Ciprofloxacin: Side Effects, Contraindications and Dosage
- Fluoroquinolones (1/5): general pharmacology
- Fluoroquinolones (2/5): ciprofloxacin
- Fluoroquinolones (3/5): levofloxacin
- Fluoroquinolones (4/5): ofloxacin
- Fluoroquinolones (5/5): norfloxacin
Review literature: (Auque et al, 2002) (Henry et al, 2002 ) (Krčméry and Naber, 1999) (Talan et al, 2004) (Simon und Stille, 1997).
Mechanism of Action of Ciprofloxacin
Ciprofloxacin is a fluoroquinolone antibiotic, which interferes with the bacterial DNA synthesis via inhibition of the DNA gyrase or topoisomerase II. Fluoroquinolone antibiotics are bactericidal.
Indications for Ciprofloxacin
Ciprofloxacin is active against a variety of bacteria:
- Gram-negative pathogens including Pseudomonas, Mycoplasma, Chlamydia,..
- Gram-positive pathogens, but not Pneumococci or Enterococci
- Some anaerobic bacteria
Urologic indications for ciprofloxacin are urinary tract infection (increasing resistance), prostatitis, acute pyelonephritis, epididymitis or perioperative antibiotic prophylaxis for transurethral surgery.
Pharmacokinetics of Ciprofloxacin
- Good bioavailability after oral administration, maximum concentration in serum after 60–90 min of oral administration.
- Good tissue penetration
- Half-life of 3–5 h, renal elimination.
Side Effects of Ciprofloxacin
- Gastrointestinal side effects: Nausea, vomiting, diarrhea, pseudomembranous colitis
- Neurotoxicity with headache, dizziness, psychosis and seizures.
- Allergy. Rarely serious allergic skin reactions.
- Photosensitization
- Orthopedic side effects: cartilage damage, tendon damage with spontaneous tendon rupture.
Interactions with Ciprofloxacin:
Do not give iron salts or magnesium or aluminum-containing antacids together with ciprofloxacin. Increasing concentrations of theophylline or methotrexate during treatment with ciprofloxacin. Increases creatinine if given in combination with cyclosporine. Increases warfarin or glibenclamid effect.
Contraindications to Ciprofloxacin
- Pregnancy and lactation
- Contraindicated in children under 5 years. Caution in children older than 5 years: cartilage damage.
Dosage of Ciprofloxacin
Dosage depends on the severity of the infection and renal function:
- Oral dosage: 250–500 mg p.o. 1-0-1
- Intravenous dosage: 200–400 mg i.v. 1-0-1
- Treatment of uncomplicated gonorrhea with a single dose 250 mg p.o.
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References
- Auquer u.a. 2002 AUQUER, F. ; CORDON, F. ; GORINA, E. ; CABALLERO, J. C. ; ADALID, C. ; BATLLE, J.:
- Single-dose ciprofloxacin versus 3 days of norfloxacin in
uncomplicated urinary tract infections in women.
In: Clin Microbiol Infect
8 (2002), Nr. 1, S. 50–4
- Henry u.a. 2002 HENRY, Jr. ; BETTIS, R. B. ; RIFFER, E. ; HAVERSTOCK, D. C. ; KOWALSKY, S. F. ; MANNING, K. ; HAMED, K. A. ; CHURCH, D. A.:
- Comparison of once-daily extended-release ciprofloxacin and
conventional twice-daily ciprofloxacin for the treatment of uncomplicated
urinary tract infection in women.
In: Clin Ther
24 (2002), Nr. 12, S. 2088–104
- Krcmery und Naber 1999 KRCMERY, S. ; NABER, K. G.:
- Ciprofloxacin once versus twice daily in the treatment of complicated
urinary tract infections. German Ciprofloxacin UTI Study Group.
In: Int J Antimicrob Agents
11 (1999), Nr. 2, S. 133–8
- Martin u.a. 1998 MARTIN, S. J. ; MEYER, J. M. ; CHUCK, S. K. ; JUNG, R. ; MESSICK, C. R. ; PENDLAND, S. L.:
- Levofloxacin and sparfloxacin: new quinolone antibiotics.
In: Ann Pharmacother
32 (1998), Nr. 3, S. 320–36
- Mombelli u.a. 1999 MOMBELLI, G. ; PEZZOLI, R. ; PINOJA-LUTZ, G. ; MONOTTI, R. ; MARONE, C. ; FRANCIOLLI, M.:
- Oral vs. intravenous ciprofloxacin in the initial empirical management
of severe pyelonephritis or complicated urinary tract infections: a
prospective randomized clinical trial.
In: Arch Intern Med
159 (1999), Nr. 1, S. 53–8
- Naber u.a. 1999 NABER, K. G. ; THEURETZBACHER, U. ; MONEVA-KOUCHEVA, G. ; STASS, H.:
- Urinary excretion and bactericidal activity of intravenous
ciprofloxacin compared with oral ciprofloxacin.
In: Eur J Clin Microbiol Infect Dis
18 (1999), Nr. 11, S. 783–9
- Raz u.a. 2000 RAZ, R. ; NABER, K. G. ; RAIZENBERG, C. ; ROHANA, Y. ; UNAMBA-OPARAH, I. ; KORFMAN, G. ; YANIV, I.:
- Ciprofloxacin 250 mg twice daily versus ofloxacin 200 mg twice daily
in the treatment of complicated urinary tract infections in women.
In: Eur J Clin Microbiol Infect Dis
19 (2000), Nr. 5, S. 327–31
- Reid u.a. 2000 REID, G. ; POTTER, P. ; DELANEY, G. ; HSIEH, J. ; NICOSIA, S. ; HAYES, K.:
- Ofloxacin for the treatment of urinary tract infections and biofilms
in spinal cord injury.
In: Int J Antimicrob Agents
13 (2000), Nr. 4, S. 305–7
- Simon und Stille 1997 SIMON, C. ; STILLE, W.:
- Antibiotika-Therapie in Klinik und Praxis.
9. Auflage.
Stuttgart New York : Schattauer, 1997
- Talan u.a. 2004 TALAN, D. A. ; KLIMBERG, I. W. ; NICOLLE, L. E. ; SONG, J. ; KOWALSKY, S. F. ; CHURCH, D. A.:
- Once daily, extended release ciprofloxacin for complicated urinary
tract infections and acute uncomplicated pyelonephritis.
In: J Urol
171 (2004), Nr. 2 Pt 1, S. 734–9
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Deutsche Version: Nebenwirkungen, Kontraindikationen und Dosierung von Ciprofloxacin
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