Ciprofloxacin Ciprofloxacin instructions for use

Ciprofloxacin belongs to the group of gram-negative fluoroquinolones (second generation). The mechanism of its antimicrobial action is due to the inhibition of DNA gyrase of gram-negative and topoisomerases of gram-positive bacteria.

Due to morphological changes in the structure of the cell wall, the process of growth and division of the pathogenic microorganism is disrupted. Due to the cessation of the synthesis of proteins that stabilize the membrane and provide resistance to environmental factors, the pathogen dies. The low risk of developing flora resistance is due to a dual mechanism of action. Resistance to the drug can develop due to mutations in the genes encoding subunits of the enzymes DNA gyrase and topoisomerase.

The probability of a double mutation in genes is quite low; moreover, during the use of Ciprofloxacin®, resistance to other antibacterial agents that are not included in the class of gyrase inhibitors cannot develop. This explains its effectiveness on strains that cannot be treated with aminopenicillins and other beta-lactams, tetracyclines, aminoglycosides, etc.

Application diagram

The medicine is instilled 1 or 2 drops into the conjunctival sac of each eye after 4 hours. If the infection is severe, then the interval should be 1 hour, and the dosage should be 2 drops. After the severity of symptoms decreases, the dosage is reduced, and the interval between instillations is increased. If a bacterial corneal ulcer is diagnosed, the dosage regimen will be more complex. During the first 6 hours, the drug is dripped every 15 minutes, 1 drop, then every half hour in the same dose. This is on the first day. On the second day, 1 drop is instilled every hour, but only during waking hours. And then from the third to the fourteenth day the medicine is used every 4 hours at the same dosage also during the daytime. A break is taken during sleep.

For the treatment of ear diseases, the application regimen is as follows: the medicine is instilled twice or four times a day, 3 or 4 drops into the external auditory canal. Usually the duration of treatment is from 5 to 10 days. In some situations, the timing and dosage may be adjusted by the attending physician.

Release forms of ciprofloxacin

infusions Ciprofloxacin Manufacturers

Composition and release form

The drug is produced by pharmaceutical companies in Russia, Ukraine and Romania. The active ingredient is ciprofloxacin. The pharmacy supplies different dosage forms. The appearance of the tablets and packaging depends on the manufacturing company. Main forms of release:

1. Tablets in a soluble coating containing 0.25, 0.5 or 0.75 g of active substance and additional components.
2. The solution for infusion is transparent, colorless, packaged in 100 ml bottles. 1 ml contains 2.33 mg of active substance and auxiliary ingredients.
3. The concentrate for preparing the solution is supplied in 10 ml bottles, 5 pieces in each package. 1 ml contains 100 mg of ciprofloxacin and excipients.
4. Drops for instillation into the eyes and ears (0.3%) in volumes of 1, 2, 5 and 10 ml. Each package contains from 1 to 5 glass bottles or plastic syringe tubes. 1 ml contains 3 mg of active substance.

Recipe for "Ciprofloxacin" in Latin for tablets: Rp.: Ciprofloxacini 0.5 D. td N 10 in tabul.

Price of Ciprofloxacin in different dosage forms in pharmacies in Moscow, St. Petersburg, regions

Ciprofloxacin (instructions for use are available for review at pharmacies or online resources) can be purchased in any form only if you have a doctor's prescription. This applies to both ordinary pharmacies and online stores. The price of the drug is not the same everywhere; on average, one package costs 10-30 rubles.

For example, in the online store WER.ru:

• a package of 10 tablets with a dosage of 0.25 g can be purchased for 17 rubles;
• a package of 10 tablets with a dosage of 0.5 g costs twice as much. The buyer pays 34 rubles for it;
• the price of a 5 ml bottle of liquid intended for instillation into the eyes is 20 rubles;
• for 24 rubles you can purchase a solution for infusion in a volume of 0.2 g.

In the Moscow pharmacy "Yuteka" the prices are as follows:

• 10 tablets with a dosage of 0.25 g can be purchased for 13 rubles;
• eye drops in a regular 5 ml bottle are sold for 19 rubles;
• drops in a 10 ml bottle can be purchased for 21.5 rubles;
• the price of the solution for infusion depends on the manufacturer. A package costs 24 rubles, and the price of a solution is 31 rubles.

The drug is sold at approximately the same price in other pharmacies in Moscow. The prices for this medicine in St. Petersburg pharmacies are not much different.

For example, at the Evalar pharmacy:

• the cost of a package of 10 tablets is 17 rubles;
• drops can be bought for 19, 20 or 22 rubles.

Similar prices can be seen in pharmacies located in other cities of our country. If there is a difference, it is 2-3 rubles. Ciprofloxacin is an inexpensive drug that is available by prescription only. Before use, the patient must study the instructions for use and make sure that he has no intolerance to the substances contained in the drug.

Article design: Mila Friedan

Contraindications

The drug has some contraindications and restrictions for use. Absolute contraindications to treatment with tablets and infusions are:

1. Pseudomembranous colitis.
2. Lactose intolerance and lactase deficiency.
3. Intolerance or hypersensitivity to the components of the drug.
4. Fungal and viral lesions of the organs of vision (for drops).

The drug should not be taken by pregnant or breastfeeding women. Also, Ciprofloxacin is contraindicated in patients under 18 years of age, except in cases where the child suffers from anthrax, cystic fibrosis, or Pseudomonas aeruginosa. The use of eye drops is contraindicated in children under 1 year of age.

There is a list of conditions when Ciprofloxacin can be used with caution. These include:

1. Severe atherosclerotic damage to cerebral vessels.
2. Elderly and old age.
3. Cerebrovascular disease.
4. Epilepsy.
5. Acute and chronic mental disorders.
6. Anamnestic information and tendon lesions during treatment with fluoroquinolones.
7. Heart disease, which increases the risk of an increase in the QT interval on the ECG and the development of heart rhythm disturbances - acute myocardial infarction, sinus bradycardia, heart failure. This limitation applies to the administration of solution for infusion.

In addition, elderly people should take the medicine with caution.

Who is Ciprofloxacin intended for?

Basically, the attending physician resorts to prescribing such a remedy when the patient experiences infections in:

• Areas of the respiratory tract. The disease manifests itself as a result of the appearance of gram-negative bacteria in a sick person. They are observed in people with pneumonia, lung diseases (including chronic diseases), bronchiectasis;
• Middle ear and sinuses. Damage to these organs is associated with the emergence of gram-negative bacteria;
• Kidneys and genitourinary system;
• Human skin and soft tissues;
• Bones and joints;
• Small pelvis, with gonorrhea and prostatitis;
• In the gastrointestinal tract, when diarrhea and E. coli occur.

Patients with reduced immunity from infections also need this drug.

Indications

When can Ciprofloxacin be used? Is this an antibiotic or not? A specialist will answer all these questions. Doctors confidently claim that the medication belongs to the group of antibacterials. Therefore, it can be used for various infectious diseases caused by microorganisms sensitive to the main active ingredient. An antibacterial agent is prescribed as the main element of complex therapy for diseases of the respiratory tract, pelvic organs, bones, joints, skin, and ENT organs. In addition, in patients with reduced immunity, tablets can be used for preventive purposes.

Broad-spectrum antibiotics are also suitable for topical use. "Ciprofloxacin" is used for infectious conjunctivitis, blepharitis, corneal ulcers, chronic dacryocystitis. As a prophylactic agent, the medicine is used after eye surgery or after a foreign body enters the eye.

The medication cannot be prescribed during pregnancy and lactation. Experts say that the antibacterial agent can cause serious harm to an unborn baby. The use of Ciprofloxacin tablets is recommended after reaching the age of 15.

In rare cases, patients may experience hypersensitivity to elements of the drug. If any allergic reactions occur, the patient should consult a doctor. It may be necessary to discontinue the antibacterial agent or adjust the daily dosage.

For patients over 65 years of age, the medication is prescribed with caution. An antibiotic taken under supervision by people who have impaired kidney function

Tablets are contraindicated for renal failure.

Prescription during pregnancy and lactation

The safety and effectiveness of the drug during pregnancy have not been established.

Animal experiments showed that the drug caused arthropathy in young animals. The use of doses exceeding 6 times the average daily dose for humans in pregnant female rats and mice did not provoke any abnormalities in fetal development.

In rabbits receiving 30 and 100 mg/kg Ciprofloxacin orally, gastrointestinal dysfunction was observed and, as a consequence, weight loss and an increase in miscarriage cases. No teratogenic effect was detected.

When the drug was administered into a vein at a dose of 20 mg/kg, there was also no teratogenic effect or toxic effect on the embryo and the mother’s body.

The use of topical Ciprofloxacin during pregnancy is possible if indicated and provided that the benefits to the mother's body outweigh the risks to the fetus.

According to the FDA classification, the drug belongs to category C.

Ciprofloxacin is excreted into milk, so nursing women need to decide (taking into account the importance of the drug for the mother) to stop breastfeeding or refuse treatment with Ciprofloxacin

Local forms are used with caution during lactation, because It is unknown whether the medicine passes into breast milk in this case

It is unknown whether the medicine passes into breast milk in this case

Local forms are used with caution during lactation, because It is unknown whether the medicine passes into breast milk in this case

Ciprofloxacin instructions for use

Adults. Uncomplicated and complicated respiratory tract infections (including pneumonia) caused by microorganisms sensitive to ciprofloxacin. Ciprofloxacin should not be used as a first-line drug in the treatment of community-acquired pneumonia caused by Streptococcus pneumoniae (low activity against pneumococci). The drug can be used in the treatment of pneumonia caused by Klebsiella, Enterobacter, Proteus, E. coli, Pseudomonas, Haemophilus, Branhamella, Legionella and Staphylococcus. Otitis media, sinusitis, infections caused by gram-negative microorganisms including Pseudomonas and Staphylococcus. Eye infections, kidney and urinary tract infections, genital infections, for example, inflammation of the appendages, gonorrhea, prostatitis. In the abdominal cavity - intestinal bacterial infections, biliary tract infections and peritonitis. Infections of the skin and soft tissues, bones and joints, sepsis, prevention or treatment of infections in immunocompromised patients (for example, taking immunosuppressants or with neutropenia), selective intestinal decontamination in patients after immunosuppressive therapy. Children. Exacerbation of respiratory failure in cystic fibrosis caused by Pseudomonas aeruginosa in children 5-17 years old. Pulmonary anthrax in children and adults. If necessary, ciprofloxacin can be used in children and adolescents with complex urinary tract infections or pyelonephritis, and in exceptional cases also for other indications. In the form of eye drops: superficial eye infections, infections of the ocular appendages and corneal ulcers caused by microorganisms sensitive to ciprofloxacin.

