person. Diarrhea caused by an infectious agent (in children); periodontitis.
| Infusion (premixed): 200 mg in 100 ml D5W, 400 mg in 200 ml D5W | |
| Injection, Solution (Cipro): 10 mg/mL | |
| Ophthalmic Ointment (Ciloxan): 0.3% | |
| Ophthalmic Solution (Ciloxan): 0.3% | |
| Suspension (oral): 250 mg/5 ml (5%), 500 mg/5 ml (10%) | |
| Otic Solution (Cetraxal): 0.2% (single-dose container: 0.25 mL) | |
| Tablets (extended-release, film-coated):500 mg, 1,000 mg | |
| Tablets (film-coated): 100 mg, 250 mg, 500 mg, 750 mg |
(IV)
Reconstitution
- Available prediluted in an infusion container and ready to use. The final concentration should not exceed 2 mg/mL.
Rate of Administration
- Infuse for at least 60 minutes (reduces the risk of venous irritation).
Storage
- Keep it at room temperature.
- Keep it at room temperature.
(PO)
- Can be taken with food to reduce GI upset.
- Take at least 2 hours before or 6 hours after taking antacids, calcium, iron, or zinc-containing products.
- Do not use feeding or gastric tubes to administer the suspension.
- For the NG tube, crush the immediate-release tablet and mix it with water. Before and after administration, flush the tube.
(Ophthalmic)
- Place a gloved finger on the lower eyelid and pull until a pocket form between the eye and the lower lid.
- Put ointment or drops in your pocket.
- Ask the patient to gently close their eyes for 1–2 minutes (so that medication will not be squeezed out of the sac).
- Instruct the patient to roll the eyeball with the ointment to increase the drug's contact area with the eye.
-Instruct the patient to apply digital pressure to the lacrimal sac at the inner canthus for 1 minute to reduce systemic absorption.
- Ophthalmic solution should not be used for injection.
Due to adverse events related to joints/surrounding tissue, it is not recommended as a first choice during pregnancy/lactation or in children under the age of 18 years.
| Fistulating Crohn’s disease | |
| BY MOUTH | |
| Adult: 500 mg twice daily |
| Respiratory-tract infections | |
| BY MOUTH | |
| Adult: 500–750 mg twice daily | |
| BY INTRAVENOUS INFUSION | |
| Adults should take 400 mg every 8–12 hours, spread out over 60 minutes. |
| Pseudomonal lower respiratory tract infection in cystic fibrosis | |
| BY MOUTH | |
| Adult: 750 mg twice daily |
| Urinary-tract infections | |
| BY MOUTH | |
| Adult: 250–750 mg twice daily | |
| BY INTRAVENOUS INFUSION | |
| Adults should take 400 mg every 8–12 hours, spread out over 60 minutes. |
| Acute uncomplicated cystitis in women | |
| BY MOUTH | |
| Adults: Take 250 mg twice daily for three days. |
| Acute or chronic prostatitis | |
| BY MOUTH | |
| Adult: 500 mg twice daily for 28 days | |
| BY INTRAVENOUS INFUSION | |
| Adults should take 400 mg every 8–12 hours, spread out over 60 minutes. |
| Gonorrhea | |
| BY MOUTH | |
| Adult: 500 mg for 1 dose |
| Most other infections | |
| BY MOUTH | |
| Adults: 500 mg twice daily at first, then increased to 750 mg. | |
| twice daily, in severe or deep-seated infection | |
| BY INTRAVENOUS INFUSION | |
| Adults should take 400 mg every 8–12 hours. | |
| 60 minutes |
| Surgical prophylaxis | |
| BY MOUTH | |
| Adults should take 750 mg 60 minutes before the procedure. |
| Anthrax (treatment and post-exposure prophylaxis) | |
| BY MOUTH | |
| Adult: 500 mg twice daily | |
| BY INTRAVENOUS INFUSION | |
| Adults should take 400 mg every 12 hours | |
| 60 minutes |
| Prevention of secondary case of meningococcal meningitis | |
| BY MOUTH | |
| Child 1 month–4 years: 30 mg/kg (max. per dose 125 mg) for 1 dose | |
| 250 mg for a single dose in a child aged 5–11 years. | |
| 500 mg for a single dose in a child aged 12–17 years. | |
| Adult: 500 mg for 1 dose |
-Used with caution in patients who are sensitive to fluoroquinolones.
