Ciprofloxacin

Pharmacology

Ciprofloxacin is a synthetic fluoroquinolone antibiotic. Ciprocin has strong activity against most Gram-negative aerobic bacteria including Enterobacteriaceae and Pseudomonas aeruginosa. It inhibits the DNA synthesis of the bacterial enzymes responsible for supercoiling. 

Uses of Ciprofloxacin

Ciprofloxacin is used for bacterial infections. It is indicated for 

• Respiratory infections 
• Urinary tract infections
• Pelvic inflammatory disease
• Infectious diarrhea (Shigella dysentery, Vibrio cholera)
• Typhoid fever
• Intra-abdominal infections
• Neonatal infections
• Prostatitis
• Skin and soft collar infections
• Used as fever
• Meningitis
• Surgical prophylaxis.

Ciprofloxacin 750 mg is specially indicated for the treatment of pseudomonal infections of the lower respiratory tract; severe infections particularly due to pseudomonas, staphylococcus and streptococci. 

Dosage 

Tablet for Adults: The usual dosage range of Ciprofloxacin for adults is 250-750 mg twice daily. It is recommended that the usual dosage should not be exceeded for any treatment. Otherwise, it may suffer greatly. 

Urinary Tract Infections:

• Acute uncomplicated – 100mg or 250mg – 3 days.
• Mild/Moderate – 250mg – 7 to 14 days.
• Severe/Complicated – 500mg – 7 to 14 days.

Respiratory Tract Infections:

• Mild/Moderate – 500mg – 7 to 14 days.
• Severe/Complicated – 750mg – 7 to 14 days.

Acute Sinusitis: 

• Mild/Moderate – 500mg – 10 days.

Skin and Soft Tissue Infections:

• Mild/Moderate – 500mg – 7 to 14 days.
• Severe/Complicated – 750mg – 7 to 14 days.

Bone and Joint Infections:

• Mild/Moderate – 500mg ≥4-6 weeks.
• Severe/Complicated – 750mg ≥4-6 weeks.

Infectious Diarrhea: 

• Mild/Moderate/Severe – 500mg – 3 to 5 days.

Typhoid Fever:

• Mild/Moderate – 500mg – 10 to 14 days.
• Severe – 750mg – 10 to 14 days.
• Carrier Stage – 500mg – 28 days.

Others:

• Pelvic Inflammatory Diseases: 500 to 750 mg – 2 times/day (14 days).
• Infectious Diarrhea (Shigella dysenteriae, Vibrio cholera): 500 mg – 2 times/day (1 to 5 days.
• Intra-abdominal infections: 500 to 750 mg – 2 times/day (5 to 14 days).
• Prostatitis: 500 to 750 mg – 2 times/day (2 to 6 weeks).
• Gonorrhea: 500 mg as a single dose
• Neutropenic patients with fever due to bacterial infection: 500 to 750 mg – 2 times/day co-administered with appropriate antibacterials.
• Meningitis: 500 mg as a single dose.
• Surgical prophylaxis: 500 mg as a single dose, before 60 minutes of the procedure.

Extended-release tablet: Ciprofloxacin 1000mg tablet should be used once daily for 3 days for the treatment of Complicated Urinary Tract Infection and Acute Uncomplicated Phelonephritis

Suspension: Pediatric (1 to 17 years): 

• Enteric fever: 10-30mg /kg/day in two divided doses for 10 days.
• Acute invasive diarrhea: 10-30mg/kg/day in two divided doses for 3 days. 
• Shigellosis: 10-30mg/kg/day in two divided doses for 5 days. 
• UTI : 20-40mg/kg/day in two divided doses for 10-21 days.

For IV infusion: The dosages are different from tablets and suspensions. Follow the instructions as given below:

• Urinary Tract Infection: 
  • Mild to Moderate: 200 mg/12 hourly – 7 to 14 days; 
  • Severe or Complicated: 400 mg/12 hourly – 7 to 14 days.
• Lower Respiratory Tract infection: 
  • Mild to Moderate: 400 mg/12 hourly – 7 to 14 days; 
  • Severe or Complicated: 400 mg/8 hourly – 7 to 14 days
• Nosocomial Pneumonia: 
  • Mild/Moderate/Severe: 400 mg/8 hourly – 7 to 14 days
• Skin and Skin Structure: 
  • Mild to Moderate: 400 mg/12 hourly – 7 to 14 days; 
  • Severe or Complicated: 400 mg/8 hourly – 7 to 14 days
• Bone and Joint Infection: 
  • Mild to Moderate: 400 mg/12 hour – more than 4-6 weeks;
  • Severe/Complicated: 400 mg /8 hour – more than 4-6 weeks
• Intraabdominal (Acute abdomen): 
  • Complicated: 400 mg/12 hour – 7 to 14 days
• Acute Sinusitis: 
  • Mild/Moderate: 400 mg/12 hour – 10 days
• Chronic Bacterial Prostatitis: 
  • Mild/Moderate: 400 mg/12 hour – 28 Days.

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Administration 

Read the following instructions carefully before using Ciprofloxacin IV infusion.

• Check the solution bag if there is any leakage or not. If leakage is found then discard the solution.
• Never use the solution if it looks cloudy.
• Regulate the flow of the clamp according to administration.
• Suspend the bag from the hanger.

Duration: The duration and dosages may vary depending on the types of infection for the patients. So take advice from a registered physician before taking any dosage. Generally, treatment should be continued for at least 2 days after the signs and symptoms of the infection have disappeared.

Interaction 

Ciprofloxacin has some drug interactions. It should not be used within four hours of medications containing magnesium/aluminum Hydroxide, or iron salts as interference with absorption may occur. Increased plasma levels of theophylline have been observed following concurrent administration with Ciprofloxacin.

Contradiction 

It is contradicted with the patients who have hypersensitivity to Ciprofloxacin or its elements. 

Side Effects of Ciprofloxacin

Some minor side effects of Ciprofloxacin may be seen during its medication. All of them are given below:

• Headache
• Nausea or vomiting
• Cough
• Runny nose
• Diarrhea
• Fatigue, exhaustion, and weakness
• Skin rash
• Drowsy
• Joint pain, light sensitivity

If any serious condition is observed, then taking advice from a registered physician is recommended. 

Precautions & Warnings

Ciprofloxacin should be used with caution in patients with suspected or known CNS disorders such as arteriosclerosis or epilepsy or other factors which predispose to seizures and convulsion.

Pregnancy and Lactation

There is no clinical report or caution of using ciprofloxacin in pregnancy and lactation. But it should be used if it is essential for treatment.

Use in Special Populations

Though Ciprofloxacin is effective, it is not recommended for the special population as a first-choice drug.

Overdose Effects

There is no information on the overdose of using Ciprofloxacin. But sometimes overdose may lead to seizures, hallucinations, confusion, abdominal discomfort, renal and hepatic impairment.

Therapeutic Class

4-Quinolone preparations, Anti-diarrhoeal Antimicrobial drugs

Storage

Store below 30°C in a cool and dry place, away from light and moisture. Keep out of reach of children.