Contraindications for use

Ciprofloxacin® preparations are prohibited for use in children.
An exception may be prescriptions for life-saving indications, when the expected benefit outweighs the risk:

• pulmonary form of cystic fibrosis;
• anthrax.

This limitation is due to toxicity and a large number of side effects, including severe damage to cartilage tissue.

Possible local administration in the form of eye drops, from one year of life and eyes, ointments - from two years.

Other contraindications:

• hypersensitivity to Ciprofloxacin® and a history of allergic reactions to the use of fluoroquinolones;
• hemolytic anemia associated with deficiency of glucose-6-phosphate dehydrogenase;
• diseases of the ligamentous apparatus, tendon injuries;
• pathologies of the nervous system;
• the patient is taking non-steroidal anti-inflammatory drugs (strong neurotoxic effect) or tizanidine (severe arterial hypotension, up to collapse);
• pregnancy (high probability of teratogenic effects) and lactation.

Use with caution in patients with severe atherosclerotic changes in blood vessels, cerebrovascular accidents, epilepsy, in old age, with renal and liver failure.

Concomitant use with anticoagulants increases the risk of bleeding. In patients receiving therapy for diabetes mellitus with hypoglycemic agents, treatment is carried out strictly under the control of blood sugar levels, due to the possibility of developing hypoglycemic conditions, including coma.

Synergistic interactions are observed when Ciprofloxacin® is used with beta-lactams, metronidazole®, aminoglycosides and lincozimides.

Did you know that ciprofloxacin® is successfully used to get rid of Helicobacter pylori, a bacterium that causes gastritis and stomach ulcers?

Read more: Antibiotic treatment regimens for Helicobacter pylori

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Anna Chernenko

Infectious disease doctor of the highest category with extensive experience. Specialist in the field of therapy of infectious diseases of various etiologies, methods of laboratory diagnostics of biomaterial.

Contraindications

The list of contraindications to the use of Ciprofloxacin includes the following conditions:

• deficiency of glucose-6-phosphate dehydrogenase in the body;
• pregnancy and breastfeeding;
• pseudomembranous colitis;
• hypersensitivity to fluoroquinolones.

Additionally, the drug should not be prescribed to children and adolescents under 18 years of age, and should not be used with caution in patients with cerebral atherosclerosis, abnormalities in cerebral circulation, mental disorders, seizures and epilepsy. Patients with impaired renal or hepatic function and elderly patients also require special monitoring.

Patients with impaired renal or hepatic function and elderly patients also require special monitoring.

How to use the drug, dosage.

A drug such as Ciprofloxacin is used orally. The course of taking the medicine depends on the patient’s condition, the development of his illness, the severity of damage to the body, as well as the course of the disease under the supervision of doctors. The doctor also evaluates the patient’s health during treatment based on the results of research in the bacteriological laboratory.

Cases of diseases when taking Ciprofloxacin is necessary for children. Diseases, doses and frequency of administration:

• Those suffering from the lower respiratory tract as a result of damage to various infectious diseases are treated with doses of five hundred to seven hundred and fifty mg twice a day. The medicine should be used for 1-2 weeks;
• Infections that are located in the respiratory tract (in the upper region) are divided into several subtypes: Otitis externa (malignant). The medication should be taken in doses of 500-750 mg twice a day. The duration of the treatment course is from one month to three;
• Exacerbation of the disease chronic sinusitis. The dose of the drug is prescribed from 500 to 750 mg. These doses should be taken twice a day for 1 to 2 weeks;
• A suppurating ear due to otitis, when the disease has become chronic, is treated with Ciprofloxacin in doses of 500 to 750 mg in the morning, a second dose in the evening. The duration of taking this drug is up to two weeks.

Drug interactions

According to the radar data, the active substance of the drug can interact with other medications and affect their absorption, excretion and therapeutic activity. In turn, the pharmacodynamics and pharmacokinetics of Ciprofloxacin may change under the influence of other drugs.

The drug reduces the activity of biochemical processes of microsomal oxidation in liver cells. As a result of this effect, the concentration of xanthines (theophylline, caffeine, etc.) in the blood increases and their half-life slows down. In a similar way, the antibiotic acts on oral glucose-lowering tablets and indirect anticoagulants, reducing the prothrombin index.

Simultaneous administration with drugs from the group of non-steroidal anti-inflammatory drugs can provoke the development of seizures. Under the influence of Metoclopramide, the absorption of the antibiotic is accelerated, due to which the maximum plasma concentration is achieved faster. Taking anti-gout medications slows down the elimination of Ciprofloxacin and increases its concentration in the blood.

When administered simultaneously with other antibacterial agents (aminoglycosides, Metronidazole, beta-lactams), good compatibility of these drugs is observed. To combat diseases caused by pseudomonas, a combination of Ciprofloxacin with Azlocillin and Ceftazidime is effectively used. For streptococcal infections it is combined with beta-lactam antibiotics. A combination of Ciprofloxacin and Vancomycin is prescribed against staphylococcal infections. Anaerobic pathogens are highly sensitive to combination with Clindamycin and Metronidazole.

Cyclosporine significantly enhances the toxic effect on the kidneys and increases the level of creatinine in the blood serum when taken together with Ciprofloxacin. When prescribing such a combination, the patient needs to monitor biochemical blood tests at least 2 times a week.

Co-administration of the drug with Tizanidine is strictly prohibited, as this combination causes a sharp decrease in blood pressure.

Pharmacological effect

The main active component of Ciprofloxacin tablets belongs to the antibacterial agents of the fluoroquinolone group. It has a bactericidal effect, leading to the death of sensitive bacteria. This effect is realized by suppressing the catalytic activity of the bacterial cell enzyme DNA gyrase. This leads to disruption of the DNA replication (doubling) process and death of the bacterial cell.

The drug has sufficient activity against active (dividing) and inactive bacterial cells. It has a bactericidal effect against a significant number of gram-positive (staphylococci, streptococci) and gram-negative (Escherichia coli, Pseudomonas aeruginosa, Proteus, Klebsiella, Yersinia, Salmonella, Shigella, gonococci) bacteria. The drug also leads to the death of specific bacteria that are intracellular parasites (mycobacterium tuberculosis, legionella, mycoplasma, ureaplasma, chlamydia). The activity of Ciprofloxacin tablets against Treponema pallidum (the causative agent of syphilis) remains unclear.

After taking the Ciprofloxacin tablet orally, the active ingredient is well absorbed into the systemic circulation and is evenly distributed in the tissues, where it has a therapeutic effect.

Dosage

Strictly on the recommendation of a doctor, you should take Ciprofloxacin tablets. This group of antibiotics can only be used as prescribed by a qualified specialist. The daily norm is determined individually in accordance with the form of the patient’s disease, as well as the characteristics of his body. The minimum dosage for patients over 15 years of age when administered orally can be 250 mg, the maximum - 750 mg. The entire daily dose is divided into two doses. The interval between taking tablets should not exceed 12 hours. The course of treatment can be long (up to 4 weeks).

The drug can also be administered intravenously. A single dose is 200-400 mg (also divided into two doses). Usually a two-week course is enough to completely overcome the disease. The doctor makes the decision to continue based on the overall picture of the dynamics of the disease. The drug is administered intravenously using a dropper over 30 minutes. With jet administration, the bioavailability of the antibacterial agent is significantly reduced.

Local treatment can be prescribed for various eye infections. The patient is injected with 1-2 drops of solution into each conjunctival sac 5-7 times a day. As soon as the doctor notices the positive dynamics of the disease, the interval between drug administrations increases. The maximum daily dosage for adult patients should not exceed 1.5 g.

Use of a drug for sinusitis

Despite the fact that acute, just like chronic sinusitis in most situations is provoked by some kind of infection or pathogenic microorganism, doctors do not always recommend treating this disease with antibiotics. But on the other hand, it can also be quite difficult to do without them. For example, it is worth using antibacterial drugs, like Ciprofloxacin 500, for sinusitis, characterized by purulent acute inflammation. It can show effective therapy, but only if the treatment was prescribed correctly.

The use of this medication directly depends on the correct identification of the etiology of the disease. In any case, this drug helps against various pathogenic microscopic organisms that cause the development of inflammatory and purulent processes.

If a simple form of this disease occurs, the doctor may prescribe 0.5 grams of the drug twice a day. It must be said that the daily dosage of Ciprofloxacin cannot exceed 1.5 grams. Typically, the duration of treatment when this disease appears is seven to ten days. Its complicated form is treated for up to four weeks. The described medicine must be taken before meals, washed down with a glass of water. As a rule, the dosage of Ciprofloxacin for sinusitis, as well as the regimen of use, is determined by the doctor strictly individually.

Interaction

The absorption of Ciprofloxacin is slowed down by antacids containing magnesium and aluminum. As a result, the concentration of active components in the blood and urine decreases. Probenecid leads to a delay in drug elimination. Ciprofloxacin can enhance the effect of coumarin anticoagulants. When taking it, you need to reduce the dose of theophylline, since the medicine reduces microsomal oxidation in hepatocytes, otherwise the concentration of theophylline in the blood will increase. Other interaction options:

• when used simultaneously with products containing cyclosporine, a short-term increase in creatinine concentration is observed;
• metoclopramide accelerates the absorption of Ciprofloxacin;
• while taking oral anticoagulants, bleeding time increases;
• While taking Ciprofloxacin, resistance to other antibiotics not included in the inhibitor group does not develop.

Special instructions and precautions

Due to the possible negative effect on the central nervous system, it is not recommended to prescribe an antibiotic to patients with abnormalities in its functioning.

If pain occurs in the tendons, immediate discontinuation of the drug is required. With this symptomatic picture, there is a risk of rupture of tendon tissue or the development of pathological processes.

To prevent the risk of developing crystalluria, patients who have an alkaline urine reaction need to reduce the dosage. If prolonged diarrhea occurs due to prolonged use of an antibiotic, it is necessary to exclude the diagnosis of pseudomembranous colitis.

During the period of medication treatment, it is necessary to limit the time spent in open sunlight, reduce the degree of physical activity and maintain a drinking regime.

In the treatment of severe or protracted infections caused by anaerobic pathogenic microflora, it is recommended to combine Ciprofloxacin with other broad-spectrum antibacterial drugs.

