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Ciprofloxacin

Ciprofloxacin is a synthetic antibacterial drug belonging to the class of quinolones. More precisely, ciprofloxacin is a fluoroquinolone.

It is an antibacterial with a bactericidal action, ie it is able to kill bacterial cells.

Ciprofloxacin - Chemical Structure

Ciprofloxacin is available in the form of many pharmaceutical formulations suitable for oral administration, via the eye, via the ear and via the parenteral route.

Indications

For what it uses

The use of ciprofloxacin is indicated for the treatment of:

  • Respiratory tract infections (oral and parenteral administration);
  • Recurrent ear or paranasal sinuses and acute external ear infections (oral, auricular and parenteral administration);
  • Genito-urinary infections (oral and parenteral administration);
  • Gastrointestinal and intra-abdominal infections (oral and parenteral administration);
  • Skin and soft tissue infections (oral and parenteral administration);
  • Osteoarticular infections (oral and parenteral administration);
  • Infections in patients with neutropenia (oral and parenteral administration);
  • Infections caused by Neisseria meningitidis (oral administration);
  • Exposure to inhalation of anthrax spores in adults, children and adolescents (oral and parenteral administration);
  • Bronchial and pulmonary infections in children and adolescents with cystic fibrosis (oral and parenteral administration);
  • Complicated infections of the kidneys and urinary tract in children and adolescents (oral and parenteral administration);
  • External infections of the eye and ocular adnexa, corneal ulcers, abscesses, conjunctivitis and blepharitis (ocular administration).

Warnings

Before starting ciprofloxacin therapy, you must inform your doctor if you are in one of the following conditions:

  • If you suffer from kidney problems;
  • If you suffer from epilepsy or other neurological diseases;
  • If you suffer from myasthenia gravis;
  • If you suffer from cardiac arrhythmias.

Furthermore, it is necessary that patients inform the doctor if they have suffered tendon problems following previous therapies with other quinolones.

A lot of caution should be used in the use of ciprofloxacin in patients with a family history of prolongation of the QT interval (the interval of time required for ventricular myocardium to depolarize and repolarize) or other cardiovascular diseases.

If - during treatment with ciprofloxacin - any type of allergic reaction appears, therapy with the drug should be stopped immediately and a doctor should be contacted immediately.

Ciprofloxacin can cause tendonitis, pain and swelling in the joints. If these symptoms appear, treatment with the drug should be stopped immediately.

Ciprofloxacin may worsen the symptoms of depression and psychosis, so caution should be exercised when administering the drug to patients with these diseases.

In the event of severe diarrhea, accompanied or not accompanied by blood or mucus, treatment with ciprofloxacin should be stopped immediately and the doctor should be contacted.

Ciprofloxacin may promote the onset of anemia in patients with a lack of the glucose enzyme

6-phosphate dehydrogenase.

If neuropathy or liver damage occurs, it is necessary to stop ciprofloxacin therapy immediately and inform your doctor.

Since ciprofloxacin can induce photosensitivity reactions, during treatment with the drug, it is advisable to avoid direct exposure to UV rays and sunlight.

Ciprofloxacin can trigger side effects that can alter the ability to drive and / or use machinery, so care should be taken.

Interactions

Before starting treatment with ciprofloxacin orally or parenterally, you must tell your doctor if you are already taking any of the following medications:

  • Vitamin K antagonists (such as, for example, warfarin) or other oral anticoagulants ;
  • Methotrexate, an anticancer medicine;
  • Theophylline, used in the treatment of asthma;
  • Tizanidine, a muscle relaxant used to treat muscle spasticity in patients with multiple sclerosis;
  • Clozapine or olanzapine, antipsychotic drugs;
  • Ropinirole, a drug used in the treatment of Parkinson's disease;
  • Phenytoin, an antiepileptic;
  • Metoclopramide, an antiemetic;
  • Cyclosporine, an immunosuppressive drug;
  • Glibenclamide, a drug used in the therapy of diabetes.

