Ciprofloxacin

Question 1

What drug class is ciprofloxacin from?

Answer 1

Quinolone

Question 2

What is ciprofloxacin’s MOA?

Answer 2

Bactericidal

Question 3

What is the indications for treatment with ciprofloxacin?

Answer 3

1. Severe Salmonella enteritis
2. Typhoid, paratyphoid
3. Shingellosis
4. Complicated UTIs
5. Bone or joint infections
6. Epididymo-orchitis
7. Prevention of meningococcal disease
8. P. aeroginosa infections, eg in cystic fibrosis
9. Prostatitis
10. Febrile neutropenia
11. Keratitis or severe bacterial conjunctivitis
12. Chronic suppurative otitis media

Question 4

How should ciprofloxacin (quinolone) be applied as an antimicrobial when selecting a suitable treatment?

Answer 4

Worldwide resistance to quinolones is increasing. Judicious use may extend their clinical life.

Reserved for proven or suspected infections where alternative agents are ineffective or contraindicated, eg complicated UTIs, bone or joint infections, epididymo-orchitis, prostatitis

Question 5

What are the precautions for using ciprofloxacin?

Answer 5

1. Serious allergic reaction to quinolones
2. Neurological
3. Tendon Damage
4. Children
5. Pregnancy

Question 6

What is the neurological precaution surrounding ciprofloxacin use?

Answer 6

Quinolones are associated with some serious neurological adverse effects, eg peripheral neuropathy (which may be irreversible). Avoid use in people with a history of peripheral neuropathy.

They may induce seizures in people with epilepsy or a history of CNS disorders. If possible avoid combining with other drugs that may increase the risk of seizures as this may further increase the risk.

Avoid quinolones in myasthenia gravis, as they may worsen muscle weakness, including respiratory muscles.

Question 7

What is the tendon damage precaution surrounding ciprofloxacin use?

Answer 7

Use cautiously if there is a history of tendon damage from a quinolone as the condition may recur. Current corticosteroid use or age >60 years increases the risk of tendon damage with quinolones; the greatest risk of Achilles tendon rupture appears to be in those with both of these risk factors.

Other risk factors may include kidney, heart or lung transplant, renal impairment, rheumatoid arthritis, hyperparathyroidism, musculoskeletal disorders, diabetes, being an athlete in training

Question 8

What is the precaution surrounding ciprofloxacin use in children?

Answer 8

Damage to growing cartilage has not been demonstrated in humans and arthropathies due to quinolone use occur at similar rates in comparator groups (data mainly from children with cystic fibrosis). Quinolones are recommended for use in children and adolescents only in severe infections where benefit outweighs the risk of arthropathy, eg febrile neutropenia, P. aeruginosa infections in cystic fibrosis. In the US and the UK ciprofloxacin is marketed for restricted indications in children.

Question 9

Can ciprofloxacin be given safely to patients who are pregnant or breastfeeding?

Answer 9

Not recommended in pregnancy (based on potential effects on developing cartilage), however, available data do not suggest an increased risk of abnormalities.

Breastfeeding: Safe to use (may cause loose bowel actions in the baby).

Question 10

What are the common adverse effects of ciprofloxacin?

Answer 10

rash, itch, nausea, vomiting, diarrhoea, abdominal pain, dyspepsia

Question 11

What are the infrequent adverse effects of ciprofloxacin?

Answer 11

headache, 
dizziness, 
insomnia, 
depression, 
restlessness, 
tremors, 
sensory disturbances (eg hearing, taste, vision), arthralgia, 
arthritis, 
myalgia, 
tendinitis,
interstitial nephritis, 
raised liver enzymes

Question 12

What are some rare adverse effects of ciprofloxacin?

Answer 12

seizures
clostridium-difficile associated disease
tendon rupture (esp. achilles tendon - onset may be rapid or take months),
anaphylaxis
psychotic reations

Question 13

What are the counselling points for ciprofloxacin?

Answer 13

This medicine may cause dizziness or faintness, which can affect your ability to drive and/or operate machinery. Drinking alcohol may worsen these effects.

Stop taking this medicine and see your doctor as soon as possible if you have any tendon soreness or inflammation (and don’t exercise), or if you develop numbness or tingling in your fingers or toes.

Ciprofloxacin is absorbed best if you take it 1 hour before, or 2 hours after, meals; drink plenty of fluids while taking it.

Dairy products, iron, zinc or calcium supplements, and aluminium- or magnesium-containing antacids may reduce the absorption of ciprofloxacin; do not take them within 2 hours of a ciprofloxacin dose.

It may increase the effects of caffeine in some people; you may need to reduce your caffeine intake.

Avoid sun exposure, wear protective clothing and use sunscreen.

Question 14

What tissue areas does ciprofloxacin have excellent penetration?

Answer 14

•excellent tissue penetration into bone and fluids, except CSF

Question 15

Does ciprofloxacin have good oral absorption?

Answer 15

•well absorbed orally; IV route necessary only when oral administration is not possible

Question 16

Why is it important to ensure adequate fluid intake with ciprofloxacin treatment?

Answer 16

•ensure adequate fluid intake and urine output; avoid alkaline urine due to increased risk of crystalluria

Question 17

What use does ciprofloxacin have in general practice?

Answer 17

•quinolones have very limited use in general practice, except in the treatment of UTIs caused by resistant organisms, or when other agents are contraindicated

Question 18

When should quinolone treatment be stopped?

Answer 18

•stop quinolone treatment at first sign of tendon pain, inflammation or peripheral neuropathy