Ciprofloxacin Antibiotic

Ciprofloxacin-Fluoroquinolone

1. CIPROFLOXACIN “Success In Life Is A Result Of Decision. Failure In Life Is A Result Of Decision” Group: WinnerzKlub Inc. Year: 2019

2. What are Fluoroquinolones? The fluoroquinolones are synthetic, broad-spectrum agents with bactericidal activity. Examples include: ciprofloxacin, moxifloxacin, & norfloxacin & ofloxacin . The newer oral quinolones provide an alternative to β - lactams in the treatment of community acquired lower respiratory infections. Related structurally to Nalidixic acid.

3. (cont’d): Inhibitors of bacterial DNA synthesis-quinolones Inhibits cytochrome P450 (CYP₁A₂) Unfortunately , bacterial resistance to quinolones is increasing world-wide, & appropriate use is needed to extend their clinical use.

4. Bacterial resistance: Year Resistance 1987 Ciprofloxacin-resistant Escherichia coli (30-40%) 2007/2008 Ciprofloxacin-resistant Neisseria meningitidis reported in USA Enterobacteria Salmonella spp Staphylococcus aureus Vibrio cholerae

5. Ciprofloxacin: Is an example of a fluoroquinolone. Is not ototoxic. Ciprofloxacin & moxifloxacin are the only quinolones available for parenteral use . Used in ocular infections. Metabolized in liver and highly dependent on kidneys for excretion.

6. Mechanism of action: Interfere with bacterial topoisomerase II (DNA gyrase) & topoisomerase IV. the enzymes involved in the supercoiling of DNA that is necessary for the duplication, transcription & repair of bacterial DNA.

7. PARAMETERS: Oral bioavailability is 50-70 %. Half-life: 4hours May be used for lower UTIs. Usually administered in dosage of 500ml twice daily. NB: Avoid in childhood and pregnancy & in pts. taking corticosteroids. Should not be used in pts. with tendonitis.

8. ACTIONS : Ciprofloxacin ear drops (0.3%) & eye drops for severe conjunctivitis & bacterial keratitis . Useful in gram (-)ve septicaemia, skin & bone infections, urinary & respiratory tract infections, some sexually transmitted diseases such as gonorrhea & in severe cases of travelers' diarrhea. As alternative (single dose) in meningococcal meningitis

9. DRUG INTERACTIONS : DRUG POSSIBLE EFFECTS & MANAGEMENT Antacids, ferrous sulfate or sucralfate May decrease absorption of ciprofloxacin, reducing drug effectiveness. Administer quinolone at least 2hrs before these medications. Theophylline & other xanthines Ciprofloxacin & norfloxacin may inhibit the theophylline metabolism, resulting in increased theophylline plasma concentration & toxicity. Monitor theophylline plasma concentration closely, as dosage adjustments may be required. Thyroxine Decreases absorption of thyroxine from GIT. A 4hrs interval with administration of thyroxine. Iron Forms complexes with iron, reducing overall bioavailability

10. Side Effects: Gastric disturbances Photosensitive rashes Occasional neurotoxicity

11. Sa Oji: Sources: Pharmacology for Health Professionals, 4 th Ed., B.Bryant & K.Knights . Clinical Medicine, 8 th Ed., Kumar and Clarks.