When administered orally or parenterally, ciprofloxacin may increase the plasma levels of the following drugs:

  • Pentoxifylline ;
  • Caffeine ;
  • Duloxetine, an antidepressant;
  • Lidocaine, a local anesthetic;
  • Sildenafil, a drug used to treat erectile dysfunction.

The concomitant administration of ciprofloxacin orally and the following drugs may reduce the efficacy of ciprofloxacin itself:

  • Antacid drugs ;
  • Omeprazole, a drug used to reduce acid secretion of the stomach;
  • Mineral supplements ;
  • Sucralfate, a cytoprotective agent used in the therapy of duodenal ulcer and gastric ulcer;
  • Preparations containing magnesium, aluminum, calcium or iron .

In any case, it is always a good idea to inform your doctor if you are taking - or have recently been taken - drugs of any kind, including non-prescription medicines and herbal and / or homeopathic products.

Furthermore, milk and dairy products, or drinks with added calcium, should not be taken concurrently with ciprofloxacin administered orally, as these foods interfere with its absorption.

Side effects

Ciprofloxacin can cause various types of side effects, although not all patients experience them. The type of adverse effects and the intensity with which they occur depend on the different sensitivity that each individual has towards the drug.

The main side effects that may occur during ciprofloxacin treatment are listed below.

Gastrointestinal disorders

Treatment with ciprofloxacin may favor the onset of:

  • Nausea and vomit;
  • Diarrhea;
  • Abdominal pains;
  • Indigestion;
  • Stomach ache;
  • Pancreatitis;
  • Colitis associated with antibiotic use.

Cardiovascular disorders

Ciprofloxacin therapy may cause vasodilation, vasculitis, hypotension, fainting, tachycardia and prolongation of the QT interval.

Skin and subcutaneous tissue disorders

Treatment with ciprofloxacin may cause:

  • Skin eruptions;
  • Itch;
  • Urticaria;
  • Photosensitization reactions;
  • Increased sweating;
  • petechiae;
  • Stevens-Johnson syndrome;
  • Toxic epidermal necrolysis.

Nervous system disorders

Ciprofloxacin therapy may cause:

  • Headache;
  • Sleep disorders;
  • Alterations in the sense of taste;
  • Uncertain gait;
  • Peripheral neuropathy;
  • Tremors;
  • Convulsions.

Psychiatric disorders

Treatment with ciprofloxacin may favor the onset of:

  • agitation;
  • Hyperactivity;
  • Depression;
  • Psychotic reactions;
  • Confusion;
  • Disorientation;
  • Anxious reactions;
  • Unusual dreams;
  • Hallucinations.

Hepatobiliary disorders

Ciprofloxacin therapy may promote the onset of liver disorders, hepatitis, hepatic necrosis and cholestatic jaundice.

Kidney and urinary tract disorders

Ciprofloxacin treatment can cause renal failure, crystalluria, haematuria and inflammation of the urinary tract.

Blood and lymphatic system disorders

Ciprofloxacin therapy may cause:

  • Eosinophilia, ie an increase in the blood concentration of eosinophils;
  • Leukopenia, ie the decrease in the number of leukocytes in the bloodstream;
  • Neutropenia, ie the decrease in blood levels of neutrophils;
  • Agranulocytosis, ie the decrease in the number of granulocytes in the blood;
  • Increase or decrease in the number of platelets in the bloodstream;
  • Prothrombin levels alteration;
  • Hemolytic anemia.

Other side effects

Other side effects that may occur during treatment with ciprofloxacin are:

  • Allergic reactions, even serious, in sensitive subjects;
  • Superinfections with bacteria resistant to ciprofloxacin or fungi;
  • Temperature;
  • Asthenia;
  • Pains in muscles and bones;
  • cramps;
  • Tinnitus;
  • Decrease or loss of hearing;
  • Auricular congestion, secretion or itching (typical of the administration of the ciprofloxacin by the ear);
  • Water retention;
  • Hyperglycemia;
  • Intracranial hypertension;
  • Diplopia;
  • Changes in color perception;
  • Inflammation and / or tendon rupture.

