Ciprofloxacin

General characteristics. Structure:

Active ingredient: 2 mg of ciprofloxacin of a hydrochloride (in terms of ciprofloxacin).

Antimicrobic drug from group of ftorkhinolon. Possesses a wide range of antimicrobic action.

Pharmacological properties:

Pharmacodynamics. Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes, Campylobacter jejuni, Citrobacter freundii, Citrobacter diversus, Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Morganella morganii, Neisseria gonorrhoeae, Proteus mirabilis, Proteus vulgaris, Providencia stuartii, Providencia retgeri, Pseudomonas aeruginosa, Salmonella typhi, Serratia marcescens, Shigella flexneri, Shigella sonnei, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus, Acinetobacter spp is active concerning Enterococcus faecalis. Acinetobacter calcoaceticus, aeromonas caviae, Aeromonas hydrophilia, Brucella melitensis, Campilobacter coli, Edwardsielaa tarda, Enterobacter aerogenes, Haemophilus ducreyi, Klebsiella oxytoca, Legionella pneumophila, Moraxella (Branhamella) catarrhalis, Neisseria meningitides, Pasteurella multocida, Salmonella enteritidis, Vibrio vulnificus, Yersenia enterocolitica, Chlamydia trachomatis, Mycobecterium tuberculosis.

Shows activity in relation to the microorganisms steady practically against all antibiotics, sulfanamide and nitrofuran drugs. In some cases ciprofloxacin is active concerning strains of the microorganisms having stability to other drugs of group of ftorkhinolon. Ciprofloxacin resistance of microorganisms develops slowly and gradually.

Indications to use:

I use drug at adult patients at the bacterial infections caused by sensitive microorganisms:

- respiratory diseases (acute and chronic bronchitis, pneumonia, bronchoectatic disease, mucoviscidosis);

- infections of ENT organs (average otitis, antritis, frontal sinusitis, sinusitis, mastoiditis, tonsillitis, pharyngitis);

- infections of kidneys and urinary tract (cystitis, pyelonephritis);

- infections of bodies of a small pelvis and generative organs (prostatitis, adnexitis, salpingitis, oophoritis, endometritis, tubular abscess, pelviperitonitis, gonorrhea, venereal ulcer, clamidiosis);

- infections of an abdominal cavity (bacterial infections of digestive tract, bilious ways; peritonitis, intraperitoneal abscesses, salmonellosis, typhoid, campilobacteriosis, иерсиниоз, shigellosis, cholera);

- infections of skin and soft tissues (contaminated wounds, ulcers, burns, abscesses, phlegmon);

- infections of bones and joints (osteomyelitis, septic arthritis);

- sepsis;

- infections against the background of the immunodeficiency (arising at treatment by immunodepressive drugs or at patients with a neutropenia, and also for selective decontamination of intestines against the background of treatment by immunodepressants);

- for prevention of bacterial infections at surgical interventions.

Route of administration and doses:

The drug is administered intravenously kapelno slowly. Duration of infusion makes 30 minutes at a dose of 200 mg and 60 minutes – at a dose of 400 mg. The infusion solutions ready to use, it is possible to combine from 0,9% solution of sodium chloride, 5% and 10% dextrose solution, Ringer's solution. At uncomplicated infections of urinary tract, infections of lower parts of respiratory tracts the single dose makes 200 mg; at the complicated infections of upper parts of urinary tract, at the heavy course of infections (including at pneumonia, osteomyelitis) a single dose – 400 mg.

In need of intravenous treatment of especially heavy, life-threatening or recurrent infections which are especially caused by Pseudomonas aeruginosa, Streptococcus pneumoniae or stafilokokka, the dose can be increased to 400 mg with frequency rate of introduction to 3 times a day. Treatment duration at osteomyelitis can reach 2 months. At a chronic carriage of salmonellas – on 200 mg 2 times a day, a course of treatment – up to 4 weeks. If necessary the dosage can be increased to 500 mg 3 times a day. At acute gonorrhea – 100 mg, once.

The maximum daily dose in case of parenteral use — 1200 mg. The average duration of treatment at acute uncomplicated gonorrhea and cystitis – 1 day. At infections of kidneys, urinary tract and an abdominal cavity duration of treatment makes up to 7 days. At other infections duration of a course of treatment usually makes 7–14 days. At patients with the weakened immunity treatment is carried out during the entire period of a neutropenia. At the infections caused by streptococci and chlamydias, treatment duration not less than 10 days. 

At peritonitises it is admissible to use intraperitoneal administration of infusion solution in a dose of 50 mg 4 times a day on 1 l of dialyzate. For prevention of infections at surgical interventions enter on 200-400 mg in 0,5-1 hour prior to operation; lasting operation over 4 watch, enter repeatedly in the same dose. 

Patients with a renal failure need correction of the mode of dosing depending on the size of clearance of creatinine.

Features of use:

Infusion solution of drug is compatible to the following infusion solutions: normal saline solution, 5% solution of glucose, 2,5% Ringer's solution with a dextrose, the combined solutions for parenteral food (amino acids, carbohydrates, electrolytes). Infusion solution of drug cannot be mixed with heparin or solutions with alkali reaction (for example, with bicarbonate sodium solution).

Influence on ability to drive the car and potentially dangerous mechanisms: for treatment it is necessary to refuse driving and potentially dangerous to mechanisms because of possible emergence of dizziness, drowsiness, constraint and a visual disturbance that can lead to deterioration in reactionary ability and decrease in concentration of attention.

Use of drug is contraindicated during pregnancy. For the period of treatment it is necessary to stop breastfeeding.

