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CIPROFLOXACIN HYDROCHLORIDE

CIPROFLOXACIN HYDROCHLORIDE

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Published by Cay Sevilla
Drug Study
Drug Study

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Published by: Cay Sevilla on Jan 14, 2011
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CIPROFLOXACIN HYDROCHLORIDE
(ci-pro-flox'a-cin)
Cipro, Cipro IV, Cipro XR 
CIPROFLOXACIN OPHTHALMIC
CiloxanClassifications:
 
ANTIINFECTIVE
;
QUINOLONE ANTIBIOTIC
Pregnancy Category:
C
Availability
100 mg, 250 mg, 500 mg, 750 mg tablets; 500 mg extended-release tablets; 50 mg/mL,100 mg/mL suspension; 200 mg, 400 mg injection; 3.5 mg/mL ophth solution
Actions
Synthetic quinolone that is a broad spectrum bactericidal agent. Inhibits DNA-gyrase, anenzyme necessary for bacterial DNA replication and some aspects of transcription, repair,recombination, and transposition.
Therapeutic Effects
Effective against many gram-positive and gram-negative organisms including
Citrobacter diversus, Enterobacter cloacae, Enterobacter aerogenes, Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Proteusmirabalis, Proteus vulgaris, Pseudomonas aeruginosa, Serratia marcescens,Staphylococcus aureus, Streptococcus pyogenes, Shigella,
and
Salmonella
. Less activeagainst gram-positive than gram-negative bacteria, although active against many gram- positive aerobic bacteria, including penicillinase-producing, non-penicillinase-producing,and methicillin-resistant
Staphylococci.
However, many strains of 
Streptococci
arerelatively resistant to the drug. Inactive against most anaerobic bacteria. Resistant tosome strains of methicillin-resistant
Staphylococcus aureus
(MRSA).
Uses
UTIs, lower respiratory tract infections, skin and skin structure infections, bone and jointinfections, GI infection or infectious diarrhea, chronic bacterial prostatitis, nosocomial pneumonia, acute sinusitis. Post-exposure prophylaxis for anthrax.
Ophthalmic:
Cornealulcers, bacterial conjunctivitis caused by
Staphylococci, Streptococci,
and
 P. aeruginosa
.
Contraindications
Known hypersensitivity to ciprofloxacin or other quinolones, syphilis, viral infection;tendon inflammation or tendon pain; pregnant women (category C), lactation.
 
Cautious Use
Known or suspected CNS disorders (i.e., severe cerebral arteriosclerosis or seizuredisorders); myasthenia gravis; myocardial ischemia, atrial fibrillation, QT elongation,CHF; GI disease, colitis; CVA; uncorrected hypokalemia; patients receiving theophyllinederivatives or caffeine, severe renal impairment and crystalluria during ciprofloxacintherapy, and patients on coumarin therapy; children.
Route & Dosage
Uncomplicated UTI
 Adult:
 
PO
250 mg q12h or 500 mg XR q.d.
x
3 d.
IV
200 mg q12h, infused over 60 min
Complicated UTI
 Adult:
 
PO
1000 mg XR q.d.
x
7–14 d.
IV
400 mg q12h, infused over 60 min
Acute Sinusitis
 Adult:
 
PO
500 mg b.i.d.
x
10 d
Moderate to Severe Systemic Infection
 Adult:
 
PO
500–750 mg q12h
IV
200–400 mg q12h, infused over 60 min
Renal Impairment
Cl
cr 
30–50 mL/min:
PO
250–500 mg q12h,
IV
no change in dose; <30 mL/min:
PO
250– 500 mg q18h,
IV
200–400 mg q18–24h
Bacterial Conjunctivitis
 Adult:
 
Ophthalmic
1–2 drops in conjunctival sac q2h while awake for 2 d, then 1–2 dropsq4h while awake for the next 5 d
Ointment
1/2-inch ribbon into conjunctival sac t.i.d.times 2 d, then b.i.d. times 5 d
Corneal Ulcers
 Adult:
 
Ophthalmic
2 drops q15min for 6 h, 2 drops q30min for the next 18 h, then 2 dropsq1h for 24 h, then 2 drops q4h for 14 d
Administration
For patients with renal impairment, oral and IV doses are lowered according tocreatinine clearance.
Oral
Do not give an antacid within 4 h of the oral ciprofloxacin dose.
Intravenous
 
 
 PREPARE:
 
Intermittent:
Dilute in NS or D5W to a final concentration of 0.5–2 mg/mL.Typical dilutions are 200 mg in 100–250 mL and 400 mg in 250–500 mL.
 ADMINISTER:
 
Intermittent:
Give slowly over 60 min. Avoid rapid infusion and use of asmall vein.
 INCOMPATIBILITIES 
 
Solution/additive:
 
Aminophylline,
 
clindamycin,
 
heparin.
 
 Y-site:
Aminophylline,
 
ampicillin,
 
ampicillin/sulbactam,
 
cefepime,
 
dexamethasone,furosemide,
 
heparin,
 
hydrocortisone,
 
phenytoin,
 
propofol,
 
sodium bicarbonate,theophylline,
 
warfarin.
 
Discontinue other IV infusion while infusing ciprofloxacin or infuse throughanother site.
Reconstituted IV solution is stable for 14 d refrigerated.
Adverse Effects ( 1%)
GI:
Nausea, vomiting, diarrhea, cramps, gas, pseudomembranous colitis.
Metabolic:
Transient increases in liver transaminases, alkaline phosphatase, lactic dehydrogenase,and eosinophilia count.
Musculoskeletal:
Tendon rupture.
CNS:
Headache, vertigo,malaise, peripheral neuropathy, seizures (especially with rapid IV infusion).
Skin:
Rash, phlebitis, pain, burning, pruritus, and erythema at infusion site.
Special Senses:
 
 Local burning and discomfort, crystalline precipitate on superficial portion of cornea,
lidmargin crusting, scales, foreign body sensation, itching, and conjunctival hyperemia.
Diagnostic Test Interference
Ciprofloxacin does not interfere with
urinary glucose
determinations using
cupric sulfate solution
or with
 glucose oxidase tests;
may cause false positive on
opiate screening tests.
 
Interactions
Drug:
May increase
theophylline
levels 15–30%;
ANTACIDS
,
sulcralfate,
 
iron
decreaseabsorption of ciprofloxacin; may increase PT for patients on
warfarin.
 
Pharmacokinetics
Absorption:
60–80% absorbed from GI tract.
Ophthalmic:
Minimal absorption throughcornea or conjuctiva.
Onset:
Topical 0.5–2 h.
Duration:
Topical 12 h.
Peak:
1–2 h.
Distribution:
Widely distributed including prostate, lung, and bone; crosses placenta;distributed into breast milk.
Elimination:
Excreted primarily in urine with some biliaryexcretion.
Half-Life:
3.5–4 h.

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