Before treating infectious diseases of the urogenital tract, laboratory tests are required to determine the resistance of the microflora to the selected antibiotic.

Intravenous administration of an antibacterial agent can lead to a local allergic reaction: pain and swelling that appears at the site of the injection solution. This side effect is observed when the solution is administered faster than 30 minutes at a dosage of 200-250 mg. After administration of the drug, the local reaction disappears on its own.

A negative reaction from the central nervous system is observed mainly after the first administration of the drug. Moderate side effects are not an indication for discontinuation of the antibiotic. The exception is convulsions, if they occur, you must immediately stop using the product. It is also necessary to refuse the antibiotic if, after the first use, the patient experiences changes in the psycho-emotional state, especially if suicidal thoughts and depression occur.

If there is a need to administer an antibacterial drug with medications for anesthesia, you should regularly monitor your blood pressure.

Antibiotic therapy should be continued for another 3 days after the main signs of the infectious disease have stopped and body temperature has normalized. After the general condition improves, the use of the injectable form of the antibacterial medication should be discontinued. It is recommended to continue treatment using the tablet form of the drug.

Drug interactions

The absorption of the drug is reduced when it is used in complex therapy with drugs that contain aluminum and magnesium. The drug Probenecid inhibits the elimination of the active component of the antibiotic from the body.

Ciprofloxacin combinations that should be avoided:

1. Drugs that contain the substance cyclosporine increase the amount of creatinine.
2. Metoclopramide accelerates the absorption of the active ingredient into soft tissues.
3. Oral anticoagulants increase the intensity and duration of bleeding.

The simultaneous use of Ciprofloxacin with anticoagulants enhances their therapeutic effect, which requires adjustment of the dosage of medications taken.

Alcohol compatibility

The consumption of alcoholic beverages during the period of antibiotic use must be avoided. The combination of Ciprofloxacin with alcohol will lead to intense side effects.

Effect on reaction

The antibacterial agent can negatively affect the functioning of the central nervous system, causing prolonged headaches, attacks of dizziness and convulsions. If these side effects occur, you must stop driving vehicles and operating complex machinery.

Composition of tablets and dosage

1 tablet contains:

• Active ingredient: ciprofloxacin hydrochloride.
• Additional ingredients: potato or corn starch, lactose, magnesium stearate, crospovidonum, microcrystalline cellulose, talc, hypromellose (Hypromellosum), croscarmellose sodium, colloidal anhydrous silicon dioxide, macrogol 6000, food coloring E171 (titanium dioxide), Tween 80.

Dosage

The tablets are taken before meals. The dosage is prescribed by the doctor depending on the following factors:

1. Severity of the disease;
2. Type of infection;
3. State of the body;
4. Age;
5. Patient weight;
6. Kidney function.

For an uncomplicated infectious process, Ciprofloxacin is prescribed 250 mg 2 times a day. For complicated or severe cases, and for damage to bones or genital organs - 500 mg 2 times a day.

For elderly patients, the dose of Ciprofloxacin may be reduced, depending on the concentration of creatinine (an indicator that evaluates kidney function) in the serum, the type and severity of the disease.

Conventional drug therapy lasts 7-10 days, and in case of severe infection it increases.

Description of action

Ciprofloxacin molecule

Fluoroquinolone, a synthetic chemotherapeutic agent, a derivative of nalidixic acid with a broad antimicrobial spectrum. Intended for oral and parenteral use. It has a bactericidal effect, which depends on the concentration at the site of infection. The mechanism of bactericidal action involves blocking DNA replication by binding to DNA gyrase. Fluoroquinolones have 100 times greater affinity for bacterial gyrase compared to the homologous mammalian enzyme. Antimicrobial activity is enhanced by the cyclopropane ring at position 1, the fluorinated carbon at position 6 and the piperazine ring at position 7. It has a post-antibiotic effect that lasts 1-6 hours for gram-negative bacteria. Antibacterial spectrum: aerobic gram-negative bacteria of the family Enterobacteriaceae, Vibrio, H. influenzae, including strains of β-lactamase and other strains of the Haemophilus family, N. gonorrhoeae, N. meningitidis, M. catarrhalis, Campylobacter, H. pylori (resistant strains arise quickly), P. aeruginosa, Acinetobacter, Mycoplasma (slightly lower activity), Brucella, Chlamydia, Legionella, Mycobacterium fortuitum, Mycobacterium intracellulare, enterokoki (except for Enterococcus faecium) – slightly lower activity; staphylococci, including methicillin-resistant strains, streptococci - the activity of the drug against Streptococcus pneumoniae is insufficient to achieve a therapeutic effect, anaerobic streptococci. Not active against: Xanthomonas (Stenotrophomonas) maltophilia, Burkholderia cepacia, Nocardia, Enterococcus faecium, Ureaplasma, insufficient activity against anaerobic gram-negative bacteria (Bacteroides) and Clostridium difficile bacilli. Ineffective against Treponema pallidum. Well absorbed from the gastrointestinal tract. Bioavailability after oral administration is 70–85%, with higher bioavailability in older adults. tmax – 1–2 hours. 20–30% bound to plasma proteins. Penetrates well into tissues and organs, including inside cells. The concentration in the cerebrospinal fluid is 20% of the concentration in the serum; the concentration in the lung tissue and prostate gland is many times higher than the concentration of the antibiotic in the serum. Penetrates through the placenta and into breast milk (75% of the serum concentration). Following oral administration of 500 mg at 12-hour intervals, the AUC was the same as following 400 mg ciprofloxacin intravenous infusion over 60 minutes at the same interval. t1/2 is 4–7 hours, in case of renal failure it is extended to 12 hours. Metabolized in the liver to 4 metabolites, approximately 18% of the drug is converted. Moderately inhibits the CYP1A2 isoenzyme. It is excreted from the body unchanged (about 45% by the kidneys with urine, 25% with feces) and in the form of metabolites (about 11% with urine, 8% with feces).

Overdose

You should use the antibiotic Ciprofloxacin with caution. The instructions for use state that taking the drug in an increased dosage may lead to the development of side effects

First of all, the patient may feel symptoms of poisoning. Signs of an overdose are dizziness and nausea. This condition is treated in a hospital setting. The patient's stomach is washed and his well-being is monitored. If necessary, symptomatic therapy is carried out.

A large amount of fluid helps remove toxins from the body in case of overdose. The patient should drink plenty of mineral water or unsweetened tea. Small amounts of ciprofloxacin can be eliminated by peritoneal dialysis.

Indications for use

Ciprofloxacin, the instructions for use of which define the indications, is prescribed to treat and prevent infections and inflammations that are caused by susceptible bacteria.

Diseases for which this drug is prescribed include:

• bronchitis;
• frontal sinusitis;
• sinusitis;
• sinusitis;
• pyelonephritis;
• cystitis;
• adnexitis;
• gonorrhea.

The drug can also be used by children over 5 years old. Ciprofloxacin should be taken systematically by children. This drug is prescribed to young patients with cystic fibrosis of the respiratory organs in the treatment of complications caused by Pseudomonas aeruginosa and to prevent anthrax in the pulmonary form.

Depending on the form of the drug, the prescription may vary, for example:

• in liquid form, Ciprofloxacin can be used in the treatment of eye infections and sepsis;
• the solid form is prescribed when it is necessary to carry out selective decontamination of the intestines;
• drops are used to prevent infectious inflammations such as blepharitis, meibomitis, conjunctivitis, dacryocystitis.

pharmachologic effect

The drug Ciprofloxacin is widely used in medicine today. Is it an antibiotic or not, and we’ll find out further. The medicine, which is available in the form of tablets and also a solution for injection, belongs to the group of broad-spectrum antimicrobial drugs. The main active ingredient inhibits protein synthesis of pathogenic microorganisms. As a result, bacteria stop reproducing. Soon they die. In many cases, the drug Ciprofloxacin can be used. A group of antibiotics from this series has high activity against almost all gram-positive bacteria, as well as microorganisms that produce beta-lactamases.

The tablets are absorbed quite quickly from the gastrointestinal tract. When an antibacterial drug is used orally, its bioavailability is 75%. The intake of medicine may be affected by food intake. Therefore, experts recommend using the tablets on an empty stomach or an hour after meals. The main active component is distributed in body fluids and tissues. The highest concentration of ciprofloxacin is observed in bile. The drug is excreted in the urine.

Pharmacological properties

The antibiotic Ciprofloxacin shows high effectiveness against gram-negative, gram-positive, anaerobic and aerobic bacteria.

The mechanism of action is the inhibition of pathogenic microflora by the active DNA component. Ciprofloxacin has the ability to penetrate the skin, lymphatic fluid and plasma, muscle and soft tissue.

The degree of bioavailability is 70%. There is no connection between the effectiveness of the medication and food intake. The active substance of the drug is evenly distributed throughout the soft tissues and is found in the cerebrospinal fluid. It is excreted from the body in bile and urine.

Price and analogues

The cost of the product is on average about 40 rubles. The price depends on the pharmacy chain, manufacturer and volume of the bottle and varies for a five-milliliter bottle from 8 to 95 rubles. You can buy a bottle of 10 milliliters for an average of 30 rubles (from 20 to 42).

There are quite a lot of direct analogues of the active substance. Here is a partial list of them: “Ciprofloxacin-Teva”, “Ciprofloxacin-Solopharm”, “Ciprofloxacin-AKOS”, “Ciprolet”, “Tsipromed”, “Ciprodox”, “Cyclosan”, “Cipropharm”, “Ciprophthalm”, “Ificipro” " and others. There are products with a similar effect, but with different active ingredients. The main substance can be from the fluoroquinolone group or from other groups. But the pharmacological effect of these analogues is the same as that of ciprofloxacin: bactericidal and antibacterial.

A replacement can be sought among the following medications: Levofloxacin, Floxal, Vigamox, Norfloxacin, Albucid, Sodium Sulfacyl, Ofloxacin, Vitabact. You can try to replace it with antiseptics “Oftadek”, “Conjunctin”, “Okomistin” or combined solutions “Tobramycin”, “Maxitrol”.

The decision to replace the medicine necessary for treatment is made only by the ophthalmologist. This may be required if the pathogenic microflora is resistant to this active substance. Following the doctor's recommendations will allow you to get rid of the disease without consequences for your health.

Medicine from the company Teva

The antibiotic "Ciprofloxacin Teva" is a broad-spectrum antimicrobial agent from the group of fluoroquinolones. The main component of this type of medicine is also ciprofloxacin, which is in the form of hydrochloride monohydrate. Excipients include microcrystalline cellulose along with povidone, croscarmellose sodium, colloidal silicon dioxide and magnesium stearate.

