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Ciprofloxacin (Cipro)

Ciprofloxacin is a chemotherapeutic synthetic antibiotic that belongs to class of fluoroquinolone. This second generation antibacterial kills bacteria by troubling those enzymes that cause their DNA to get reversed after getting copied, consequently stalling the synthesis of protein as well as their DNA.  

Indications: Ciprofloxacin is used for treating not just prostate infection (prostatitis) and urinary tract infection but several other ailments also like infections of joints and bones, gastroenteritis, endocarditis, malignant otitis externa (inflammation and damage of the bones and cartilage at the base of the skull), cellulitis, respiratory tract infections, chancroid (bacterial sexually transmitted infection characterized by painful sores on the genitalia) 

The drug can also be used to treat anthrax, skin and skin-structure infections, diarrhea, typhoid fever, urethra gonorrhea and uncomplicated cervical infection. In addition, the medication is also recommended for the treatment of serious other bacterial infections, especially hospital-acquired infections.  However, ciprofloxacin is not prescribed for treating tuberculosis.  

Dosage: For adults, an oral dosage of 250-750 mg of Ciprofloxacin can be given according to the nature and the severity of the infection. The pediatric dosage of this drug is 5-15 mg/kg. In case of kidney disease (such as renal impairment), the dosage is adjusted as per the recommendation of doctor.  

Contraindication: Ciprofloxacin is considered to be contraindicated for following medical conditions:  

  • When patient is being given other drugs that are mainly metabolized by CYP1A2.  
  • When patient is being given tizanidine (Zanaflex, Sirdalud) 
  • When patient has history of hypersensitivity towards this drug or to any drug of the quinolone class, or to any of its components 
  • If patient shows local reactions in the form of skin rashes 
  • If patient shows resistance to antibiotics 
  • If patient is pregnant, nursing mother, epileptic or suffering from seizure disorders 

Mechanism of Action (MOA): Ciprofloxacin encourages breaking DNA and stalls DNA gyrase that is vital for reproducing bacterial DNA.
Absorption Ciprofloxacin is rapidly absorbed from the GI tract with maximum plasma concentrations after 2 hours of oral intake. However, the absorption process can get delayed due to presence of food.
Metabolism  Ciprofloxacin is converted into sulfociprofloxacin, oxociprofloxacin, and other metabolites.
Excretion Ciprofloxacin gets primarily excreted through urine by glomerular filtration, and tubular secretion. It also gets excreted through faeces as sulfociprofloxacin. Its elimination half-life is 3.5 to 4.5 hours and is also removed by peritoneal dialysis and haemodialysis.

Interactions: Since ciprofloxacin drug can have serious effects in the form of seizures, it needs to be carefully used in conjunctions with other drugs. Sulcralfate, antacids, and products containing iron, calcium, or zinc may interfere with the oral intake of ciprofloxacin, especially if they are taken within short duration. These drugs, and their compounds, should be taken 6 hours before or 2 hours after the intake of Ciprofloxacin, lest it would not render desired therapeutic results.  

Side Effects: The safety issues of Ciprofloxacin are just similar to other antibiotics. While elderly and children are at greater risk of experiencing adverse reactions, occasional adverse side effects may occur in other patients due to serious and fatal events like hypersensitivity, or doubtful etiology. Sometimes psychotic reactions, acute pancreatitis, interstitial nephritis, bone marrow depression, and hemolytic anemia may also occur during ciprofloxacin therapy.  

Additional adverse side effects may include temporary and/or permanent loss of vision, drug induced psychosis, irreversible double vision, involuntary muscle movements, exanthema, impaired color vision, abdominal pain, drug fever, malaise, eosinophilia, and dysesthesia (dysaesthesia).