Side effects associated with ocular administration

In addition to some of the adverse effects described above, when administered via the eye, ciprofloxacin can cause:

  • White deposits on the surface of the eye;
  • Eye discomfort, pain and / or redness;
  • Sensitivity to light;
  • Decreased visual acuity;
  • Swelling of the eyelid;
  • Dry eyes;
  • Ocular itching;
  • Increased tearing;
  • Ocular secretion;
  • Ocular toxicity;
  • Conjunctival edema;
  • Erythema of the eyelid;
  • Hordeolum.

Overdose

If you suspect you have taken an overdose of ciprofloxacin, you must contact your doctor immediately or contact the nearest hospital.

Action mechanism

Ciprofloxacin is a quinolone and, as such, exerts its bactericidal action by inhibiting two bacterial enzymes essential for cellular survival.

More specifically, ciprofloxacin - like all quinolones - inhibits DNA gyrase (or bacterial topoisomerase II) and topoisomerase IV.

These enzymes are involved in the supercoiling, rewinding, cutting and welding processes of the two strands that make up the DNA of the drum.

Due to the inhibition of these enzymes, the bacterial cell can no longer access the information contained in the genes. In this way, all cellular processes - including replication - are interrupted and the beating dies.

Mode of Use - Posology

Ciprofloxacin is available for:

  • Oral administration in the form of tablets and granules for oral suspension;
  • Intravenous administration in the form of a solution for infusion;
  • Ocular administration in the form of eye drops and ophthalmic ointment;
  • Administration by the ear in the form of ear drops.

Below are some indications on ciprofloxacin doses usually used in therapy.

Oral and intravenous administration

The dose of ciprofloxacin to be administered and the duration of treatment must be established by the doctor depending on the type and severity of the infection to be treated.

Generally, the duration of treatment varies from 5 to 21 days, but - in case of very serious infections - the doctor may decide to prolong the therapy.

Ocular administration

In the first two days of treatment, it is recommended to instill 1-2 drops of eye drops in the eye every two hours, interrupting the administration at night. In the following days, on the other hand, administrations can be done at four-hour intervals.

For the treatment of corneal ulcers or abscesses, in the first two days of therapy, the ointment must be applied in the conjunctival sac every two hours (even at night). Later, applications can be run every four hours.

For the treatment of blepharitis and bacterial conjunctivitis, the ointment is usually applied three times a day for two days. Subsequently, applications are reduced to two per day, for a period of another five days.

Auricular administration

For the treatment of external otitis, it is recommended to administer four ear drops, inside the ear canal, twice a day.

Pregnancy and breastfeeding

When ciprofloxacin is administered orally or parenterally it is preferable to avoid its use in pregnant women.

Ciprofloxacin administered parenterally or orally is excreted in breast milk, therefore mothers who are breast-feeding should not use the drug, due to the possible negative effects that may occur in the child.

When ciprofloxacin is administered via the eye or ear, however, it can be used by pregnant women and breastfeeding mothers, only under the strict supervision of the doctor and only after a careful evaluation of the relationship between the expected benefit for the mother and the potential risks to the fetus or baby.

In any case, pregnant women and breastfeeding mothers - before taking any type of medication - should always seek medical advice.

Contraindications

The use of ciprofloxacin is contraindicated in the following cases:

  • In patients with hypersensitivity known to ciprofloxacin itself;
  • In patients with known hypersensitivity to other quinolones;
  • In patients already on tizanidine therapy (only when ciprofloxacin is administered orally or parenterally);
  • In patients with suspected or established perforation of the tympanic membrane (when ciprofloxacin is administered via the ear).

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