The drug is used for infectious and inflammatory diseases caused by microorganisms sensitive to it. For example, it is used against the background of diseases of the respiratory system, otolaryngological system, for problems with the kidneys and urinary tract, as well as in case of infection of the genital organs, digestive system, skin, soft tissues, and so on.

Adverse reactions

Incorrect use of Ciprofloxacin 500 mg tablets can negatively affect the functioning of the entire body. In such a situation, the following adverse reactions may occur:

1. Digestive system: diarrhea, flatulence, nausea, characteristic abdominal pain, cholesterol jaundice, vomiting, hepatitis, anorexia, hepatonecrosis.
2. Central nervous system: nightmares, dizziness, sleep disturbance, depression, increased intracranial pressure, cerebral artery thrombosis, hallucinations, fatigue, peripheral paramnesia, nightmares.
3. Urinary system: crystalluria, urinary retention, albuminuria, urethral bleeding, polyuria, urinary retention.
4. Cardiovascular system: tachycardia, arterial hypotension, flushing of the facial skin, bradycardia.
5. Hematopoietic system: thrombocytopenia, hemolytic anemia, leukopenia, leukocytosis.
6. Laboratory tests: hyperglycemia, increased levels of liver transaminases, hyperglycemia, hypoprothrombinemia.
7. Arthritis, tendon rupture, arthralgia, myalgia, vasculitis, general weakness, candidiasis, pseudomembranous colitis.
8. Local reactions: general pain, phlebitis, hyperemia.
9. Allergic manifestations: urticaria, facial swelling, shortness of breath, drug fever, pinpoint hemorrhages, erythema nodosum, Quincke's edema.

Side effects

Systemic application

• digestive system: nausea/vomiting, diarrhea, flatulence, abdominal pain, loss of appetite and decreased volume of food eaten, cholestatic jaundice (especially in patients with a history of liver disease), hepatitis, hepatonecrosis;
• nervous system: headache, dizziness, migraine, anxiety, fatigue, tremor, severe dreams (nightmares), insomnia, peripheral paraalgesia, hyperhidrosis, cerebral artery thrombosis, increased intracranial pressure, fainting, depression, confusion, hallucinations, other manifestations psychotic reactions, rarely progressing to states in which the patient is capable of harming himself;
• sense organs: disturbances of smell and taste, visual disturbances (changes in color perception, diplopia), noise and ringing in the ears, hearing impairment up to its loss;
• cardiovascular system: heart rhythm disturbances, tachycardia, decreased blood pressure; for the solution additionally – vasodilation, benign intracranial hypertension, cardiovascular collapse;
• hematopoietic system: anemia, leukopenia, thrombocytopenia, granulocytopenia, leukocytosis, hemolytic anemia, thrombocytosis, inhibition of bone marrow hematopoiesis, pancytopenia;
• laboratory parameters: increased activity of liver enzymes, hyperglycemia, hypoglycemia, hypoprothrombinemia, hyperbilirubinemia, hypercreatininemia;
• urinary system: crystalluria, hematuria, glomerulonephritis, urinary retention, dysuria, polyuria, albuminuria, urethral bleeding, interstitial nephritis, decreased nitrogen excretory function of the kidneys;
• musculoskeletal system: arthritis, arthralgia, tendovaginitis, myalgia, tendon ruptures;
• hypersensitivity reactions: shortness of breath, urticaria, itching, increased photosensitivity, angioedema, blisters (accompanied by bleeding), small nodules (forming scabs), petechiae (point hemorrhages on the skin), drug fever, swelling of the face/larynx, eosinophilia, vasculitis, nodular erythema, exudative erythema multiforme (including Stevens-Johnson syndrome), Lyell's syndrome (toxic epidermal necrolysis);
• other reactions: superinfections (including candidiasis), asthenia, flushing of the face;
• local reactions (for solution): swelling, pain and phlebitis at the injection site.

If the above worsens or any other adverse reactions not listed in the instructions occur, you should consult a doctor.

Local application

• hypersensitivity reactions: burning and itching, hyperemia and slight soreness of the conjunctiva (when instilled into the eyes) or in the area of ​​the outer ear and eardrum (when instilled into the ear), the development of superinfection;
• other reactions (when instilled into the eyes): nausea, unpleasant taste in the mouth immediately after instillation, photophobia, swelling of the eyelids, lacrimation, sensation of a foreign body in the eye, decreased visual acuity, white crystalline precipitate (formed in patients with corneal ulcers), keratopathy , keratitis, formation of corneal spots/infiltration of the cornea.

Directions for use and dosage

The treatment regimen is determined by the type and severity of the infection. Ciprofloxacin - instructions for its use indicate 3 methods of use. The drug can be used externally, internally or by injection. Dosage is also affected by kidney function, and sometimes by age and body weight. For older people and children it is much lower. Tablets are taken orally; it is recommended to do this on an empty stomach. Injections are used in more severe cases to make the drug work faster. According to the instructions, before prescribing, a test is performed to determine the sensitivity of the pathogen to the medication.

Ciprofloxacin tablets

For an adult, the daily dose ranges from 500 mg to 1.5 g. It is divided into 2 doses at intervals of 12 hours. To prevent crystallization of salts, the antibiotic is washed down with plenty of liquid (most importantly, not milk). Treatment lasts until the symptoms of the infectious disease are completely relieved and for a couple of days after. The average duration of treatment is 5-15 days. According to the instructions, therapy is extended to 2 months for osteomyelitis, and to 4-6 weeks for lesions of bone tissue and joints.

Drops

The ophthalmic drug is instilled 1-2 drops into the conjunctival sac of the affected eye every 4 hours. According to the instructions, for more severe infections, use 2 drops. To treat otolaryngology diseases, the medicine is instilled into the ears, after first cleaning the external auditory canal. Use a dosage of 3-4 drops up to 4 times throughout the day. After the procedure, the patient needs to lie down for a couple of minutes on the opposite ear to the sore ear. Duration of therapy is from 7 to 10 days.

Ointment

Eye ointment is placed in small quantities behind the lower eyelid of the affected eye several times throughout the day. This form of release is not so widespread, because there are drops. It is produced by only one plant - OJSC Tatkhimfarmpreparaty. For this reason and due to ease of use, eye drops are often used rather than ointment.

Ciprofloxacin intravenously

The solution is administered as an intravenous infusion. For an adult patient, Ciprofloxacin in ampoules is prescribed by dropper with a daily dosage of 200-800 mg. For lesions of joints and bones, 200-400 mg is administered twice a day. Treatment lasts approximately 7 to 10 days. Ampoules of 200 ml are prescribed intravenously for administration over half an hour, and 400 ml - over an hour. They can be combined with sodium chloride solution. Ciprofloxacin injections for intramuscular administration are not prescribed to patients.

Russian analogues of the drug

There are both exact substitutes for Ciprofloxacin, which have the same active ingredient, and analogues of the drug, similar in their mechanism of action in the body, affecting the same microbes, but differing in composition.

Complete analogues of "Ciprofloxacin" in tablets are:

• "Ciprolon";
• "Vero-Ciprofloxacin";
• "Ciprobax";
• "Ciflox-Alium";
• "Ecocifol".

In the form of a solution for droppers, domestic manufacturers produce only drugs under the names:

• "Ciprofloxacin";
• "Ciprofloxabol."

Domestic drops used in the treatment of infectious lesions of the organs of vision and hearing:

• "Betaziprol";
• "Ciprofloxacin-Acos".

Drugs that differ from Ciprofloxacin in the active substance, but have similar properties, are widely used in the treatment of various infectious diseases:

• "Oflox";
• "Tariferid";
• "Lofox";
• "Ecolevid";
• "Leflobakt";
• "Zarquin";
• "Moxifloxacin Canon";
• "Aquamox."

It is well known that Russian analogues have a lower price. But, as experts note, domestic drugs are less readily purified from harmful impurities, and therefore, when used in treatment, undesirable hypersensitivity reactions and side effects occur more often.

Side effects

Taking pills can disrupt the functioning of various body systems:

Musculoskeletal:

1. Myalgia (pain in the muscle area);
2. Tenosynovitis (inflammation of the tendon and its surrounding membrane);
3. Arthralgia (joint pain).

Blood:

1. Thrombocytosis (increased number of platelets in the blood);
2. Anemia (low hemoglobin);
3. Tachycardia (increased heart rate to 90 beats per second);
4. Arrhythmia (sinus rhythm disorder);
5. Decreased blood pressure.

Gastrointestinal tract (gastrointestinal tract):

1. Nausea;
2. Vomit;
3. Diarrhea;
4. Constipation;
5. Dry mouth;
6. Stomach ache;
7. Hepatitis.

Genitourinary:

1. Vaginitis (inflammation of the vaginal mucosa);
2. Hemorrhagic cystitis (damage to the bladder);
3. Acidosis (displacement of acid-base balance);
4. Frequent or difficult urination.

Respiratory:

1. Bronchospasm (narrowing of the bronchi);
2. Dyspnea (shortness of breath);
3. Embolism (thromboembolism) of the pulmonary artery.

Nervous:

1. Dizziness;
2. Depression;
3. Pain in the eyes;
4. Hallucinations;
5. Noise in ears;
6. Confusion (twilight confusion).

Allergic reaction:

1. Urticaria (nettle fever, nettle rash);
2. Quincke's edema;
3. Rash;
4. Skin irritation;
5. Anaphylactic shock (anaphylaxis).

Does Ciprofloxacin cause fungus?

Among the pharmacological features of Ciprofloxacin is the possible appearance of fungus (vaginal fungus) as a result of antibiotic treatment. Quite a lot of patients who received this drug complain about similar consequences from taking it.

The explanation for this side effect is the so-called fungal superinfection - as a result of the destruction of beneficial microorganisms with protective functions in the vagina. The fungus can also appear in the oral cavity.

Consult your doctor about taking Ciprofloxacin in parallel with another drug or herbs to reduce the risk of fungi.

Does Ciprofloxacin harm bones?

Ciprofloxacin is recommended for the treatment of bone and joint infections, so their condition should not worsen when taken. But some adults sometimes complain of joint pain, especially if they were also taking corticosteroids.

Similar complaints have been reported in children. Among the undesirable side effects, such as pain in bones and joints, a clear recommendation is given - if the drug has such an effect, stop treatment with Ciprofloxacin. This antibiotic, in the long term, can cause joint inflammation, changes in muscle function, and muscle spasms.

