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 MECHANISM OF ACTION
Ciprofloxacin is a broad-spectrum bactericidal agents of the fluoroquinolone class (Ciprofloxacin is a 2nd generation quinolone) with a wide range activity against gram-negative and gram-positive organisms.
Ciprofloxacin inhibits bacterial enzymes DNA gyrase and topoisomerase IV. DNA gyrase catalyzes the negative supercoiling of the circular DNA found in bacteria and Topoisomerase IV, on the other hand, is involved in the separation process of the DNA daughter chains after bacterial DNA duplication.
Depending on the type of bacterium, these enzymes represent either the primary or secondary target of antimicrobial action. In Gram-negative bacteria, such as E.coli, fluoroquinolones predominantly inhibit DNA gyrase, whereas for Gram-positive organisms like Staph.aureus, Topoisomerase IV is the principle target.
Ultimately, the action of Ciprofloxacin on DNA gyrase or on topoisomerase IV, results in damage to bacterial DNA and bacterial cell death.
Infections caused by bacteria susceptible to Ciprofloxacin like respiratory, urinary tract, gastrointestinal, abdominal, and skin infections
|Type of Infection|| Dose every
|Mild/Moderate Urinary Tract Infection||250 mg||7-14|
|Complicated/Severe Urinary Tract Infection||500 mg||7-14|
|Uncomplicated Urinary Tract Infection||250 mg||3|
|Intra abdominal (complicated)||500 mg||7-14|
|Bone and Joint (Moderate-Severe)||500-750 mg||28-42|
|Acute Bacterial Sinusitis||500 mg||10|
|Acute Bacterial Exacerbation of Chronic Bronchitis (moderate-severe)||500-750 mg||7-14|
|Complicated Skin and Skin Structure Infections (SSSI)||750 mg||7-14|
|Uncomplicated Skin and Skin Structure Infections (SSSI)||500 mg||7-14|
|Chronic Bacterial Prostatitis||500 mg||28|
|Typhoid fever (Mild/Moderate)||500 mg||10|
|Inhalation anthrax (Post exposure)||500 mg||60 days|
- Known hypersensitivity to Ciprofloxacin or other quinolones
- Patients who are pregnant or lactating
- Patients below 18 years of age [exept FDA approved in pediatric patients for the prevention of inhalational anthrax (post-exposure)]. An increased incidence of musculoskeletal disorders (arthralgia, arthritis, tendinopathy, and gait abnormality) has been observed rarely in pediatric patients receiving Ciprofloxacin
 WARNINGS AND PRECAUTIONS
- Tendinitis may rarely occur (1:1000). It most frequently involves the Achilles tendon and may lead to tendon rupture. This risk is further increased in older patients usually over 60 years of age, in patients taking corticosteroids, in patients receiving daily doses of 1000 mg and in patients with kidney, heart or lung transplants. Discontinue if pain or inflammation in a tendon occurs
- Hypersensitivity reactions: Anaphylactic reactions and allergic skin reactions, serious, occasionally fatal, may occur after first dose (Rarely)
- Clostridium difficile-associated colitis: evaluate if diarrhea, particularly if severe, persistent and/or bloody, during or after treatment with Ciprofloxacin occurs.
- Quinolones may lower the seizure threshold and may trigger seizures. Use with caution in patients with a history of epilepsy.
- Photosensitisation: It is recommended that patients should not expose themselves unnecessarily to strong sunlight or to artificial UV rays (e.g. solarium), during treatment to prevent photosensitisation
- Renal impairment: dose should be adjusted
- Prolongation of the QT interval : use with caution in patients (Especially in Elderly People) with known prolongation and when taking other drugs that prolong the QT intervals (e.g. Procainamide, Amiodarone, Sotalol, Chlorpromazine, Thioridazine, Citalopram, Escitalopram, Gatifloxacin, Moxifloxacin)
- Peripheral neuropathy (Rare cases): discontinue if symptoms occur in order to prevent irreversibility (symptoms of neuropathy include pain, burning, tingling, numbness, and/or weakness or other alterations of sensation including light touch, pain, temperature, position sense, and vibratory sensation)
- Hepatotoxicity: Severe, and sometimes fatal, hepatoxicity has been reported rarely. Discontinue immediately if signs and symptoms of hepatitis occur (jaundice, dark urine, pruritus or tender abdomen)
- May exacerbate muscle weakness in persons with myasthenia gravis.
- Multivalent cation containing products including iron salts, zinc salts, magnesium or aluminium-containing antacids, didanosine, calcium, dairy products decrease the absorption of Ciprofloxacin. Ciprofloxacin should be taken 2 hours before or 4 hours after cation containing products administration.
- Sucralfate: The bioavailability of Ciprofloxacin tablets is significantly reduced when administered together with sucralfate. Ciprofloxacin should be taken 2 hours before or 4 hours after Sucralfate administration.
- Vitamin K antagonists (Warfarin): Effect may be enhanced. Monitor prothrombin time, INR, watch for bleeding.
- Use with caution in patients receiving drugs known to prolong the QT (See WARNINGS AND PRECAUTIONS)
- Ciprofloxacin is an inhibitor of human CYP1A2. Coadministration of ciprofloxacin with other drugs primarily metabolized by this isoenzyme (e.g. theophylline, methylxanthines, tizanidine) results in increased plasma concentrations of these drugs. Concomitant administration with tizanidine is contraindicated.
 PREGNANCY AND LACTATION
- Pregnancy Category C (US). Ciprofloxacin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
- Nursing mothers: Ciprofloxacin is excreted in human milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
 SIDE EFFECTS
Most common adverse reactions are nausea, diarrhea, elevated transaminase levels, vomiting, and rash.
For More serious adverse reactions see WARNINGS AND PRECAUTIONS
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