Ciprofloxacin - instructions for use, dose, side effects, contraindications

Antimicrobial agent of a broad spectrum of action of a group of fluoroquinolones. Has a bactericidal effect. Suppresses DNA-gyrase and inhibits the synthesis of bacterial DNA.

Highly active against most Gram-negative bacteria: Pseudomonas aeruginosa, Haemophilus influenzae, Escherichia coli, Shigella spp., Salmonella spp., Neisseria meningitidis, Neisseria gonorrhoeae.

Active with respect to Staphylococcus spp. (including strains producing and not producing penicillinase, methicillin-resistant strains), some strains Enterococcus spp., Campylobacter spp., Legionella spp., Mycoplasma spp., Chlamydia spp., Mycobacterium spp.

Ciprofloxacin is active against bacteria that produce beta-lactamases.

Ciprofloxacin is resistant Ureaplasma urealyticum, Clostridium difficile, Nocardia asteroides. Action against Treponema pallidum insufficiently studied.

Pharmacokinetics:

Quickly absorbed from the digestive tract. Bioavailability after oral administration is 70%. Food intake has little effect on the absorption of ciprofloxacin. The binding with plasma proteins is 20-40%. It is distributed in tissues and body fluids.Penetrates into cerebrospinal fluid: ciprofloxacin concentration at the non-inflamed meninges reach 10%, with inflamed - up to 37%. High concentrations are achieved in bile. Excreted in urine and bile.

Indications:

For systemic use: bacterial infections caused by susceptible microorganisms: ENT infections (otitis media, sinusitis, frontal sinusitis, sinusitis, mastoiditis, tonsillitis, pharyngitis), lower respiratory infections (bronchitis and acute exacerbation of chronic pneumonia, bronchiectasis, cystic fibrosis), pelvic organs (cystitis, pyelonephritis, prostatitis, adnexitis, salpingitis, oophoritis, endometritis, tubular abscess, pelvic inflammation), skin and soft tissue (infected ulcers, wounds, burns, abscess, cellulitis), bones and joints (ost eiomyelitis, septic arthritis); sexually transmitted diseases (gonorrhea, chancroid, chlamydia), abdominal infections (bacterial gastrointestinal infections, gallbladder and biliary tract, intraperitoneal abscess, peritonitis, salmonellosis, typhoid, campylobacteriosis, yersiniosis, shigellosis, cholera), bacteremia, septicemia, severe infection on the background of immunodeficiency and neutropenia, prevention of infections during surgical interventions.

In ophthalmology: infectious and inflammatory diseases of the eyes (acute and subacute conjunctivitis, blepharitis, blepharoconjunctivitis, keratitis, keratoconjunctivitis, bacterial corneal ulcer, chronic dacryocystitis, meibomite, infectious eye injuries after injuries or foreign bodies), pre- and postoperative prophylaxis of infectious complications in ophthalmic surgery.

In otorhinolaryngology: otitis externa, treatment of postoperative infectious complications.

ICD-10

XIV.N10-N16.N10 Acute tubulointerstitial nephritis

XI.K80-K87.K81.0 Acute cholecystitis

XI.K65-K67.K65.0 Acute peritonitis

X.J20-J22.J20 Acute bronchitis

X.J00-J06.J04 Acute laryngitis and tracheitis

X.J00-J06.J03 Acute tonsillitis

X.J00-J06.J02 Acute pharyngitis

X.J00-J06.J01 Acute Sinusitis

X.J00-J06.J00 Acute nasopharyngitis (runny nose)

VII.H00-H06.H04.3 Acute and unspecified inflammation of lacrimal ducts

XIV.N10-N16.N11 Chronic tubulointerstitial nephritis

XI.K80-K87.K81.1 Chronic cholecystitis

X.J40-J47.J42 Chronic bronchitis, unspecified

X.J30-J39.J37 Chronic laryngitis and laryngotracheitis

X.J30-J39.J35.0 Chronic tonsillitis

X.J30-J39.J32 Chronic Sinusitis

X.J30-J39.J31.2 Chronic pharyngitis

X.J30-J39.J31.0 Chronic rhinitis

X.J30-J39.J31 Chronic rhinitis, nasopharyngitis and pharyngitis

VII.H10-H13.H10.4 Chronic conjunctivitis

VII.H00-H06.H04.4 Chronic inflammation of lacrimal ducts

I.A30-A49.A41 Other septicemia

I.A30-A49.A40 Streptococcal septicemia

VII.H00-H06.H01.0 Blepharitis

VII.H10-H13.H10.2 Other acute conjunctivitis

VIII.H65-H75.H66 Purulent and unspecified otitis media

XI.K80-K87.K83.0 Cholangitis

XII.L00-L08.L03 Phlegmon

XIII.M86-M90.M86 Osteomyelitis

XIV.N30-N39.N30 Cystitis

XIV.N30-N39.N34 Urethritis and urethral syndrome

Contraindications:

Hypersensitivity (in the same number to other fluoroquinolones), deficiency of glucose-6-phosphate dehydrogenase, children and adolescence (up to 18 years, end of the period of intensive growth - for systemic use); in ophthalmology: viral keratitis, children's age (up to 1 year - for eye drops, up to 2 years - for ophthalmic ointment).

