Ciprofloxacin

Introduction - What is Ciprofloxacin?

Ciprofloxacin is a fluoroquinolone antibiotic. More precisely, it is a second generation fluoroquinolone. Like all antibiotics, it is used to treat bacterial infections. Ciprofloxacin unfolds its spectrum of action particularly in the area of ​​gram-negative rods.

Read more on the subject at: Fluoroquinolones

Rod bacteria are all types of bacteria that look rather elongated under the microscope (in contrast to the so-called cocci, which are spherical bacteria). The term "gram negative" is a description of the bacterial property in a special staining method (Gram staining).

Gram-negative rods are, in most cases, bacteria found in the digestive tract (Enterobacteria). These can be treated particularly well with ciprofloxacin. Newer substances from the group of fluoroquinolones are also effective against other groups of bacteria. Ciprofloxacin is used as a broad-spectrum antibiotic in diseases that are primarily triggered by bacteria from the digestive tract.

Indications

The indications for therapy with ciprofloxacin are diverse, as it is an antibiotic with a very broad spectrum of activity.

For example, ciprofloxacin plays an important role in the treatment of infections with Pseudomonas. This type of bacteria often causes infections that those affected catch in hospital. The most common diseases are pneumonia (nosocomial pneumonia) and urinary tract infection (nosocomial urinary tract infection).

Read more on the subject at: Nosocomial infection

In addition, many other diseases can be covered with the spectrum of activity of ciprofloxacin. For example, bacterial infections of the eye are treated with a special eye ointment containing ciprofloxacin.

Infections of the genital organs or of joints and soft tissues can also be treated with ciprofloxacin. In the gastrointestinal tract, ciprofloxacin plays a role in the treatment of severe gastrointestinal infections. Diverticulitis (inflammation of pouches in the large intestine) can also be treated with ciprofloxacin. Acute inflammation of the pancreas (Pancreatitis) can optionally be treated with ciprofloxacin. Further indications for ciprofloxacin are, for example, the treatment of infections with salmonella.

Active ingredient and effect

Ciprofloxacin is an antibiotic and therefore effective in the area of ​​bacterial infections. It belongs to the group of fluoroquinolones. Ciprofloxacin develops its effect via a so-called gyrase inhibition.

Gyrase is an enzyme that is required in bacteria to multiply the genetic material. The gyrase of bacteria is also called topoisomerase II. By inhibiting this topoisomerase II, the bacteria can no longer copy their genetic material (DNA). This inhibits the growth of the bacterial colony (bacteriostatic) and the bacteria then die (bactericidal).

In addition to gyrase inhibition, other mechanisms of action of ciprofloxacin are also being discussed, as its effectiveness cannot be explained by the inhibition of gyrase alone. So far, however, no specific mechanisms of action have been confirmed in experiments.

The mode of action of Ciprofloxacin is particularly effective because the active ingredient is very tissue-permeable. This property describes the ability of ciprofloxacin to spread particularly well in the tissue. Therefore, it is well suited for the treatment of many tissue infections including bones.

Side effects

Like all antibiotics, ciprofloxacin also has side effects, which are primarily based on the desired effect (the killing of bacteria). Treatment with ciprofloxacin not only kills the bacteria that cause the disease. Ciprofloxacin can also inhibit and kill bacteria that naturally occur in the body in the digestive tract and on the skin.

This mainly leads to side effects in the digestive tract such as nausea, vomiting, diarrhea and abdominal pain. Killing bacteria on the skin causes problems, especially for people with a weakened immune system. Instead of the protective bacteria, other pathogens such as fungi settle on the skin.If these cannot be fought adequately by the immune system, a fungal infection occurs.

Also read: Skin fungus

Other side effects of ciprofloxacin include disorders of nerve functions. This becomes noticeable in the form of memory disorders or disorders of the senses. In connection with therapy with ciprofloxacin, joint and muscle pain have recently been discussed more frequently, and tendon injuries are also more common.

Read more on the subject at: Achilles tendonitis caused by antibiotics

The heart rhythm can also be influenced by fluoroquinolones such as ciprofloxacin. As a side effect, the so-called QT time can be increased.
If the liver is already damaged, ciprofloxacin can also cause severe liver failure; acute liver failure has rarely been reported in people with healthy liver.

People at risk for diseases of the aorta such as aortic aneurysms (bulging of the main artery) or dissections (tears in the vascular wall) can result in a significant increase in risk and thus in some cases fatal side effects from taking ciprofloxacin.

Read more on the subject at: Antibiotic side effects

Interactions

Ciprofloxacin can interact with drugs in a number of ways. Substances that have side effects similar to those of ciprofloxacin are of particular importance. Drugs that cause cardiac arrhythmias, for example, in combination with ciprofloxacin can aggravate this problem. Substances that increase the risk of damage to the vessel walls can also interact with ciprofloxacin and thus cause aortic aneurysms or dissections.

In addition, the metabolism of ciprofloxacin also plays an important role. For example, ciclosporin and ciprofloxacin are both partially excreted through the kidneys. Simultaneous therapy with both active ingredients can damage the kidneys. In the liver, on the other hand, there can be an interaction with blood thinners or immunosuppressants.

The information for healthcare professionals should be checked for possible interactions with ciprofloxacin for every person who takes several drugs, as this antibiotic is processed by enzymes that are particularly frequently used in drug metabolism.

Ciprofloxacin and alcohol - are they compatible?