Possible damage to the musculoskeletal system also includes inflammation of the tendons, and even rupture, most often the Achilles tendon.

Bloating from Ciprofloxacin

Deviations in the functioning of the gastrointestinal tract, often encountered negative consequences of Ciprofloxacin. Especially with long-term therapy, usually with chronic cystitis. Bloating is one of these problems - the whole range of unpleasant sensations is possible - stomach discomfort, nausea, vomiting, heartburn, diarrhea.

Medical sources also mention data about colitis, which develops after the use of Ciprofloxacin. The appearance of such symptoms is a sign that you need to stop taking the drug and consult a doctor about further treatment of cystitis.

This doesn't necessarily happen to you. You may be among the lucky ones who do not experience any side effects from Ciprofloxacin, which means you can safely continue treatment.

Can I take ciprofloxacin during pregnancy and breastfeeding?

pregnancy, lactation, breastfeeding of a child, a physiological barrier between the circulatory system of the mother and the fetus, the occurrence of various deformities and malformations in the fetus, a negative effect on DNA, which leads to various mutations, toxic effects on fetal tissue during intrauterine development. Negative effects of ciprofloxacin on the fetus

has arthrotoxicity

Analogues, price and storage conditions

In the pharmacy chain, the drug is sold only by prescription. The packaging indicates the expiration date and date of manufacture of the medicine. Each pack comes with instructions for use.

The drug should be stored at room temperature. The storage location should be dry and dark, out of the reach of children. It is not recommended to store the solution in the refrigerator or freeze it, since under the influence of low temperatures a soluble precipitate forms in the vials.

The shelf life of the drug depends on the form of release and the manufacturing company and ranges from 2 to 5 years. An opened bottle of ear drops is stored for no more than 4 weeks; for eye drops this period is 2 weeks.

Analogs of "Ciprofloxacin" in chemical structure and pharmacological effects are:

• Tablets “Procipro”, “Ciprinol”, “Quintor”, “Tseprova”, “Ciprobid”, “Tsiprobay”, “Tsiprolet”, “Ciprodox”, “Cifran”, “Cipropan”, “Ciprofloxacin Teva”.
• infusion solutions “Ificipro”, “Basijen”, “Procipro”, “Tsiprova”, “Quintor”, “Ciprinol”, “Ciprobid”.
• Drops “Rocip”, “Tsiprolet”, “Tsipromed”, “Betatsiprol”, “Tsiprolon”.

The average cost of a package of 500 mg tablets is 40 rubles. The price of Ciprofloxacin in the form of eye drops ranges from 20-25 rubles.

Possible drug overdose

There have been no cases of overdose with Ciprofloxacin, so there is no data on this matter. If there is a possible allergic reaction (or intolerance to the components of the drug), you should stop taking it. Ciprofloxacin is considered the “gold standard” in the antibiotic market. Ciprofloxacin tablets are included in Russian and foreign clinical recommendations, such as the US Society of Infectious Diseases, the Russian Society of Pulmonologists, the Alliance of Clinical Chemotherapists and Microbiologists and others.

ABVA RUS company cares about the safety of its drugs and the health of consumers. Following the ethical principles and requirements of the legislation of the Russian Federation, ABVA RUS JSC collects and analyzes information about side effects. REPORT SIDE EFFECTS

Ciprofloxacin. Brief instructions for use

Ciprofloxacin tablets should be swallowed whole with a small amount of liquid. On an empty stomach or after a meal. When taking Ciprofloxacin tablets on an empty stomach, the active substance is absorbed faster. The instructions for use of Ciprofloxacin tablets indicate the following recommended dosages and dosage regimens:

• For mild to moderate lower respiratory tract infections, take 0.5 grams 2 times a day. For the same severe infections - 0.75 grams 2 times a day. The course of treatment is 7-14 days.
• For acute sinusitis, you should take 0.5 grams 2 times a day. The course of treatment is 10 days.
• For mild to moderate infections of the skin and soft tissues, you should take 0.5 grams 2 times a day, for severe infections - 0.75 grams 2 times a day. The course of treatment is 7-14 days.
• For infections of bones and joints, you should take Ciprofloxacin: for mild and moderate cases - 0.5 grams 2 times a day, for severe cases - 0.75 grams 2 times. The course of treatment is up to 4-6 weeks.
• For uncomplicated urinary tract infections, you should take 0.25-0.5 grams 2 times a day. The course of treatment is 7-14 days; for complicated urinary tract infections, 0.5 grams should be taken every 12 hours for 7-14 days.
• For chronic prostatitis, you should take 0.5 grams 2 times. The course of treatment is 28 days.
• For uncomplicated gonorrhea, take 0.25 grams once.
• For severe acute intestinal infections (salmonellosis, shigellosis, campylobacteriosis, etc.), you should take Ciprofloxacin 0.5 grams 2 times. The course of treatment is 5-7 days.
• For typhoid fever, you should take 0.5 grams 2 times. The course of treatment is 10 days.
• For complicated intra-abdominal infections, take 0.5 grams every 12 hours. The course lasts 7-14 days.
• For the prevention and treatment of pulmonary anthrax, you should take 0.5 grams 2 times a day for 60 days.
• In patients with immunodeficiency, treatment is prescribed depending on the severity of the infection and the type of pathogen. Therapy is carried out throughout the entire period of neutropenia.
• For patients with chronic renal failure: when creatinine clearance (CC) is more than 50 ml/min, no dose adjustment is required. With CC 30-50 ml/min, you should take 0.25-0.5 grams every 12 hours. With CC 5-29 ml/min, 0.25-0.5 g should be taken every 18 hours. If the patient is undergoing hemodialysis or peritoneal dialysis, it is necessary to take 0.25-0.5 grams per day, the drug should be taken after the hemodialysis session.

For what pathologies is it prescribed?

pathogenic Use of ciprofloxacin

Description of the drug

Ciprofloxacin is a broad-spectrum eye drop. Antimicrobial and antibacterial action is based on the content of an antibiotic, which is effective against many groups of pathogens. They have a number of advantages:

• low cost;
• availability and dispensing without a prescription;
• rapid suppression of pathogenic microflora;
• minimal number of side effects.

The drug in drops is easy to dose, so it is recommended for treatment at home. In severe cases of the disease, it can be combined with the simultaneous use of antibiotic tablets.

Therapy of eye diseases

To treat diseases affecting the organs of vision, the doctor prescribes Ciprofloxacin eye drops by writing a prescription. To compose an application to a pharmacy, only Latin is used:

1. Rp: Sol. Ciprofloxacini 0.3% – 5.0.
2. DTD No. 1 in flac.
3. S. 2 drops 4 times a day in each eye. The course of treatment is 5 days.

This antibacterial agent is used in ophthalmology to eliminate inflammation affecting the eyes.

Ciprofloxacin is effective in combating diseases such as:

1. Keratitis.
2. Blepharitis.
3. Conjunctivitis.
4. Bacterial corneal ulcer.
5. An infection that affects the eyes as a result of injury or a foreign body.

The dosage regimen and procedure schedule are determined depending on the severity of the inflammatory process and the stage of development of the disease.

In the presence of an inflammatory process of mild to moderate severity, drops are used every 4 hours for 5-7 days. If the disease is severe, you will need to use the eye composition every 2 hours. The drop is applied to the cornea from the outer corner of the eye. Excess is carefully blotted with a sterile napkin, avoiding sudden movements and pressure on the eyeball.

Contraindications to the use of Ciprofloxacin are individual intolerance to the components or active substance of the drug, viral keratitis, and the age of the young patient from 0 to 12 months. During treatment, side effects may occur, such as itching and burning in the eyes, photophobia, tearing or dry mucous membranes.

Application in medicine

Ciprofloxacin is used to treat a variety of infectious problems, including bone and joint infections, endocarditis, gastroenteritis, malignant otitis externa, respiratory tract infections, loose tissue inflammation, urinary tract infections, prostatitis, anthrax, and chancroid.

Ciprofloxacin only treats bacterial infections, it does not treat viral infections such as the common cold. Although for some uses, including acute sinusitis, lower respiratory tract infections, and uncomplicated gonorrhea, ciprofloxacin is not considered a first-line agent.

This antibiotic figures prominently in treatment guidelines issued by major medical societies for serious infections, particularly those that may be caused by gram-negative bacteria, including Pseudomonas aeruginosa. For example, in combination with metronidazole, ciprofloxacin is one of several first-line antibiotic agents recommended by the Infectious Diseases Society of America for the treatment of community-acquired abdominal infections in adults. It also figures prominently in treatment guidelines for acute pyelonephritis, complex or nosocomial urinary tract infection, acute or chronic prostatitis, certain types of endocarditis, certain skin infections, and prosthetic joint infections.

In other cases, treatment guidelines are more stringent, recommending in most cases that older, narrower-spectrum drugs may be used as first-line therapy for less severe infections to minimize the development of fluoroquinolone resistance. For example, the Infectious Diseases Society of America recommends that the use of ciprofloxacin and other fluoroquinolones for urinary tract infections be reserved for cases of proven or suspected resistance to narrow-spectrum drugs, including nitrofurantoin or trimethoprim-sulfamethoxazole. According to the recommendations of the European Association of Urology, ciprofloxacin can be used as an alternative for uncomplicated urinary tract infections, however, the potential for adverse events should be taken into account.

Although ciprofloxacin is approved by regulatory authorities for the treatment of respiratory infections, it is not recommended for respiratory infections in most treatment guidelines, in part due to its modest activity against the common respiratory pathogen pneumococcus. Respiratory quinolones, such as levofloxacin, which have greater activity against this pathogen, are recommended as first-line agents for community-acquired pneumonia in patients with important comorbidities and in patients requiring hospitalization (Infectious Diseases Society of America, 2007). Similarly, ciprofloxacin is not recommended as a first-line agent for acute sinusitis.

Ciprofloxacin is approved for the treatment of gonorrhea in many countries, but this recommendation is widely considered outdated due to the development of resistance.

Available forms

Ciprofloxacin for systemic administration is available as immediate-release tablets, extended-release tablets, oral suspension, and intravenous solution. It is also available for topical administration in the form of eye drops and ear drops.