Carefully:

In connection with the threat of the development of adverse reactions from the central nervous system ciprofloxacin should be used only for vital signs in the pathology of the central nervous system in history: organic brain damage, epilepsy, lowering convulsive threshold, severe atherosclerosis of the brain vessels (risk of blood supply disorders, stroke), in old age, with severe violations of kidney and liver function (concentration in blood plasma).

In patients with allergic reactions to fluoroquinolone derivatives in the anamnesis, it is possible to develop a reaction to ciprofloxacin. During the treatment should avoid sunlight and UV exposure, intense physical exertion, control the drinking regime, pH urine.

Pregnancy and lactation:

Action category for the fetus by FDA - C.

Contraindicated in pregnancy (safety and efficacy in women during pregnancy is not established). Ciprofloxacin passes through the placenta. Shown, that ciprofloxacin caused arthropathy in young animals. In experiments on rats and mice receiving ciprofloxacin in doses exceeding the usual daily dose for a person 6 times, adverse effects on the fetus were not detected. In experiments on rabbits that received doses of ciprofloxacin 30 and 100 mg / kg intravenously, it was shown that the drug causes gastrointestinal dysfunction leading to loss of body weight in females and an increase in the number of miscarriages; however, there is no teratogenic effect. With intravenous doses up to 20 mg / kg ciprofloxacin did not exert a toxic effect on the mother's body and embryo, did not show teratogenic effect.

The use of local forms of ciprofloxacin in pregnancy is possible if the intended use exceeds the potential risk to the fetus.

Ciprofloxacin is excreted into breast milk, so during lactation it is necessary to decide whether to stop taking ciprofloxacin or breastfeeding, based on the importance of the drug for the mother.

Be wary of using local forms of ciprofloxacin during lactation (it is not known whether excreted ciprofloxacin in breast milk with topical application).

Dosing and Administration:

Inside, intravenously, topically. The dosage regimen is set individually depending on the localization and severity of the course of the infectious process, the state of the organism, age, body weight, functional state of the kidneys. Inside (without chewing and drinking with a sufficient amount of liquid) for 250 mg (for severe infections - 500-750 mg) 2-3 times a day; Prolonged form is taken 1 time per day. With infections of the urinary tract - 500 mg per day in 2 divided doses, with acute gonorrheal urethritis - 0.5 g once. Intravenously drip - 200 mg (for severe infections - 400 mg) 2 times a day; the duration of the infusion is 30 minutes at a dose of 200 mg and 60 minutes at a dose of 400 mg.

Patients with severe renal dysfunction daily dose reduced by half, elderly patients - by 30%.

In severe infection and / or inability to take tablets, treatment is begun with intravenous infusion. The duration of treatment depends on the severity of the disease. Average duration of treatment: 1 day - with acute uncomplicated gonorrhea and cystitis; up to 7 days - with infections of the kidneys, urinary tract and abdominal cavity; during the whole period of the neutropenic phase - in patients with weakened protective forces of the body, but no more than 2 months - with osteomyelitis and 7-14 days - with all other infections. With streptococcal infections due to the danger of late complications, as well as in chlamydial infections, treatment should last at least 10 days. In patients with immunodeficiency treatment is carried out throughout the neutropenia period.

Treatment should be carried out at least 3 days after the normalization of body temperature or the disappearance of clinical symptoms.

Locally: with mild and moderate infection, eye drops are injected 1-2 drops into the conjunctival sac of the affected eye every 4 hours, with severe infection - 2 drops every hour. After the condition is improved, the dose and frequency of instillations are reduced.

The ophthalmic ointment is placed behind the lower eyelid of the affected eye.

Ear drops: instill 5 drops into the affected ear 3 times a day. After the disappearance of the symptoms of the disease, the application should be continued for the next 48 hours.

Side effects:

With systemic application.

