Increased risk of aortic aneurysm and dissection esp. Discontinue at 1st sign of skin rash, jaundice, any other hypersensitivity, hepatitis, or photosensitivity. Monitor blood glucose in diabetic patients; discontinue if hypoglycemia occurs. History of joint-related disorders esp. Maintain adequate hydration, avoid alkaline urine to avoid crystalluria. May mask symptoms of syphilis; test for syphilis before treating gonorrhea, then follow-up after 3mos.
Avoid excessive sun or UV light. See Contraindications. Oral forms: take at least 2hrs before or 6hrs after magnesium- or aluminum-containing antacids, sucralfate, metal cations, multivitamins containing zinc or iron, or didanosine buffered forms. Severe hypoglycemia with oral antidiabetics eg, glyburide, glimepiride ; monitor. Potentiated by probenecid. Monitor renal function with concomitant cyclosporine. Monitor methotrexate, oral anticoagulants eg, warfarin , phenytoin, clozapine, ropinirole, sildenafil.
Reduced absorption with omeprazole XR. You may take this medicine with or without food. Drink plenty of fluids while you are using this medicine. Drinking extra water will help prevent some unwanted effects of ciprofloxacin.
Do not take this medicine alone with milk, yogurt, or other dairy products. Do not drink any juice with calcium added when you take this medicine. It is okay to have dairy products or juice as part of a larger meal when you take this medicine. It is best to take these medicines at least 2 hours before or 4 to 6 hours after taking ciprofloxacin. These medicines may keep ciprofloxacin from working properly. Keep using this medicine for the full treatment time, even if you feel better after the first few doses.
Your infection may not clear up if you stop using the medicine too soon. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. If you miss a dose of the oral liquid or tablet and it is 6 hours or more until your next regular dose, take the missed dose as soon as possible, and then go back to your regular schedule.
If you miss a dose and it is less than 6 hours until your next regular dose, skip the missed dose and take your next dose at the regular time. If you miss a dose of the extended-release tablet and it is 8 hours or more until your next regular dose, take the missed dose as soon as possible, and then go back to your regular schedule.
Instill the contents of 1 single use container 0. Discard used container. Otic Suspension Otiprio Gather all materials needed: Acute otitis externa: one vial of ciprofloxacin otic suspension; one 1 mL luer lock syringe for each affected ear; one 18 to 21 gauge preparation needle for each affected ear; one 20 to 24 gauge, 1. Ice pack and drape to keep the otic suspension vial cold is optional.
Otitis media with effusion: one vial of ciprofloxacin otic suspension; two 1 mL luer lock syringes; two 18 to 21 gauge preparation needles; two 20 to 24 gauge, 2 to 3 inch blunt, flexible administration needles; and alcohol pads. Ciprofloxacin suspension MUST be kept cold during preparation; if the suspension thickens during preparation, place vial back in refrigeration. Hold vial by the aluminum seal while shaking to prevent gelation.
Shake the vial for 5 to 8 seconds to mix well until a visually homogenous suspension is obtained. Withdraw 0. Replace the needle with a 20 to 24 gauge, 1. Prime the needle leaving a dose of 0. Using a different syringe, but the same vial, prepare a second syringe for the other ear if needed and dispose of the vial.
Storage: Syringes can be kept at room temperature or in the refrigerator for up to 3 hours prior to administration. Keep syringes on their side. Cetraxal : - Discard unused portion. Do not store for later use. Ciprofloxacin should not be used in patients with quinolone hypersensitivity. Serious and occasionally fatal hypersensitivity reactions have been reported in patients receiving quinolone therapy.
Some reactions were accompanied by cardiovascular collapse, loss of consciousness, tingling, pharyngeal or facial edema, dyspnea, urticaria, and pruritus. Severe hypersensitivity reactions characterized by rash, pyrexia or elevated body temperature, eosinophilia, angioedema, or other symptoms of an allergic reaction have been reported in patients receiving quinolone antibiotics.
Ciprofloxacin should be discontinued at the first appearance of a skin rash or any other sign of hypersensitivity. Serious anaphylactic reactions require immediate emergency treatment with epinephrine.
Oxygen, intravenous steroids, and airway management, including intubation, should be administered as indicated. Use ciprofloxacin cautiously in patients who have cardiac arrhythmias or other cardiac disease that predisposes to cardiac arrhythmias. Females, people 65 years and older, patients with sleep deprivation, pheochromocytoma, sickle cell disease, hypothyroidism, hyperparathyroidism, hypothermia, systemic inflammation e.
