Ciprofloxacin for Food Poisoning

Food poisoning (acute bacterial gastroenteritis) is an illness caused by the consumption of contaminated food or water. The most common causes of food poisoning are bacteria Escherichia coli, Salmonella, Clostridium perfringens, Campylobacter, and Staphylococcus aureus and viruses Norovirus.

Difference between Food poisoning and Traveler's diarrhea

It is important to note the difference between food poisoning and traveler's diarrhea.

Traveler's diarrhea is generally manifested by malaise, sickness, and abdominal cramps, followed by the sudden onset of watery diarrhea. The most common causes are Enterotoxigenic Escherichia coli, Shigella, Salmonella, Campylobacter jejuni, Vibrio parahaemolyticus, Norovirus, Rotavirus.

While food poisoning is often caused by bacteria, this illness may result from ingesting a poison (toxin) produced by toxin-forming bacteria (such as Staphylococcus aureus or Bacillus cereus), not from the bacteria itself, or from eating poisonous plants and animals. In addition to diarrhea food poisoning is often accompanied with more severe vomiting and other symptoms.

However, the treatment principles are similar for food poisoning and traveler's diarrhea.

Ciprofloxacin for Food poisoning and Traveler's diarrhea

Ciprofloxacin (Cipro) is a prescription broad-spectrum fluoroquinolone antibiotic highly active against Gram-negative bacteria. Ciprofloxacin is a good antibiotic for traveler's diarrhea and food poisoning due to its activity against food-borne bacteria such as E. coli, Vibrio cholera, Campylobacter jejuni, Yersinia, Salmonella and Shigella.

Ciprofloxacin is a safe and effective prophylaxis for travelers' diarrhea and is superior to Trimethoprim/Sulfamethoxazole2. Ciprofloxacin is upto 95% effective in preventing traveler's diarrhea4.

Treatment of Shiga toxin-producing E. coli is supportive and antibiotic use is controversial3.

Ciprofloxacin dosage:

Note: The mainstay of infectious diarrhea treatment is adequate rehydration.

Treatment of Infectious diarrhea:

• Traveler's diarrhea (empirical treatment): 500 mg twice daily for 3 days.
• Salmonella: 500 mg twice daily for 5-7 days.
• Shigella: 500 mg twice daily for 3 days.
• Campylobacter: 500 mg twice daily for 7 days.
• Cholera (Vibrio cholerae): 1 g for one dose.

Prophylaxis of Infectious diarrhea:

500 mg once daily2.

Ciprofloxacin alternatives

Alternative treatment for children between the ages of 2 and 8 years, for pregnant women, and other cases fluoroquinolones contraindications:

• Azithromycin is an alternative treatment for children between the ages of 2 and 8 years, for pregnant women, and other cases fluoroquinolones contraindications.
• Rifaximin is a good alternative for travelers’ diarrhea caused by diarrheagenic Escherichia coli. Not effective for dysentery5.

Side effects:

• Gastrointestinal: nausea (2.5%), diarrhea (1.6%), vomiting (1%), abdominal discomfort.
• Central nervous system: insomnia (3%), dizziness (2%), restlessness (1%).
• Hypersensitivity: rash (2%); allergic reaction.

Precautions:

Tendinopathy and tendon rupture: There have been reports of tendon inflammation (commonly Achilles, shoulder, or hand tendons) and rupture with fluoroquinolones. The risk is increased in older adults ( > 60 years of age), individuals receiving concurrent corticosteroids. Other factors that may independently predispose to tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders.

Children: Do not use ciprofloxacin in children younger than 18 years of age because of increased incidence of disorders related to joints and cartilage.

Prolonged QT interval. Fluoroquinolones may prolong QTc interval. Patients with a history of QTc prolongation, uncorrected hypokalemia, or hypomagnesemia are at higher risk.

Phototoxicity: Avoid excessive sunlight; may cause moderate-to-severe phototoxicity reactions.

Crystalluria: Rarely, crystalluria has occurred. Ensure adequate hydration.

Peripheral sensory disturbances: Discontinue if symptoms sensory or sensorimotor disturbances occur, including paresthesias, hypoesthesias, dysesthesias, and weakness.

Drug interactions

• Antacids (aluminum- and magnesium-containing), calcium, sucralfate, didanosine, iron salts, zinc salts: decreased absorption of ciprofloxacin. Cipro should be administered 2 hours before or 6 hours after antacids, sucralfate, or supplements containing calcium, iron, or zinc.
• Theophylline: increased serum levels of theophylline; additive CNS stimulation and risk of seizures.
• Tizanidine: serum levels of tizanidine may be raised 7-fold. Concurrent administration is contraindicated.
• BCG or Typhoid live vaccines: ciprofloxacin may decrease the therapeutic effect of live vaccine.
• CYP1A2 substrates: ciprofloxacin may increase the levels of CYP1A2 substrates.
• Glyburide: possible severe hypoglycemia.
• QTc-prolonging agents: prolongation of the QT interval.

Pregnancy & Lactation:
Pregnancy Risk Factor: C
Cipro crosses the placenta and concentrates in amniotic fluid; maternal serum levels may be decreased during pregnancy. Reports of arthropathy (observed in immature animals and reported rarely in humans) have limited the use of fluoroquinolones in pregnancy. According to the FDA, the Teratogen Information System concluded that therapeutic doses during pregnancy are unlikely to produce substantial teratogenic risk. In general, reports of exposure have been limited to short durations of therapy in the first trimester. When considering treatment for life-threatening infection and/or prolonged duration of therapy (such as in anthrax), the potential risk to the fetus must be balanced against the severity of the potential illness.

Breast-Feeding:
Cipro is excreted in breast milk. However, AAP suggests maternal use of ciprofloxacin is compatible with breast-feeding since absorption of ciprofloxacin by nursing infants would be negligible.

References:

• 1. U.S. Ciprofloxacin (Cipro) Prescribing Information PDF
• 2. Heck JE, Staneck JL, Cohen MB, Weckbach LS, Giannella RA, Hawkins J, Tosiello R. Prevention of Travelers' Diarrhea: Ciprofloxacin versus Trimethoprim/Sulfamethoxazole in Adult Volunteers Working in Latin America and the Caribbean. J Travel Med. 1994 Sep 1;1(3):136-142. PubMed
• 3. Zhang X, McDaniel AD, Wolf LE, Keusch GT, Waldor MK, Acheson DW. Quinolone antibiotics induce Shiga toxin-encoding bacteriophages, toxin production, and death in mice. J Infect Dis. 2000 Feb;181(2):664-70. PubMed
• 4. David J. Diemert. Prevention and self-treatment of travelers' diarrhea. Clin Microbiol Rev. 2006 Jul; 19(3): 583–594. PubMed
• 5. Hong KS, Kim JS. Rifaximin for the treatment of acute infectious diarrhea. Therap Adv Gastroenterol. 2011 Jul;4(4):227-35 PubMed

By HealthyStock Research Group, September 2009
Medical resources reviewed: August 2018