From the side organs of the digestive tract: nausea, vomiting, eating disorders, diarrhea, constipation, pseudomembranous colitis, epigastric and abdominal pain, abdominal discomfort, hiccups, ulcers, dryness and soreness of the oral mucosa, flatulence, bleeding in the digestive tract, pancreatitis, cholestatic jaundice, hepatitis, necrosis of cells liver.

From the side nervous system and sense organs: headache, dizziness, agitation, anxiety, insomnia, nightmares, confusion, depression, phobias, fatigue, visual impairment (change in color vision, diplopia, nystagmus, eye pain), taste, smell, tinnitus, transient hearing disorders, mood changes, gait disorders, increased intracranial pressure, paresthesia, sweating, ataxia, tremor, convulsions, toxic psychosis, paranoia, hallucinations, migraines.

From the side cardiovascular system and blood (hematopoiesis, hemostasis): decreased blood pressure, cardiovascular collapse, arrhythmia, cerebral thrombosis, paroxysmal tachycardia, leukopenia, leukocytosis, anemia, thrombocytopenia, thrombocytosis, prothrombin level change.

From the side respiratory system: pulmonary embolism, dyspnea, respiratory distress, bronchospasm, effusion to the pleura.

From the side musculoskeletal system: arthralgia, myalgia, tenosynovitis.

From the side genitourinary system: frequent urination, crystalluria, hematuria, cylinduria, polyuria, proteinuria, acidosis, urinary retention, hemorrhagic cystitis, nephritis, vaginitis, gynecomastia.

Allergic reactions: rash, petechiae, blisters, papules, skin vasculitis, Stevens-Johnson syndrome, Lyell syndrome, multiforme exudative erythema, exfoliative dermatitis, itching of the skin, swelling of the lips, face, neck, conjunctiva, limbs, angioedema, hives, anaphylactic shock.

Other: hyperpigmentation, eosinophilia, fever, photosensitivity, transient increase in hepatic transaminase, alkaline phosphatase, creatinine, urea, serum triglycerides,glucose, potassium, bilirubin; dysbiosis, candidiasis; at the site of intravenous injection - pain, burning sensation, phlebitis.

When local application: allergic reactions, itching, burning, mild soreness and hyperemia of the conjunctiva or in the region of the tympanic membrane; rarely - eyelid swelling, photophobia, lacrimation, foreign body sensation in the eye, unpleasant aftertaste in the mouth immediately after instillation, decreased visual acuity, appearance of white crystalline precipitate in patients with corneal ulcer, keratitis, keratopathy, staining or infiltration of the cornea, development of superinfection.

Overdose:

Symptoms: there are no specific symptoms.

Treatment: gastric lavage, the use of emetics, the introduction of a large amount of fluid, the creation of acid urine, in addition - hemodialysis and peritoneal dialysis (only 10% of the drug can be withdrawn); all activities are held against the backdrop of maintaining vital functions. The specific antidote is unknown.

Interaction:

With the simultaneous use of ciprofloxacin with didanosine, ciprofloxacin absorption decreases due to the formation of ciprofloxacin complexones with aluminum and magnesium buffers in didanosine.

With simultaneous use with warfarin, the risk of bleeding increases.

With the simultaneous use of ciprofloxacin and theophylline, an increase in the concentration of theophylline in the blood plasma, an increase in the half-lifetheophylline, which leads to an increased risk of toxic action associated with theophylline.

Simultaneous reception of antacids, as well as preparations containing ions of aluminum, zinc, iron or magnesium, can cause a decrease in absorption of ciprofloxacin, so the interval between the appointment of these drugs should be at least 4 hours.

Special instructions:

Cases of crystalluria have been reported, especially in patients with an alkaline urine reaction (pH 7 or higher). To avoid the development of crystalluria, exceeding the recommended daily dose is inadmissible, adequate fluid intake and maintenance of acid urine reaction are also necessary.

When pain occurs in the tendons or the appearance of the first signs of tendovaginitis treatment should be discontinued (individual cases of inflammation or rupture of the tendon during treatment with fluoroquinolones are described).

It can reduce the speed of psychomotor reactions, especially against the background of alcohol, which should be taken into account by patients,working with potentially dangerous mechanisms or driving vehicles.

If severe diarrhea develops, pseudomembranous colitis should be excluded (in which case ciprofloxacin contraindicated).

Simultaneous intravenous administration of barbiturates requires control of cardiovascular function (heart rate, blood pressure, ECG parameters).

Adolescents under 18 years of age are prescribed only in the case of resistance of the pathogen to other chemotherapeutic drugs.

Solution in the form of eye drops is not intended for intraocular injections. When using other ophthalmic agents, the interval between administrations should be at least 5 minutes.

Instructions

Ciprofloxacin (Ciprofloxacinum)