Ciprofloxacin
Mechanism :
Ciprofloxacin is a broad-spectrum antimicrobial agent for oral administration. Ciprofloxacin has activity against a wide range of gram-negative and gram-positive microorganisms. The bactericidal action of ciprofloxacin results from inhibition of the enzymes topoisomerase II (DNA gyrase) and topoisomerase IV, which are required for bacterial DNA replication, transcription, repair, and recombination.
Indication :
- Pyelonephritis
- Pneumonia
- Typhoid
- Pyoderma
- Appendicitis
- Gastroenteritis
- Pelvic infection
- Septic arthritis
- Cholera
- Plague
- Inhalational Anthrax (off-label)
- Cystic fibrosis (off-label)
Contraindications :
Ciprofloxacin is contraindicated in persons with a history of hypersensitivity to ciprofloxacin or any of the quinolones. Concomitant administration with tizanidine is contraindicated. Ciprofloxacin should be used in pediatric patients only for infections listed above. An increased incidence of adverse events related to joints and/or surrounding tissues, has been observed. Convulsions increased intracranial pressure, and toxic psychosis have been reported in patients receiving quinolones, including ciprofloxacin.
Dosing :
Oral:
30-40 mg/kg/day PO divided into 12 hourly doses (Maximum: 500 mg/dose) for 10-21 days.
IV:
20-30 mg/kg/day IV in 8-12 hourly divided doses (Maximum: 1.2 g/day) for 10-21 days.
In cholera give for 1-3 days. In anthrax, give for 60 days.
Adverse Effect :
Arthralgia, pseudomembranous colitis, erythema nodosum, Stevens-Johnson syndrome, reversible haematological disorders.
Interaction :
Tizanidine: The hypotensive and sedative effects of tizanidine were also potentiated.
Theophylline: Elevated serum concentrations of theophylline.
Caffeine: Reduced clearance of caffeine and a prolongation of its serum half-life.
Magnesium/aluminium antacids, sucralfate: May substantially decrease its absorption, resulting in serum and urine levels considerably lower than desired.
Cyclosporine: Associated with transient elevations in serum creatinine.
Oral anticoagulant: Prothrombin time or other suitable coagulation tests should be closely monitored.
Methotrexate: Increased plasma levels of methotrexate.
Metoclopramide: Accelerates the absorption.
Non-steroidal anti-inflammatory drugs: In combination of very high doses of quinolones have been shown to provoke convulsions.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | 50–100% of normal dose |
| <10 | 50% of normal dose. (100% dose may be given for short periods under exceptional circumstances) |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Oral: 250 mg every 8–12 hours. IV: 200 mg every 12 hours |
| HD | Not dialysed. Oral: 250–500 mg every 12 hours. IV: 200 mg every 12 hours |
| HDF/High flux | Unknown dialysability. Oral: 250– 500 mg every 12 hours. IV: 200 mg every 12 hours |
| CAV/VVHD | Dialysed. Oral: 500–750 mg every 12 hours. IV: 200–400 mg every 12 hours |
Hepatic Dose :
No dosage adjustments are recommended.