Pregnancy

The FDA classifies ciprofloxacin in pregnancy category C. This category includes drugs for which there are no adequate and well-controlled human studies in pregnancy and for which animal studies have shown potential for harm to the fetus, but the potential benefits may warrant use of the drug in pregnant women despite the potential risks. The Teratogen Information System's review of published data on experience with the use of ciprofloxacin in pregnancy concluded that therapeutic doses during pregnancy are unlikely to pose a significant teratogenic risk (quantity and quality of evidence = fair), but the data are insufficient to support a statement that there is no risk.

Two small post-marketing epidemiological studies of mostly short-term exposure in the first trimester found that fluoroquinolones did not increase the risk of major malformations, spontaneous abortion, preterm birth, or low birth weight. However, it is noted that these studies are insufficient to reliably assess the definitive safety or risk of less common defects from ciprofloxacin in pregnant women and the developing fetus.

Breast-feeding

Fluoroquinolones have also been reported to be present in mother's milk and transmitted to breastfed infants. The FDA recommends that because of the risk of serious adverse reactions (including joint damage) for breastfed infants whose mothers are taking ciprofloxacin, a decision should be made whether to stop feeding or discontinue the medication based on its implications for the mother.

Children

Oral and intravenous ciprofloxacin is approved by the FDA for use in children for only two indications due to the risk of chronic musculoskeletal injury:

1. Pulmonary anthrax (after exposure)
2. Complicated urinary tract infections and pyelonephritis due to E. coli, but not as first-line drugs. Current American Academy of Pediatrics guidelines note that systemic ciprofloxacin administration in children should be limited to infections caused by drug-resistant pathogens or when safe or effective alternatives are not available.

Medicinal properties

The antibiotic Ciprofloxacin has pronounced antimicrobial and bactericidal properties. Particularly active against gram-negative and gram-positive microorganisms. This group includes:

• Pseudomonas aeruginosa;
• Haemophilus influenzae;
• Escherichia coli;
• Shigella spp;
• Salmonella spp;
• Neisseria meningitidis;
• N. gonorrhoeae.

The drug is also active against strains of Staphylococcus spp. and Enterococcus spp. The group of fluoroquinolone antibiotics to which the drug belongs has a detrimental effect on microbes that produce beta-lactamases.

Its big advantage is that it takes a very long time for bacteria to develop resistance to the component. The following group of microorganisms is resistant to the action of Ciprofloxacin:

• Streptococcus faecium;
• Ureaplasma urealyticum;
• Nocardia asteroides;
• Treponema pallidum.

The mechanism of action of the drug is determined by the suppression of DNA - gyrase of microorganisms. In this case, DNA synthesis is disrupted, and the growth and division of bacteria stops.

Ciprofloxacin has antimicrobial and bactericidal properties.

What else is the drug used for?

Ciprofloxacin is prescribed for infectious diseases caused by microorganisms sensitive to this drug. These include:

• damage to the respiratory system;
• disease of the middle ear, paranasal sinuses;
• infection of the kidneys and ureteral canals;
• lesions of the skin and soft tissues;
• infection of joints and bone base;
• diseases of organs located in the pelvic area;
• gonorrhea;
• diseases of the gastrointestinal system;
• infectious diseases in people with weak immunity.

When to use the medicine

Ciprofloxacin is prescribed for bacterial infections affecting various organs. Indications for use of tablet form and injections:

• inflammation of the lower respiratory tract (bronchitis, pneumonia);
• pathologies of the ENT organs - otitis, sinusitis;
• diseases of bones, joints, muscle tissue;
• pathologies of the genitourinary system (including gonorrhea and prostatitis);
• gynecological diseases, including postpartum infections;
• inflammation of the gastrointestinal tract;
• dental;
• biliary tract.

Treatment with Ciprofloxacin is indicated for complex co-infections with bacterial groups that are resistant to many antibiotics.

What external remedies (drops and ointment) can be used for:

• blepharitis;
• conjunctivitis;
• keratitis;
• chronic dacryocystitis;
• corneal ulcerations;
• post-traumatic treatment;
• prophylaxis before surgery.

Drops in otolaryngology are used in the treatment of otitis media, for instillation into the ear canals.

Side effects from the use of the drug

Ciprofloxacin 500 tablets are, first of all, an antibiotic, and therefore patients cannot avoid negative reactions from the functioning of various body systems:

• The skin and subcutaneous tissue may react with erythema multiforme and erythema nodosum.
• On the part of the heart and blood vessels, a prolongation of the QT interval is possible, ventricular arrhythmia (including pirouette type), the development of vasculitis, as well as the appearance of hot flashes, migraines and fainting cannot be excluded.
• The liver and digestive system as a whole usually react with flatulence, and anorexia may occur.
• Especially many side effects occur from the psyche and nervous system. For example, intracranial hypertension is possible along with insomnia, agitation, tremor, and in rare cases, peripheral sensitivity disorders are observed. Among other things, sweating may occur in combination with paresthesia, impaired coordination and gait. Attacks of seizures are also possible along with feelings of fear and confusion, nightmares, depression, hallucinations, disturbances of taste and smell, visual disturbances (diplopia), tinnitus, temporary hearing loss, and so on. If such reactions are detected, you should immediately discontinue this drug and notify your doctor.
• The hematopoietic system reacts to taking this antibiotic with thrombocytopenia, very rarely leukocytosis, thrombocytosis, hemolytic anemia, agranulocytosis, pancytopenia (life-threatening), bone marrow suppression.
• Allergic and immunopathological reactions include drug fever, as well as photosensitivity, rarely bronchial spasms, anaphylactic shock, myalgia, interstitial nephritis and hepatitis.
• The musculoskeletal system responds to the use of this medication with arthritis, increased muscle tone, and cramps. Very rarely, weakness may occur in combination with tendonitis, tendon ruptures and exacerbation of myasthenia gravis symptoms.
• The respiratory organs react with shortness of breath (including asthmatic conditions).
• As part of general well-being, asthenia may be observed along with fever, edema, sweating (hyperhidrosis), and so on.
• It is possible, among other things, to influence laboratory parameters in the form of hyperglycemia, changes in prothrombin concentration, increased amylase activity, and the like.

Ciprofloxacin: adverse reactions and overdose

Each body reacts differently to a particular medicine. Negative phenomena may occur in one or more organs. Most often, side effects from Ciprofloxacin occur from:

• CNS - headaches, sleep disturbances, anxiety, fatigue, excessive sweating, disturbance of consciousness;
• heart and blood vessels - rapid heartbeat, surges in blood pressure, hot flashes;
• sensory organs - impaired taste and smell, deterioration of hearing and vision;
• Gastrointestinal tract - nausea accompanied by vomiting, flatulence, diarrhea, epigastric pain;
• musculoskeletal system and muscles - arthritis, myalgia, tendovaginitis;
• hematopoiesis - anemia, leukopenia, thrombocytosis;
• genitourinary system - dysuria, polyuria, urine retention, urethral bleeding;
• allergic manifestations - hives, redness, peeling and itching, swelling of the skin.

This is interesting! How to take Amiksin tablets: instructions for use

Overdose

There are no characteristic signs of overdose; excessive intake can provoke any of the above. If symptoms not related to the disease appear, you should stop taking it and consult a doctor . In case of overdose, emergency detoxification is carried out, then maintenance therapy is prescribed.

Ciprofloxacin has a number of side effects.

Treatment regimen for adults and children

The drug is indicated for use in adults and children over 15 years of age. For pneumonia, a tablet or injection form of the drug is prescribed.

The drug is taken orally at a dose of 250-500 mg twice a day, the course of treatment is a week. After all negative symptoms have been removed, the drug should be taken for another 3 days as a prevention of relapse of the disease.

When prescribing injections of Ciprofloxacin, 200 mg of the drug is administered twice a day. The course of treatment is from a week to two.

IMPORTANT! Despite the fact that fluoroquinolones are low-toxic, they are strictly prohibited in pediatric practice, since they have a negative effect on the development of the musculoskeletal system in children.

Peculiarities

It is very important to take into account that the bacterial form is constantly subject to mutation processes and adapts to antibacterial agents. Therefore, when prescribing Ciprofloxacin, it is necessary to check the resistance of specific pathogens to this drug.
To do this, it is necessary to culture sputum or nasal lavages in order, firstly, to identify the pathogen, and secondly, to make sure that it is not resistant to Ciprofloxacin. Advanced forms of the disease, which are severe and with complications, are best treated with intravenous infusions.

It is important to remember that any antibacterial agent destroys not only pathogenic microflora, but also beneficial bacteria. To avoid the development of dysbiosis during antibacterial therapy, it is necessary to take Bifidumbacterin, Linesk, and also eat fermented milk products enriched with live bacteria.

If you are prone to allergic reactions, it is recommended to take antihistamines prescribed by your doctor simultaneously with Ciprofloxacin. Self-prescription of the drug is unacceptable, since it has a number of serious contraindications and side effects.

IMPORTANT! While taking Ciprofloxacin, drinking alcohol is prohibited!

If the patient has a history of any pathology of the central nervous system, it is not recommended to prescribe the drug, since its use will lead to a number of undesirable side effects.

In old age, treatment of pneumonia with Ciprofloxacin should be carried out with caution. The reason for stopping the drug may be pain in the tendons.

Analogs

Analogues of the drug:

• Ciprodox;
• Tseprova;
• Promed;
• Basijen;
• Inficipro;
• Procipro;
• Ecofitsol.

Similar in mechanism of action:

• Nolitsin;
• Oflocid;
• Gatispan;
• Maximak;
• Zanotsin;
• Ivacin;
• Abaktal;
• Eleflox;
• Levotek;
• Levofloxacin.

The shelf life of the medicinal product from the date of release is 2 years. It is recommended to store the drug in a dark and dry place, maintaining the integrity of the packaging. Only the attending physician can prescribe this remedy. To avoid side effects, you must strictly adhere to the dosage and course prescribed by your doctor.

Indications, contraindications and restrictions on use

Ciprofloxacin injections are prescribed in the following cases:

• neutropenia, which is accompanied by immunodeficiency states;
• inflammatory and infectious diseases of the lower and upper respiratory systems;
• prostatitis of bacterial nature;
• damage to the urinary system by an infectious pathogen;
• diseases of the gastrointestinal tract;
• hospital-acquired pneumonia, which occurred due to artificial ventilation of the lungs;
• diarrhea caused by infection in the digestive tract;
• acute and chronic conjunctivitis;
• meibomite;
• septic type arthritis;
• urogenital infections;
• blepharitis, keratitis;
• infections of the skin, soft, joint and bone tissues.

Ciprofloxacin helps prevent infection after surgery. Prophylactic use of an antibiotic is recommended to prevent infections in patients with immunocompromised conditions.