Side effects:

Allergic reactions: sometimes - an itch and erubescence; seldom - the anaphylactic and anaphylactoid reactions (which are shown such symptoms as a small tortoiseshell, a face edema it is very rare - sudden falling of arterial pressure and shock; in some cases - Stephens-Johnson's syndrome, a toxic epidermal necrolysis (Lyell's disease) and an exudative multiformny erythema.

Local reactions: at intravenous administration – pain and an inflammation in an injection site, a dorsodynia and breasts, the increased sweating;

From a nervous system: sometimes - a headache, dizziness, exhaustion, disturbance of flavoring sensitivity; seldom - paresthesias in hands, a shiver, concern, conditions of fear, attacks of spasms and confusion of consciousness; very seldom - a vision disorder and hearing, disturbances of flavoring sensitivity and sense of smell, decrease in tactile sensitivity, disturbance of concentration of attention, psychotic reactions like hallucinations and depressions, a lack of coordination (including when walking)

From the alimentary system: nausea, diarrhea, sometimes - appetite loss, vomiting, abdominal pains, digestion disturbances; seldom - dryness in a mouth, gastrointestinal bleeding, increase in level of bilirubin in blood serum); very seldom - diarrhea with blood (seldom or never it can be a sign of an inflammation of intestines or pseudomembranous colitis, an abnormal liver function (hepatitis, a cholelithiasis).

 From bodies of a hemopoiesis: sometimes - an eosinophilia, a leukopenia; seldom - a neutropenia, thrombocytopenia (strengthening of tendency to hemorrhages or bleedings); very seldom - the expressed agranulocytosis (is followed by resistant or recurrent fervescence, an inflammation of almonds and permanent deterioration in health); in some cases - hemolitic anemia, a pancytopenia.

From cardiovascular system: seldom - tachycardia, hypotension and hypertensia; very seldom – increase in an interval of QT on the cardiogram, a vascular collapse, a torsade de pointes of ventricles.

From a musculoskeletal system: seldom - damages of sinews (including a tendinitis), joint and muscular pains; very seldom - a rupture of an Achilles tendon (can have bilateral character and be shown during 48 h after an initiation of treatment), muscular weakness (has special value for patients with a myasthenia); in some cases - рабдомиолиз.

From urinogenital system: sometimes – a vaginitis, it is very rare - deterioration in function of kidneys up to an acute renal failure (for example, owing to allergic reactions - intersticial nephrite).

Other: sometimes - an adynamy; very seldom – a hypoglycemia, fever, an allergic pneumonitis, a vasculitis.

Laboratory indicators: sometimes - increase in activity of ALT, nuclear heating plant, increase in level of creatinine in blood serum; seldom - increase in LDG, increase or decrease in content of glucose.

Interaction with other medicines:

At the combined treatment with non-steroidal anti-inflammatory drugs, theophylline drug can raise a threshold of convulsive readiness.

At simultaneous use with warfarin the risk of bleeding increases.

Removal of ciprofloxacin is slightly slowed down under the influence of Cimetidinum and a probenetsid. Ciprofloxacin strengthens nephrotoxic effect of cyclosporine. Glucocorticoids increase risk of a rupture of sinews (especially at advanced age).

Alcohol can strengthen side effects from the central nervous system (dizziness, catalepsy, drowsiness)

At the patients with diabetes receiving peroral hypoglycemic means or insulin against the background of reception of ciprofloxacin are possible hypo - and hyper glycemic states (careful monitoring of level of glucose in blood is recommended).

Contraindications:

Hypersensitivity to ciprofloxacin or to other hinolona; epilepsy; the damages of sinews connected with reception of hinolon in the anamnesis; children's and teenage age up to 18 years.

Precautionary measures

In the course of treatment by drug control of concentration in blood of urea, creatinine, hepatic transaminases is necessary.

With care to apply at patients with the previous damage of a brain (a stroke or a severe injury) because of a possibility of development of spasms.

At use of drug for the patients with a diabetes mellitus who are at the same time receiving peroral hypoglycemic means (insulin or glibenclamide) it must be kept in mind that ciprofloxacin can cause a hypoglycemia.

In order to avoid development of a photosensitization patients are recommended not to be exposed to power solar or artificial ultra-violet irradiation (for example, long stay under a direct sunlight or visit of a sunbed), at emergence of phototoxic effects (skin rash) it is necessary to stop treatment by drug.

At patients with deficit glyukozo-6-fosfatdegidrogenazy development of hemolysis of erythrocytes is possible.

At emergence of heavy, persistent diarrhea with or without blood impurity, it is necessary to inform the doctor. Diarrhea can be the cause of the coloenteritis caused by an antibioticotherapia. At suspicion of pseudomembranous colitis it is necessary to cancel immediately drug and to begin the corresponding treatment. In this case it is impossible to apply the medicines oppressing motility of intestines.

Use of drug for elderly people can lead to development of a tendinitis (first of all an Achilles tendon) and to its gap. At suspicion on a tendinitis it is necessary to cancel drug and to begin treatment of the affected sinew, having provided it an immobilization.

During treatment it is necessary to avoid alcohol intake.

Overdose:

Symptoms: there are no specific symptoms of overdose.

Treatment: symptomatic therapy (there is no specific antidote), carrying out a hemodialysis and peritoneal dialysis is possible though by means of these methods only an insignificant part of ciprofloxacin is removed.

Issue conditions:

According to the recipe

Packaging:

Solution for infusions of 0,2% in bottles of 100 ml in packaging No. 1, No. 56.