Severe infections, staphylococcal infections and infections caused by gram-positive and anaerobic bacteria
In the treatment of severe infections caused by staphylococcus infections caused by anaerobic bacteria, Ciprobay® should be used in combination with appropriate antibacterial agents.
Infections due to Streptococcus pneumoniae
Ciprobay® is not recommended for the treatment of infections caused by Streptococcus pneumoniae, because of its insufficient effectiveness against the pathogen.
Infections of the reproductive tract
In genital infections presumably caused by strains Neisseria gonorrhoeae, resistant to fluoroquinolones, should take into account information on local resistance to ciprofloxacin and confirm the sensitivity of the causative agent in laboratory tests.
Heart Disease
The drug Ciprobay® has an effect on the elongation of the QT interval (see the "Side effect" section). Given that women have a larger average duration of the QT interval than men, they are more sensitive to drugs that cause prolongation of the QT interval. In elderly patients, there is also increased sensitivity to the action of drugs that cause prolongation of the QT interval. Therefore, use with caution the preparation Ciprobay ® in combination with drugs that extend the QT interval (for example, antiarrhythmic drugs of classes I A and III, tricyclic antidepressants, macrolides and antipsychotic drugs) (see.(See "Interactions with Other Drugs"), or in patients at increased risk of QT interval prolongation or pirouette-type arrhythmia (eg, congenital QT prolongation syndrome, unadjusted electrolyte imbalance, such as hypokalemia or hypomagnesemia, and with such heart diseases like heart failure, myocardial infarction, bradycardia).
Use in children
It was found that, ciprofloxacin, like other drugs of this class, causes arthropathy of large joints in animals. When analyzing the current data on the safety of ciprofloxacin in children under 18 years of age, most of whom have cystic fibrosis of the lung, there is no association between cartilage damage and joints with drug administration. It is not recommended to use Ciprobay® in children for the treatment of other diseases, except for the treatment of complications of cystic fibrosis of the lungs (in children from 5 to 17 years) associated with Pseudomonas aeruginosa and for the treatment and prevention of pulmonary forms of anthrax (after suspected or proven infection Bacillus anthracis).
Hypersensitivity
Sometimes after taking the first dose of Ciprobay®, hypersensitivity to the drug, including allergic reactions, may develop, which should be reported immediately to the treating physician (see the "Side effect" section). In rare cases, after the first application, anaphylactic reactions may occur up to anaphylactic shock. In these cases, the use of Ciprobay® should be stopped immediately and appropriate treatment should be given.
Gastrointestinal tract
If a severe and prolonged diarrhea occurs during or after treatment with Ciprobay®, the diagnosis of pseudomembranous colitis should be ruled out, which requires immediate discontinuation of the drug and the appropriate treatment (vancomycin inside in a dose of 250 mg 4 times a day) (see section "Side effect"). Contraindicated in the use of drugs that suppress the intestinal peristalsis.
Hepatobiliary system
When using the drug Ciprobay®, cases of liver necrosis and life-threatening liver failure were noted. If you have the following signs of liver disease, such as anorexia, jaundice, darkening of the urine, itching, abdominal tenderness, taking Ziprobay® should be discontinued (see section "Side effect").
In patients taking Ziprobai® and having liver disease, there may be a temporary increase in activity of "liver" transaminases, alkaline phosphatase or cholestatic jaundice (see section "Side effect").
Musculoskeletal system
Patients with severe myasthenia gravis should be treated with Ciprobay ® with caution, as possible exacerbation of symptoms.
When taking Ziprobay®, cases of tendinitis and rupture of tendons (predominantly Achilles tendon) may occur, sometimes bilateral, within the first 48 hours after initiation of therapy. Inflammation and rupture of the tendon can occur even a few months after discontinuation of treatment with Ciprobay®. In elderly patients and patients with diseases of tendons treated simultaneously with corticosteroids, there is an increased risk of tendonopathy.
At the first signs of tendonitis (painful swelling in the joint area, inflammation), ciprofloxacin should be discontinued, physical activity should be avoided, there is a risk of rupture of the tendon, as well as consult a doctor.
Ciprofloxacin should be used with caution in patients who have a history of tendon disease associated with the administration of quinolones.
Nervous system
Ciprobay ®, like other fluoroquinolones, can provoke cramps and reduce the threshold of convulsive readiness. Patients with epilepsy and advanced CNS diseases (eg, lowering the threshold of convulsive readiness, convulsive seizures in the anamnesis, cerebral circulation disorders, organic brain lesions or stroke) due to the threat of the development of adverse reactions from the CNS preparation Ziprobay ® should be used only in those cases , when the expected clinical effect exceeds the possible risk of side effects of the drug.
When using the drug Ciprobay®, cases of development of epileptic status were reported (see section "Side effect"). In case of seizures, the drug should be discontinued. Mental reactions may occur even after the first use of fluoroquinolones, including Ciprobay®. In rare cases, depression or psychotic reactions can progress to suicidal thoughts and self-damaging behavior, such as suicide attempts, including those that have occurred (see "Side effect").If a patient develops one of these reactions, stop taking Ziprobai® and inform the doctor about it.
In patients taking fluoroquinolones, including Ciprobay®, there have been cases of sensory or sensorimotor polyneuropathy, hypoesthesia, dysesthesia, or weakness. If symptoms such as pain, burning, tingling, numbness, weakness occur, patients should be informed by the doctor before continuing the use of the drug.
Skin covers
When taking Ziprobai®, a photosensitization reaction may occur, so patients should avoid contact with direct sunlight and UV light. Treatment should be discontinued if symptoms of photosensitivity are observed (for example, skin changes resemble sunburn) (see section "Side effect").
Cytochrome P450
It is known that Ciprobay® is a moderate inhibitor of CYP 450 1A2 isoenzymes. Caution should be exercised when using the drug Ciprobay® and drugs metabolized by these enzymes, such as tizanidine, theophylline, methylxanthine, caffeine, duloxetine, ropinirole, clozapine, olanzapine and others, since an increase in the concentration of these drugs in the blood serum, due to the inhibition of their metabolism by ciprofloxacin, can cause specific undesirable reactions.
Local Reactions
With the intravenous administration of the drug Ciprobay®, there may be a local inflammatory reaction at the site of the drug (swelling, pain). This reaction is more common if the infusion time is 30 minutes or less. The reaction quickly passes after the end of the infusion and is not a contraindication for the subsequent administration of the drug, unless its course becomes complicated.
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.
With simultaneous intravenous administration of ciprofloxacin and preparations for general anesthesia from the group of barbituric acid derivatives, continuous monitoring of heart rate, blood pressure, and ECG is necessary.
In vitro ciprofloxacin may interfere with bacteriological research Mycobacterium tuberculosis, suppressing its growth, which can lead to false-negative results in the diagnosis of this pathogen in patients taking Ziprobay®.
NaCl content
It is necessary to take into account the content of sodium chloride in the solution of ciprofloxacin, in the treatment of patients in whom sodium consumption is limited (heart failure, renal failure, nephrotic syndrome).