The use of an antibacterial agent is prohibited in the presence of the following conditions:

• individual intolerance to the active ingredient;
• pregnancy;
• tendon diseases;
• breastfeeding period;
• cystic fibrosis;
• age up to 18 years.

Antibiotic injections are prescribed with extreme caution if there are abnormalities in the functioning of the kidneys and liver; dosage adjustments and regular monitoring of laboratory parameters are also required. Relative contraindications to the use of the drug: cerebral atherosclerosis, cerebrovascular accident, mental disorders, epilepsy

During pregnancy and breastfeeding

Ciprofloxacin penetrates the placental barrier and may therefore pose a threat to the normal formation and development of the fetus. Taking antibiotics during the entire period of pregnancy is strictly prohibited.

Since the active ingredient is excreted from a woman’s body through breast milk, the drug cannot be used during lactation. If there is an urgent need to take Ciprofloxacin during this period, the newborn is transferred to artificial feeding.

For liver and kidney dysfunction

Since Ciprofloxacin is excreted from the body through the kidneys, patients with abnormalities in the functioning of the organ need to adjust the dosage of the medication downward. There is a possibility of developing crystalluria. To prevent the development of side effects, exceeding the dose prescribed by the doctor is strictly prohibited. While using Ciprofloxacin, you must drink plenty of fluids to maintain acidic urine reactions.

Administration of an antibiotic to patients with impaired liver function increases the risk of necrosis of the soft tissues of the organ and the development of severe liver failure. If symptoms such as itching, urticaria, jaundice, or abdominal pain occur, the use of the antibiotic should be discontinued immediately.

In childhood

There is no data on the safety of the use of antibacterial drugs by persons under 18 years of age. In pediatrics (children over 5 years old), the medicine can be prescribed in exceptional cases if there is a risk of anthrax infection.

Use in elderly patients

Old age is a relative contraindication to the use of antibiotics, which requires extremely careful use due to the high risks of side effects, especially from the liver and kidneys. The dosage is selected individually depending on the patient’s health condition

Additional Information

The medicine is not intended for injection or eye washing. If simultaneous use with other medicinal drops is recommended, an interval of at least 10–15 minutes should be maintained. During the first day, it is necessary to carefully monitor the manifestation of allergies.

When instilling Ciprofloxacin, it is recommended to temporarily stop wearing contact lenses. Some patients add them to storage solutions for conjunctivitis to disinfect. Drivers should be careful: in rare cases, blurred vision may occur.

Overdose

There are no reported cases of overdose with Ciprofloxacin drops: the antibiotic concentration is only 0.3% per vial. If you accidentally ingest the medicine, you must rinse your stomach or drink activated charcoal.

Terms of sale

The drug is dispensed without a doctor's prescription, despite the presence of an antibiotic in the composition.

The cost of Ciprofloxacin eye drops is 50–56 rubles. The difference in price depends on the volume of the bottle: the drug 10 mg costs 87 rubles.

Storage conditions

The expiration date and storage of the composition are indicated in the instructions. They are left sealed in a dry place for 3 years. After opening, the solution must be used within 30 days: after this, the antibiotic loses its medicinal properties. Drops should be protected from exposure to sunlight.

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Interaction with other drugs

When used simultaneously with other anti-inflammatory drugs, no allergies or side effects are observed. But acceleration of absorption of some anticoagulants and caffeine-based drugs has been proven. Use with cyclosporine may temporarily increase blood creatinine.

Drops should not be taken together with alkaline solutions: the latter reduce the healing properties of the antibiotic.

Mechanism of action

When taken orally, the antibiotic is completely absorbed in the digestive tract. It reaches its highest concentration after 1.5 - 2 hours. It has a fairly high bioavailability - almost 70%. It has an average percentage of binding to blood proteins - about 40.

The drug is evenly distributed in the tissues of the body, and a larger volume is observed in them than in the blood. It has good permeability and can penetrate the placenta and into breast milk. A fair amount of Ciprofloxacin settles in the bile. About 40% is excreted in its original form through the kidneys, partly with bile. The half-life is approximately 4 hours.

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How long to take Ciprofloxacin

Ciprofloxacin is an antibiotic, so do not self-medicate; there may be negative consequences from uncontrolled use.

Ciprofloxacin is taken in dosage and duration depending on the nature of the infection and how it affects the body. Standard application practice is within 5-21 days. However, your doctor may extend this period, but you must be monitored.

If we talk about the treatment of chronic cystitis, it is clear that you will need long-term treatment. During treatment with Ciprofloxacin, you need to drink plenty of fluids and maintain regular dosing hours. The drug should not be taken with milk, and forget about orange juice.

What dose of Ciprofloxacin to take is prescribed by your doctor.

What does Ciprofloxacin help with and how to use it

What Ciprofloxacin helps with and how to use it correctly can be found in the instructions included with the drug.
However, it is best to rely not on the instructions, but on the recommendations of the attending physician who prescribes this remedy for treatment.

Instructions for use and dosage for the treatment of thrush:

• adults need to take 0.5 g of Ciprofloxacin twice a day. As a rule, treatment of thrush with this drug lasts 5-6 days.
• for children to use Ciprofloxacin, since the child’s body is at the stage of development, and the skeleton is not yet fully formed. This antibiotic can have a detrimental effect on the growth of the child, and in this case it does not matter what Ciprofloxacin helps with.
• Ciprofloxacin is also prohibited during pregnancy Treatment with this drug is prescribed to pregnant women only in extreme cases, when the life and health of the expectant mother is at risk. The danger of this antibiotic lies in the fact that the active substances of Ciprofloxacin can penetrate into the fetus through the placenta, and the detrimental effect of the drug components on the fetus is even more detrimental than the effect on the development of children and adolescents.

Ciprofloxacin should be taken on an empty stomach with a glass of water. On average, treatment with Ciprofloxacin can last from seven to ten days.

If a patient with kidney problems needs to take Ciprofloxacin, then the dosage of the antibiotic will need to be adjusted. Careful monitoring of patients taking Ciprofloxacin is also required if they suffer from atherosclerosis, epilepsy or are already elderly.

Drink plenty of fluids during the entire period of treatment with Ciprofloxacin . If acute diarrhea is observed during treatment with this antibiotic, then it is necessary to stop taking the drug and select an analogue. If diarrhea is moderate, then you need to take additional medications to restore intestinal microflora.

When treating with Ciprofloxacin, it is advisable to monitor the level of urea and creatinine in the blood.

It is necessary to refrain from driving vehicles while taking Ciprofloxacin, since the reaction rate may be significantly reduced.

Video about ciprofloxacin

Side effects of ciprofloxacin

Overall, the safety of ciprofloxacin and other fluoroquinolones appears to be similar to other antibiotics, but serious adverse effects occur on occasion. Some controversy has been described in the literature about whether fluoroquinolones produce serious adverse events at a higher rate than other broad-spectrum antibiotics.

In clinical trials prior to approval, 49,038 patients were treated with ciprofloxacin. Most adverse events were only mild or moderate in severity and subsided shortly after discontinuation of the drug and did not require treatment. Ciprofloxacin was discontinued due to adverse events in 1% of patients receiving the drug orally. The most commonly reported drug-related events from clinical trials of all formulations, all dosages, all dosing periods, and all indications for ciprofloxacin therapy were nausea (2.5% of cases), diarrhea (1.6% of cases) , abnormal liver function test results (1.3%), vomiting (1%), and rash (1%). Other adverse events were <1%.

The FDA warns of an increased risk of tendinitis and tendon rupture, especially in patients over 60 years of age, patients who also use corticosteroids, and patients with kidney, lung, or heart transplants. Tendon rupture is possible both during therapy and months after its completion. In a case-control study using a United Kingdom health system database, fluoroquinolone use was associated with a 1.9-fold increase in tendon problems. The relative risk increases to 3.2 in those over 60 years of age and to 6.2 in those also taking corticosteroids at that age. Among 46,766 quinolone users in the study, 38 (0.1%) cases of Achilles tendon rupture were identified. A study using an Italian health system database reached qualitatively similar conclusions.

Another warning is that ciprofloxacin should not be used in patients with myasthenia gravis due to the potential for worsening muscle weakness, which may lead to breathing problems, death, or mechanical ventilation. Fluoroquinolones are known to block neuromuscular transmission.

Caused by Clostridium difficile

diarrhea is a serious side effect of ciprofloxacin and other fluoroquinolones; It is unclear whether the risk is higher compared to other broad-spectrum antibiotics.

The 2013 FDA label warns of effects on the nervous system. Ciprofloxacin, along with other fluoroquinolones, is known to cause seizures or lower the seizure threshold and may cause other CNS side effects. Headache, insomnia, and dizziness have been reported to be fairly common in post-approval review articles, along with a much lower incidence of serious adverse CNS effects such as tremor, psychosis, anxiety, hallucinations, paranoia, and suicide attempts, especially with higher doses. Like other fluoroquinolones, it also causes peripheral neuropathy, which may be irreversible, such as weakness, burning pain, tingling or numbness.

A wide range of rare but potentially fatal adverse events that have been spontaneously reported to the FDA or the subject of case reports published in medical journals include, but are not limited to, toxic epidermal necrolysis, cardiac arrhythmias (flutter-fibrillation or prolongation of the QT interval), syndrome Stevens-Johnson, allergic pneumonitis, bone marrow suppression, hepatitis or liver failure and phototoxicity/photosensitivity. Therapy with the drug must be terminated if rash, jaundice or other signs of hypersensitivity occur.

Children and the elderly are at much greater risk of adverse reactions.

Contraindications

Two contraindications appear on the 2013 package insert:

1. Concomitant administration with tizanidine is contraindicated.
2. Contraindicated in any person with a history of hypersensitivity to any member of the quinolone class of antimicrobials, including ciprofloxacin, or any of the components of the product.

Ciprofloxacin is also contraindicated in the pediatric population, pregnancy, nursing mothers (except for the indications stated above) and in patients with epilepsy or other seizure disorders.

Genotoxicity and carcinogenicity studies

Ciprofloxacin is active in six of eight in vitro assays used as rapid screens to detect genotoxic effects, but is not active in vivo in genotoxicity assays. Long-term carcinogenicity studies in rodents concluded that there were no carcinogenic or oncogenic effects associated with ciprofloxacin at daily oral doses of up to 250 and 750 mg/kg in rats and mice, respectively (approximately 1.7 and 2.5 times the highest recommended therapeutic dose , based on mg/m2). Photococarcinogenicity test results indicate that ciprofloxacin does not reduce the time to onset of UV-induced skin tumors compared to vehicle control.

