Ciprofloxacin (Cipro) 500 mg

Ciprofloxacin is a broad-spectrum a fluoroquinolone antibiotic marketed by Bayer under the brand name Cipro.

Ciprofloxacin indicated uses include:

• Urinary tract infections: urethritis (infection of the urethra), cystitis (infection of the bladder), pyelonephritis (infection of the kidneys).
• Acute uncomplicated cystitis in women.
• Chronic bacterial prostatitis.
• Lower respiratory infections (pneumonia, bronchitis, tracheobronchitis).
• Acute sinusitis.
• Skin and skin structure infections: cellulitis (infection of the dermis and subcutaneous tissue), erysipelas (superficial form of cellulitis), folliculitis (inflammation of the hair follicles, if the infection of the follicle is deeper and involves more follicles, it moves into the furuncle and carbuncle), furuncles, carbuncles, abscesses, impetigo (large vessicles or honey-crusted sores), infected ulcers and infected burns and other.
• Bone and joint infections.
• Complicated intra-abdominal infections (used in combination with metronidazole).
• Infectious diarrhea: Escherichia coli infection, Campylobacter infection, and shigellosis.
• Typhoid fever (enteric fever) .
• STDs: gonorrhea.
• Complicated urinary tract iInfections and pyelonephritis in children (1 to 17 years of age).
• Post-exposure prophylaxis of anthrax. (in adults and children).

Nausea, diarrhea, liver function tests abnormal, vomiting and rash are the most common side effects you may experience with Ciprofloxacin.

• Absorption: Rapid (50% to 85%).
• Metabolism: Partially hepatic; forms 4 metabolites.
• Elimination half-life: 3-5 hours.
• Excretion: Urine (30% to 50% as unchanged drug); feces (15% to 43%).

Antibiotics are the mainstay treatment for all UTIs. The choice of antibiotic and length of treatment depend on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping select the most effective medication.

Fluoroquinolones are the standard alternatives to sulfa drugs (TMP-SMX). Ciprofloxacin is frequently used to treat urinary infections. In fact, it is often the first choice where there are the high rates of bacterial resistant to TMP-SMX.

For most infections the recommended Ciprofloxacin prescription dose for adults is 250-750 mg (immediate release tablets) every 12 hours.

• Convenient twice daily dosing regimen.
• Broad spectrum of antimicrobal activity.
• Does not cause a significant QT interval prolongation 14.
• Very effective antibiotic against P. aeruginosa (bacteria that causes infections of the pulmonary tract, external ear, urinary tract, burns, and wounds)
• Low cost due to generic availability.

• Tendon rupture, tendonitis and arthropathies. Rupture may ossur several months after medication has been discontinued. Fluoroquinolone-associated tendinitis most commonly involves the Achilles tendon, but the quadriceps, peroneus brevis, extensor pollicis longus, the long head of the biceps, and rotator cuff tendons have also been reported.
• Peripheral neuropathy (nerve damage). The symptoms of neuropathy include pain, burning, tingling, numbness, weakness, have deficits in light touch, pain, temperature, position sense, vibratory sensation. Ciprofloxacin should be stopped if person experiences these symptoms in order to prevent the irreversible condition.
• Poor activity against Streptococcus pneumoniae - a major cause of pneumonia and meningitis.
• Ciprofloxacin absorption may be significantly reduced by dairy products. It should not be taken with dairy or calcium-fortified juices alone. However, it may be taken with a meal that contains these products (eg. cereal with milk).
• Potential for serious drug interactions with theophylline, propranolol, warfarin and some other medications.
• Widespread use of Ciprofloxacin, sometimes inappropriate, has lead to increasing rates of bacterial resistance.
• Very rare cases of vision disturbance 15.
• Research has found that Ciprofloxacin may delay the fracture healing 16.

• Chlamydia infections 10, 11. Ciprofloxacin is not a good choice for Chlamydia infections. Althougt Ciprofloxacin has good activity ahgainst Chlamydia in test tubet, in practice even in high dosages as 2 g daily is insufficient for treatment of chlamydial infection and often results in relapsing infection.
• Gynecological infections (pelvic inflammatory disease, post-partum endometritis) 12, 13. Pelvic inflammatory disease can affect the cervix (cervicitis), uterus (endometritis), fallopain tubez (salpingitis) and ovaries (oophoritis). Ciprofloxacin not always provide optimal effective treatment for pelvic inflammatory disease if used alone.
• Cystic fibrosis 6. Ciprofloxacin is effective and well-tolerated maintenance antipseudomonal therapy in cystic fibrosis. There is increasing evidence that prevention of chronic P. aeruginosa infection is important for people with cystic fibrosis.
• Cat-scratch disease 2. This benign infectious disease caused by the intracellular parasite Bartonella usually resolves spontaneously and does not require antibiotic. In more serious cases treatment with ciprofloxacin or azithromycin is effective.
• Brucellosis 3-5. Brucellosis is an infectious disease transmitted from animals to humans. Despite ciprofloxacin is highly active in-vitro (in test tube) against Brucella, antibiotic does not provide optimal treatment for acute brucellosis and should be used in combination with aother antibacterials.
• Tuberculosis 7-8. Ciprofloxacin is a second-line treatment for tuberculosis in persons who cannot use conventional anti-tuberculosis medications or for drug-resistant tuberculosis.
• Chronic ear disease (chronic suppurative otitis media) 9. Ciprofloxacin appears to be an effective antibiotic of chronic otitis media, and superior to amoxycillin/clavulanic acid.