-Use with caution in patients with CNS disorders, such as severe cerebral arteriosclerosis or seizure disorders, as well as those who are at risk of seizures. The drug may stimulate the central nervous system.
-Black Box Alert: The drug has been linked to an increased risk of tendinitis and tendon rupture, particularly in patients over the age of 60 and those who have had a heart, kidney, or lung transplant.
Be sure to tell your doctor if:
- You have a history of liver or kidney disease.
- You have had epileptic seizures.
- You have glucose-6-phosphate dehydrogenase (G6PD) deficiency.
-You have myasthenia gravis.
- You are taking other medicines.
Pregnancy
A single dose of ciprofloxacin may be used to prevent recurrent meningococcal meningitis. Pregnancy safety has not been established. (Consult with your doctor).
Breastfeeding
The drug passes into breast milk; the amount is too small to be harmful, but it may have an adverse effect on the baby. (Consult with your doctor).
Children and infants
It is not approved for use in children for the prevention of meningococcal meningitis. (This is not usually advised.)
60 and up
A lower dose may be required.
Driving and risky work
Avoid such activities until you know how ciprofloxacin affects you, as the medication can cause dizziness and confusion.
Alcohol
This drug's sedative effects may be exacerbated by alcohol. It is preferable to avoid.
Sunlight and sunbeds
Avoid direct sunlight or sunlamps; this increases the risk of a photosensitivity reaction.
| CNS: | Seizures, confusion, headache, restlessness | |
| GI: | Pseudomembranous colitis, diarrhea, nausea, vomiting | |
| GU: | Crystalluria, interstitial nephritis | |
| Hematologic: | Leukopenia, neutropenia, thrombocytopenia, eosinophilia | |
| Musculoskeletal: | Tendon rupture | |
| Skin: | Rash, Stevens-Johnson syndrome, toxic epidermal necrolysis | |
| Other: | Hypersensitivity reactions | |
Except in the case of extremely high doses, most side effects are uncommon. Report any painful tendons or joints to your doctor immediately, stop treatment, and rest the affected limbs.
Arthropathy is a common or very common condition (in children).
Frequent (5%–2%):
Nausea, diarrhea, dyspepsia, vomiting, constipation, flatulence, confusion, and crystalluria.
Ophthalmic: Burning and crusting in the corner of the eye.
Occasional (less than 2%):
Pain/discomfort in the abdomen, headache, and rash.
Ophthalmic symptoms include: altered taste, the sensation of a foreign body in the eye, redness of the eyelids, and itching.
Rare (less than 1%):
Dizziness, confusion, tremors, hallucinations, hypersensitivity reaction, insomnia, dry mouth, and paresthesia are all possible symptoms.
Note in general Ciprofloxacin interacts with a variety of medications, including:
| Anticoagulants, | |
| Oral antidiabetics | |
| Phenytoin | |
| Theophylline/ aminophylline | |
| Non-steroidal anti-inflammatory drugs | |
| Tricyclic depressants | |
| Clarithromycin | |
| Erythromycin | |
| Antipsychotics | |
| Tinzanidine |
Do not take any over-the-counter or prescription medications unless you have first checked with your doctor or pharmacist.
Oral iron preparations and antacids
Ciprofloxacin absorption is hampered by-products containing magnesium or aluminum hydroxide. Antacids should not be taken within 2 hours of taking ciprofloxacin tablets.
1.Joint Formulary Committee (2019). BNF 78: September 2019-March 2020. 78th ed. London: Pharmaceutical Press.
2.British Medical Association (2015). British Medical Association new guide to medicine & drugs. London: Dorling Kindersley.
3.Kizior, R.J. and Hodgson, B.B. (2018). Saunders nursing drug handbook 2019. Philadelphia: Saunders.
4.Williams and Wolters Kluwer Health (2012). Nursing 2012 drug handbook. Philadelphia, Pa.: Wolters Kluwer Health/Lippincott Williams & Wilkins.
5.Kolesar, J.M. (2013). Top 300 pharmacy drug cards 2016-2017. Mcgraw-Hill.
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