Interaction

Ciprofloxacin interacts with certain foods and a number of other drugs, resulting in undesirable increases or decreases in the serum levels or distribution of one or both drugs.

Ciprofloxacin should not be taken with antacids containing magnesium or aluminum, drugs with a high content of buffering substances (sevelamer, lanthanum carbonate, sucralfate, didanosine) or with supplements containing calcium, iron or zinc. It should be taken two hours before or six hours after these foods. Antacids with magnesium or aluminum convert ciprofloxacin to insoluble salts that are not readily absorbed by the gastrointestinal tract, reducing peak serum concentrations by 90% or more, resulting in therapeutic failure. In addition, it should not be taken with dairy products or calcium-containing juices, as the peak serum concentration and area under the serum concentration-time curve may be reduced by up to 40%. However, ciprofloxacin can be taken with dairy products or calcium-containing juices if they are part of a meal.

Ciprofloxacin inhibits the drug-metabolizing enzyme CYP1A2 and may therefore reduce the clearance of drugs metabolized by this enzyme. CYP1A2 substrates that show increases in serum in patients treated with ciprofloxacin include tizanidine, theophylline, caffeine, methylxanthines, clozapine, olanzapine, and ropinirole. Coadministration of ciprofloxacin with the CYP1A2 substrate, tizanidine (Zanaflex), is contraindicated due to a 583% increase in peak serum concentration of tizanidine when administered with ciprofloxacin compared to tizanidine alone. There is a warning regarding the use of ciprofloxacin in patients taking theophylline due to its narrow therapeutic index. The authors of one review recommended that patients treated with ciprofloxacin reduce their caffeine intake. Evidence of significant interactions with several other CYP1A2 substrates, such as cyclosporine, is equivocal or conflicting.

The Committee on Drug Safety and the FDA warn that CNS adverse effects, including the risk of seizures, may be increased when NSAIDs are combined with quinolones. The mechanism of this interaction may involve synergistic increased antagonism of GABA neurotransmission.

Altered serum levels of the antiepileptic drugs phenytoin and carbamazepine (increased and decreased) have been reported in patients receiving concomitant ciprofloxacin.

Overdose

Overdose of ciprofloxacin may result in reversible renal toxicity. Treatment of overdose includes emptying the stomach by vomiting or gastric lavage, and administering aluminum, magnesium, or calcium-containing antacids to reduce drug absorption. Renal function and urine pH should be monitored. Important support includes adequate hydration and urine acidification as needed to prevent crystalluria. Hemodialysis or peritoneal dialysis can only remove less than 10% of ciprofloxacin. Ciprofloxacin can be quantified in plasma or serum to monitor drug accumulation in patients with impaired liver function or to confirm the diagnosis of poisoning in victims of acute overdose.

Chemical properties

The drug is 1-cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-3-quinolinecarboxylic acid. Its empirical formula is C17H18FN3O3, molecular weight 331.4 g/mol. It is a slightly yellowish to light yellow crystalline substance. The monohydrochloride salt of ciprofloxacin monohydrate is a slightly yellowish to light yellow crystalline substance with a molecular weight of 385.8 g/mol. The empirical formula is C17H18FN3O3HCl•H2O.

Mechanism of action

Ciprofloxacin is a broad-spectrum antibiotic active against gram-positive and gram-negative bacteria. It works by inhibiting DNA gyrase, type II topoisomerase and topoisomerase IV, which are enzymes needed to separate bacterial DNA, thereby preventing cell division.

Pharmacokinetics of ciprofloxacin

Ciprofloxacin for systemic administration is available in immediate-release, extended-release tablets, oral suspension, and as an intravenous solution. When administered over one hour as an intravenous infusion, ciprofloxacin distributes rapidly into tissues, with levels in some tissues exceeding serum levels. Penetration into the CNS is relatively moderate, with cerebrospinal fluid levels typically less than 10% of peak serum concentrations. The half-life of ciprofloxacin in serum is about 4-6 hours, 50-70% of the administered dose is excreted unchanged in the urine. In addition, 10% is excreted in the urine in the form of metabolites. Urinary excretion is practically complete by 24 hours after administration. Dose adjustment is not necessary for elderly people and persons with impaired renal function.

Ciprofloxacin is weakly bound to serum proteins (20-40%), but is an inhibitor of the drug-metabolizing enzyme cytochrome P450 1A2, leading to the potential for clinically significant drug interactions with drugs metabolized by this enzyme.

The availability of ciprofloxacin is about 70% when administered orally, so a slightly higher dose is needed to achieve the same effect when switching from intravenous to oral administration. The 750 mg immediate-release oral tablet is administered every 12 hours and produces approximately the same area under the serum concentration curve (AUC) and maximum serum concentration (Cmax) as the 400 mg dosage every 8 hours IV. Extended-release tablets allow once-daily administration, releasing the drug more slowly through the gastrointestinal tract. These tablets contain 35% of the administered dose in an immediate-release form and 65% in a slow-release matrix. Maximum serum concentrations are achieved between 1 and 4 hours after administration. Compared to the 250 and 500 mg immediate-release tablets, the 500 and 1000 mg XR tablets provide a higher Cmax but 24-hour AUCs are equivalent.

Immediate-release tablets contain ciprofloxacin as the hydrochloride and XR tablets contain a mixture of hydrochloride salt as the free base.

Story

The first members of the quinolone class of antibacterial agents were relatively low-strength drugs such as nalidixic acid, used primarily to treat urinary tract infections due to their renal excretion and tendency to concentrate in urine. In 1979, the publication of a patent filed by the pharmaceutical subsidiary of Kyorin Seiyaku Kabushiki Kaisha disclosed the discovery of norfloxacin and the demonstration that certain structural modifications, including the attachment of a fluorine atom to the quinolone ring, resulted in a significant increase in antibacterial activity. As a result of this disclosure, several other pharmaceutical companies have initiated research programs to discover additional antibacterial agents in the fluoroquinolone class.

The fluoroquinolone program at Bayer has focused on studying the effects of very small changes in the structure of norfloxacin. In 1983, the company published in vitro drug strength data for ciprofloxacin, a fluoroquinolone antibacterial drug that has a chemical structure that differs from norfloxacin by having one carbon atom. This small change resulted in a 2- to 10-fold increase in activity against most strains of Gram-negative bacteria. Importantly, this structural change resulted in a fourfold increase in activity against the important Gram-negative pathogen Pseudomonas aeruginosa

, making ciprofloxacin one of the most potent drugs known for treating this inherently antibiotic-resistant pathogen.

An oral tablet form of ciprofloxacin was approved in October 1987, only one year after the approval of norfloxacin. In 1991, a drug for intravenous administration was introduced. Sales of ciprofloxacin peaked at around €2 billion in 2001, representing 34% of Bayer's total pharmaceutical revenues, before its patent expired in 2004, after which annual sales averaged around €200 million.

The price of this drug

The described pharmaceutical product is available to all consumers. Today, the price of Ciprofloxacin 500 tablets in pharmacies ranges from thirty-five to sixty rubles.

Thus, these pills are in great demand today and are used for various pathologies. You can read about their effectiveness in the reviews that people leave on the Internet. One of the advantages of the considered antibacterial drug is its affordability. But immediately before treatment, it is imperative to consult a qualified specialist.

Effect of the drug

When absorbed into tissues affected by bacteria, Ciprofloxacin drops affect only the pathogen cells. They destroy topoisomerase II DNA gyrase, without which further reproduction does not occur. The active substance stops the growth of pathogenic microflora at any stage and prevents the formation of new colonies.

Among the positive properties of the drops is that there is no risk of addiction to the drug. They are highly effective in infecting the most resistant subspecies of microbes and bacteria that cannot be treated with tetracycline and penicillin. They are recommended when the following pathogens are detected in crops:

• aerobic;
• enterobacteria;
• gram negative;
• gram-positive;
• intracellular (Listeria, Chlamydia, Legionella).

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If the eyes are damaged by staphylococcus, eye drops are prescribed in a higher dosage due to resistance to ciprofloxacin derivatives.

Compatibility with other drugs

Due to a decrease in the activity of microsomal oxidation processes in hepatocytes, ciprofloxacin increases the concentration and lengthens the half-life of theophylline and other xanthines (for example, caffeine), oral hypoglycemic drugs, indirect anticoagulants, and helps reduce the prothrombin index. When used simultaneously with NSAIDs (except for acetylsalicylic acid), the risk of developing seizures increases. Metoclopramide accelerates the absorption of ciprofloxacin, which leads to a decrease in the time to reach the maximum concentration of the latter. Co-administration of uricosuric drugs leads to a slower elimination (up to 50%) and an increase in plasma concentrations of ciprofloxacin. When combined with other antimicrobial drugs (beta-lactam antibiotics, aminoglycosides, clindamycin, metronidazole), synergism is usually observed. Therefore, Ciprofloxacin can be successfully used in combination with azlocillin and ceftazidime for infections caused by Pseudomonas spp. with mezlocillin, azlocillin and other beta-lactam antibiotics - for streptococcal infections with isoxazolepenicillins and vancomycin - for staphylococcal infections with metronidazole and clindamycin - for anaerobic infections. Ciprofloxacin enhances the nephrotoxic effect of cyclosporine, and an increase in serum creatinine is also noted, so in such patients it is necessary to monitor this indicator 2 times a week. When taken simultaneously, Ciprofloxacin enhances the effect of indirect anticoagulants.

Dosage regimens for various forms of cystitis

The medicine is taken orally, the tablet is not chewed, but simply washed down with a sufficient amount of water. Eating does not affect therapy.

The dose of the drug is determined based on the type and form of the disease, the age category of the patient, his weight and the functionality of the paired organ. The duration of therapy depends on the severity of the disease, clinical and bacterial responses.

As a rule, treatment continues for at least three days after the body’s temperature has stabilized or painful symptoms have disappeared.

For uncomplicated cystitis, you need to take 1-2 tablets twice a day for three days. The complicated form takes a little longer to treat – from one to two weeks. The dosage of the drug is five hundred milligrams twice a day.

The drug is contraindicated for cystitis in pregnant women. It should not be prescribed to a nursing mother, because Ciprofloxacin can pass into breast milk.

If there is still a need to use this medicine, stop feeding the child before starting therapy. This medicine is not prescribed to young patients and adolescents whose age category has not reached eighteen years.