Ciprofloxacin is a synthetic, broad-spectrum antibacterial agents that inhibit (prevent the activity) DNA gyrase and topoisomerase IV. DNA gyrase is an essential enzyme that is involved in the replication, transcription, and repair of bacterial DNA. Topoisomerase IV is an enzyme known to play a key role in the partitioning of the chromosomal DNA during bacterial cell division.

• Ratings for cipro: side effects and patient comments on AskaPatient.com
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• 1. U.S. Food and Drug Administration. Ciprofloxacin (Cipro) U.S. Prescribing Information available at PDF format.
• 2. Windsor JJ. Cat-scratch disease: epidemiology, aetiology and treatment. Br J Biomed Sci. 2001;58(2):101-10.
• 3. Lopez-Merino A, Contreras-Rodri'guez A, Migranas-Ortiz R, et al. Susceptibility of Mexican brucella isolates to moxifloxacin, ciprofloxacin and other antimicrobials used in the treatment of human brucellosis. Scand J Infect Dis. 2004;36(9):636-8.
• 4. Agalar C, Usubutun S, Turkyilmaz R. Ciprofloxacin and rifampicin versus doxycycline and rifampicin in the treatment of brucellosis. Eur J Clin Microbiol Infect Dis. 1999 Aug;18(8):535-8.
• 5. Lang R, Raz R, Sacks T, Shapiro M. Failure of prolonged treatment with ciprofloxacin in acute infections due to Brucella melitensis. J Antimicrob Chemother. 1990 Dec;26(6):841-6.
• 6. Schaad UB, Wedgwood J, Ruedeberg A, Kraemer R, Hampel B. Ciprofloxacin as antipseudomonal treatment in patients with cystic fibrosis. Pediatr Infect Dis J. 1997 Jan;16(1):106-11; discussion 123-6. PubMed
• 7. Kahana LM, Spino M. Ciprofloxacin in patients with mycobacterial infections: experience in 15 patients. DICP. 1991 Sep;25(9):919-24.
• 8. Yang CK, Lin HC, Lee KY, Lin SM, Yu CT, Kuo HP. The effects of ciprofloxacin on chest radiographic regression in patients with drug intolerance or resistant tuberculosis. Chang Gung Med J. 2004 Apr;27(4):292-9.
• 9. Legent F, Bordure P, Beauvillain C, Berche P. Controlled prospective study of oral ciprofloxacin versus amoxycillin/clavulanic acid in chronic suppurative otitis media in adults. Chemotherapy. 1994;40 Suppl 1:16-23.
• 10. Skerk V, Schonwald S, Krhen I, Banaszak A, Begovac J, et al. Comparative analysis of azithromycin and ciprofloxacin in the treatment of chronic prostatitis caused by Chlamydia trachomatis. Int J Antimicrob Agents. 2003 May;21(5):457-62.
• 11. Hooton TM, Rogers ME, Medina TG, Kuwamura LE, Ewers C, Roberts PL, Stamm WE. Ciprofloxacin compared with doxycycline for nongonococcal urethritis. Ineffectiveness against Chlamydia trachomatis due to relapsing infection. JAMA. 1990 Sep 19;264(11):1418-21.
• 12. Maccato ML, Faro S, Martens MG, Hammill HA. Ciprofloxacin versus gentamicin/clindamycin for postpartum endometritis. J Reprod Med. 1991 Dec;36(12):857-61.
• 13. Arredondo JL, Diaz V, Gaitan H, Maradiegue E, et al. Oral clindamycin and ciprofloxacin versus intramuscular ceftriaxone and oral doxycycline in the treatment of mild-to-moderate pelvic inflammatory disease in outpatients. Clin Infect Dis. 1997 Feb;24(2):170-8.
• 14. Makaryus AN, Byrns K, Makaryus MN, Natarajan U, Singer C, Goldner B. Effect of ciprofloxacin and levofloxacin on the QT interval: is this a significant "clinical" event? South Med J. 2006 Jan;99(1):52-6.
• 15. Samarakoon N, Harrisberg B, Ell J. Ciprofloxacin-induced toxic optic neuropathy. Clin Experiment Ophthalmol. 2007 Jan-Feb;35(1):102-4.
• 16. Huddleston PM, Steckelberg JM, Hanssen AD, Rouse MS, Bolander ME, Patel R. Ciprofloxacin inhibition of experimental fracture healing. J Bone Joint Surg Am. 2000 Feb;82(2):161-73.