Blood glucose disturbances, including symptomatic hyperglycemia and hypoglycemia, have been reported in patients receiving systemic ciprofloxacin.
Hypoglycemia, sometimes resulting in coma, occurs more frequently in elderly patients or patients with diabetes mellitus who are receiving an oral hypoglycemic agent or insulin concomitantly with ciprofloxacin; carefully monitor blood glucose concentrations in these patients. Educate patients on the symptoms of hypoglycemia and how to treat if they experience hypoglycemia.
Discontinue ciprofloxacin if a hypoglycemic reaction occurs and initiate appropriate therapy immediately. Patients with diabetes may also be at an increased risk of developing detachment of the retina.
Use systemic ciprofloxacin with caution in patients with renal disease. Ciprofloxacin is eliminated primarily by renal excretion; however, the drug is also metabolized and partially cleared through the biliary system of the liver and through the intestine.
These alternative pathways of drug elimination appear to compensate for the reduced renal excretion in patients with renal impairment. Some modification of dosage is recommended in patients with renal impairment, including those with severe renal dysfunction or renal failure, and in patients receiving dialysis. Systemic ciprofloxacin should be used with caution in patients who have dehydration.
Crystalluria related to systemic use has been reported only rarely in humans because human urine is usually acidic. Alkalinization of the urine should be avoided in patients receiving ciprofloxacin. Hydrate patients well; hydration may help prevent the formation of highly concentrated urine and prevent crystalluria.
Use caution when administering ciprofloxacin to patients at risk for or with a preexisting history of hepatic disease. Ciprofloxacin has been associated with severe hepatotoxicity, including hepatic necrosis and hepatic failure both fatal and non-fatal.
Ciprofloxacin-induced hepatotoxicity is often associated with hypersensitivity, has a rapid onset 1 to 39 days , and may be hepatocellular, cholestatic or mixed. Of note, most patients experiencing fatal outcomes have been over the age of 55 years; therefore, caution is advised in older adults. Immediately discontinue use if signs and symptoms of hepatitis e. Patients receiving systemic ciprofloxacin and other fluoroquinolones have experienced phototoxic reactions.
Phototoxic reactions are characterized by an exaggerated sunburn reaction e. Patients should avoid direct or indirect artificial ultraviolet light or sunlight UV exposure even when using sunscreens during and for several days after ciprofloxacin therapy.
Ciprofloxacin therapy should be discontinued immediately at the first signs of phototoxicity. Almost all antibacterial agents, including systemic ciprofloxacin, have been associated with pseudomembranous colitis antibiotic-associated colitis which may range in severity from mild to life-threatening. In the colon, overgrowth of Clostridia may exist when normal flora is altered subsequent to antibacterial administration. The toxin produced by Clostridium difficile is a primary cause of pseudomembranous colitis.
It is known that systemic use of antibiotics predisposes patients to development of pseudomembranous colitis.
Consideration should be given to the diagnosis of pseudomembranous colitis in patients presenting with diarrhea following antibacterial administration. Systemic antibiotics should be prescribed with caution to patients with inflammatory bowel disease such as ulcerative colitis or other GI disease.
If diarrhea develops during therapy, the drug should be discontinued. Following diagnosis of pseudomembranous colitis, therapeutic measures should be instituted.
In milder cases, the colitis may respond to discontinuation of the offending agent. In moderate to severe cases, fluids and electrolytes, protein supplementation, and treatment with an antibacterial effective against Clostridium difficile may be warranted.
Products inhibiting peristalsis are contraindicated in this clinical situation. Practitioners should be aware that antibiotic-associated colitis has been observed to occur over 2 months or more following discontinuation of systemic antibiotic therapy; a careful medical history should be taken. While ciprofloxacin may be used to treat certain sexually transmitted diseases STD , the drug may mask or delay the symptoms of incubating syphilis when given as part of an STD treatment regimen.
Initiate appropriate therapy and perform follow-up testing as recommended based upon sexually transmitted disease diagnosis. Reserve systemic quinolones for use only when there are no alternative antibacterial treatments available in patients at risk for aortic dissection, including those with a history of aneurysm of the aorta or other blood vessels, peripheral atherosclerotic vascular diseases, hypertension, certain genetic conditions such as Marfan syndrome and Ehlers-Danlos syndrome, and elderly patients.
Epidemiologic studies report an increased rate of aortic dissection within 2 months after quinolone use, particularly in elderly patients. Systemic ciprofloxacin should be used cautiously in geriatric patients. Geriatric patients may be more susceptible to drug-associated hepatic and cardiac effects, including effects on the QT interval and aortic dissection, and may also be at increased risk for drug-associated tendon effects, especially in those receiving concomitant treatment with corticosteroids.