Ciprofloxacin is primarily metabolized in the liver and then excreted in both the liver and the kidneys. When consuming alcohol, there can therefore be interactions, as the alcohol must also be processed in the liver. Therefore, if the substances are present in the body at the same time, they can influence each other.

For example, the double stress on the liver can mean that the substances are broken down more slowly and remain in the body longer. So if you take ciprofloxacin and drink alcohol at the same time, you must expect to get drunk from a smaller amount of alcohol. It also takes longer for the alcohol to be completely eliminated from the blood.

With ciprofloxacin, a metabolic process in the liver is first necessary for the antibiotic to be fully effective. This process can be slowed down by consuming alcohol, so that the onset of action is delayed. At the same time, the ciprofloxacin is broken down more slowly, so that the simultaneous consumption of alcohol results in higher active levels, which can be toxic. This can, for example, increase the side effects of ciprofloxacin or these side effects last longer.

Effectiveness of the pill

Due to the common metabolic processes of ciprofloxacin and the pill, taking the medication at the same time can make the pill less effective. At the same time, taking the pill can also affect the way ciprofloxacin works.

Since not all pill preparations have been tested for interactions with ciprofloxacin, no general statement can be made.However, it must be assumed that the effectiveness of the pill is somewhat reduced when concomitantly treated with ciprofloxacin, so that one cannot rely on its protection.

Only when the ciprofloxacin has already been discontinued for a few days can one assume that the substance has been completely eliminated from the body and that the pill is fully effective again. Depending on the pill preparation, however, the time it takes to achieve the full effective level can vary.

Also read: Which drugs affect the way the pill works?

Contraindications - When should ciprofloxacin not be given?

The main contraindications to ciprofloxacin exist in the event of intolerance or allergic reactions to the active ingredient or other substances contained in the drug. In these cases, ciprofloxacin should never be given. Even if serious complications have previously occurred during treatment with an antibiotic from the group of fluoroquinolones, therapy with ciprofloxacin should not be repeated.

For example, anyone who has had central nervous side effects or visual problems during or after fluoroquinolone therapy should be treated with other antibiotics in the future. Even if there is an increased risk of cardiac arrhythmias or vascular diseases, ciprofloxacin should only be used with caution.

Since there are no data on the use of ciprofloxacin in children and adolescents, the therapy in the pediatric and adolescent medical field is at least a relative contraindication.

dosage

The dosage of ciprofloxacin depends on the indication as well as the form of administration (i.e. the form in which the antibiotic is taken).

When taken in tablet form, an adult can take 250 to 500 mg in the morning and evening. 400 mg is usually given as an infusion via a vein two to three times a day. The duration of the intake is recommended for five to fourteen days, depending on the disease, the affected organ and the severity of the disease.

In children, the dosage is based on body weight. Recommended are 20 to 30 mg / kg per day, divided over two to three times of intake. Here, too, the exact dosage and the duration of use depend on the underlying disease.

Particular attention must be paid to the dosage in diseases of the liver and kidneys. The dosage usually has to be adjusted (reduced) based on the liver or kidney function that is still present. Either a smaller amount of ciprofloxacin can be taken at each time of intake or the intervals between the individual ingestions can be increased.

price

The price for the ciprofloxacin depends on the amount of the active ingredient and the dosage form. Anyone who takes ciprofloxacin in the outpatient setting, for example in the form of tablets or juice, usually only pays the prescription fee of € 5.

For intravenous therapy in the clinic, the therapy costs are usually fully covered by the health insurance. Those who are privately insured, on the other hand, often have to present the fee for the medication to the pharmacy, but they are usually reimbursed. Depending on the pack size and dosage, the price for ciprofloxacin tablets is between € 15 and € 30.

Alternatives

Alternatives to ciprofloxacin are usually offered by other antibiotics from the group of fluoroquinolones. They work almost exactly the same way, but they may be effective when people cannot receive ciprofloxacin.

On the other hand, intolerance to ciprofloxacin often leads to a reaction to other fluoroquinolones, which is why it is usually preferable to switch to another class of antibiotics. Antibiotic agents such as penicillins and cephalosporins are often used in bacterial infections.

An antibiogram can be used to determine which antibiotics are most effective, for example. The bacteria obtained from the infected area of ​​the body are grown in a so-called culture and then tested for their effectiveness against typical antibiotics. After this test, a statement can be made about which antibiotics the bacteria are sensitive to (they can be treated with these antibiotics) and to which they are resistant. This sensitivity and resistance is shown in the antibiogram. Therefore, alternative active ingredients can be read on the antibiogram after a few days.

Is it possible to take it during pregnancy and breastfeeding?

Ciprofloxacin must not be used during pregnancy and breastfeeding. The main reason for this is that insufficient data are available on whether ciprofloxacin can harm the unborn or breast-fed child. In some cases, however, data are also available that indicate possible damage, which is why ciprofloxacin is not used during pregnancy or breastfeeding.

Instead, however, the use of old fluoroquinolones (from the first group) such as norfloxacin is possible after carefully weighing the benefits and risks during breastfeeding. Other classes of antibiotics must be used during pregnancy. The decision about the right antibiotic therapy must be discussed with the attending physician. A temporary break from breastfeeding is also possible during breastfeeding if antibiotic therapy is absolutely necessary.

Also read: Antibiotics in Pregnancy and Antibiotics while breastfeeding