CIPRIND 500

Indications

• Urinary tract infections
• Respiratory tract infections
• Skin and soft tissue infections
• Bone and joint infections
• Intra-abdominal infections
• Gastroenteritis
• Typhoid fever
• Anthrax prophylaxis

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations in paediatric populations, considering age, weight, and clinical condition.

Adults: Refer to the BNF for specific dosing guidelines, as dosing may vary based on the type and severity of infection, renal function, and other clinical factors.

Mechanism of action

Ciprofloxacin exerts its bactericidal effect primarily through the inhibition of DNA gyrase and topoisomerase IV, enzymes crucial for bacterial DNA replication and maintenance. By disrupting these pathways, ciprofloxacin prevents the bacteria from replicating and repairing their DNA, ultimately leading to cell death.

Pharmacodynamics

Ciprofloxacin demonstrates concentration-dependent killing, with efficacy related to the maximum concentration of the drug achieved in the serum. The drug exhibits a post-antibiotic effect, meaning that its antibacterial activity can persist even after serum concentrations have fallen below the minimum inhibitory concentration (MIC) for a duration after drug administration.

Pharmacokinetics

Ciprofloxacin is well absorbed after oral administration, with peak plasma concentrations occurring within 1 to 2 hours. It is widely distributed throughout the body, including into tissues and body fluids. The drug undergoes hepatic metabolism and is primarily eliminated via the kidneys, with around 40-50% of the dose excreted unchanged in the urine. The half-life is approximately 4 hours in healthy adults, but this can vary based on renal function.

Contra-indications

• Hypersensitivity to ciprofloxacin or other quinolone antibiotics
• Tendon disorders related to fluoroquinolone use
• Children and adolescents (unless no alternative treatment is available), due to risk of musculoskeletal toxicity

Adverse effects

• Nausea
• Diarrhea
• Headache
• Dizziness
• Rash
• Tendon rupture
• QT interval prolongation
• Photosensitivity

Interactions

• Antacids containing magnesium or aluminum can reduce the absorption of ciprofloxacin
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of CNS stimulation
• Warfarin levels may be increased when taken with ciprofloxacin, requiring monitoring of INR
• Cation-containing products (such as supplements with calcium, iron, or zinc) can interfere with ciprofloxacin absorption

Precautions

• Use with caution in patients with a history of seizures or renal impairment
• Monitor for signs of tendonitis or tendon rupture, particularly in older patients
• Consider alternative therapies in patients with known QT interval prolongation or on medications that prolong the QT interval
• Assess for potential Clostridium difficile infection in patients with diarrhea

Pregnancy

Ciprofloxacin is classified as Pregnancy Category C. It should only be used if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Ciprofloxacin is excreted in breast milk; use caution and consider the risks versus benefits when prescribing to nursing mothers.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Oral tablets
• Oral suspension
• Intravenous solution
• Ophthalmic solution