Dosage adjustments are recommended for older adults with renal dysfunction, and renal function monitoring may be useful during therapy. Antibiotics are non-selective and may result in the eradication of beneficial microorganisms while promoting the emergence of undesired ones, causing secondary infections such as oral thrush, colitis, or vaginitis.
Monitor for GI side effects and hypersensitivity reactions. Per OBRA, use should be avoided in individuals with prolonged QTc intervals or who are receiving selected antiarrhythmic agents.
Caution is warranted when prescribing systemic ciprofloxacin for neonates, infants, children, and adolescents for infections not listed in the approved labeling. One retrospective study compared the rate of tendon or joint disorders in more than 7, pediatric patients less than 19 years old who received ciprofloxacin, ofloxacin, or levofloxacin with more than 20, patients who received azithromycin. The authors state that this incidence is likely to reflect the background incidence of these disorders in pediatric patients.
Whenever clinical judgment dictates, examine patients receiving ophthalmic ciprofloxacin with the aid of magnification, such as slitlamp biomicroscopy, and where appropriate, fluorescein staining. Advise patients not to wear contact lenses if they have signs and symptoms of bacterial conjunctivitis. Systemic ciprofloxacin can cause dizziness and light-headedness; therefore, patients should know how they react to the drug before driving or operating machinery or engaging in an activity requiring mental alertness or coordination.
Based on case reports, case-control studies, and observational studies of ciprofloxacin administered during pregnancy, prolonged experience with systemic ciprofloxacin in pregnant women over several decades has not identified any drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes.
Available studies have methodological limitations including small sample size and lack of specificity for ciprofloxacin. There were no musculoskeletal dysfunctions up to 1 year of age in the ciprofloxacin exposed children. No differences in the rates of prematurity, spontaneous abortions, or low birth weight were seen in women exposed to ciprofloxacin during pregnancy; however, these small postmarketing epidemiology studies are insufficient to evaluate the risk for less common defects or to permit reliable definitive conclusions regarding the safety of ciprofloxacin in pregnant women and their developing fetuses.
Animal studies have not been conducted with otic ciprofloxacin. Because of the negligible systemic exposure associated with otic ciprofloxacin, it is expected to be of minimal risk for maternal and fetal toxicity when administered to pregnant women. Use caution when administering otic ciprofloxacin to a pregnant woman. Ciprofloxacin is present in human breast milk after intravenous and oral administration.
There is no information regarding the effects of ciprofloxacin on milk production or the breast-fed infant. Because of the potential for serious adverse reactions e.
Alternatively, advise a woman that breast-feeding is not recommended during treatment with systemic ciprofloxacin and for an additional 2 days after the last dose. However, for inhalational anthrax post-exposure , during an incident resulting in exposure to anthrax, the risk-benefit assessment of continuing breast-feeding while the mother and potentially the infant is receiving ciprofloxacin may be acceptable.
Consider the developmental and health benefits of breast-feeding along with the monther's clinical need for ciprofloxacin and any potential adverse effects on the breast-fed child from ciprofloxacin or the underlying maternal condition. Ciprofloxacin may cause intestinal flora alteration of the breast-feeding infant.
Monitor the breast-fed infant for loose or bloody stools and candidiasis i. Use caution when administering ophthalmic ciprofloxacin to a breast-feeding woman. Nursing infants of mothers receiving otic ciprofloxacin should not be affected. However, because of the potential for serious adverse reactions in nursing infants, discontinue breast-feeding or discontinue otic ciprofloxacin, taking into account the importance of the drug to the mother.
However, assess site of infection, patient factors, local susceptibility patterns, and specific microbial susceptibility before choosing an alternative agent. Previous American Academy of Pediatrics AAP recommendations considered ofloxacin, trimethoprim in combination with sulfamethoxazole , and ceftazidime to be usually compatible with breast-feeding.
PDR Search. Required field. Your Name Your name is required. Recipient's Email Separate multiple email address with a comma Please enter valid email address Recipient's email is required. Thank you. Your email has been sent. Jump to Section. Arteriosclerosis, cerebrovascular disease, neurotoxicity, peripheral neuropathy, psychiatric event, seizure disorder, stroke. For the treatment of acute, uncomplicated UTI acute cystitis. Oral dosage regular tablets.
Oral dosage extended-release tablets. Oral dosage immediate-release formulations.
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