Ciprofloxacin

Indications

Gram-Negative Rods

Gram-Positives

  • Enterococcus (see Enterococcus, [[Enterococcus]]): not recommended
  • Staphyloccus Aureus (see Staphyloccus Aureus, [[Staphyloccus Aureus]])
    • Methicillin-Sensitive Staphylococcus Aureus (MSSA): not recommended (as only levofloxacin/moxifloxacin/gemifloxacin are active)
    • Methicillin-Resistant Staphylococcus Aureus (MRSA): not recommended (as there are high levels of resistance to ciprofloxacin and newer fluoroquinolones)
  • Staphylococcus Epidermidis (see Staphylococcus Epidermidis, [[Staphylococcus Epidermidis]])
    • Methicillin-Sensitive Staphylococcus Epidermidis (MSSE): not recommended (as only levofloxacin/moxifloxacin/gemifloxacin are active)
    • Methicillin-Resistant Staphylococcus Epidermidis (MRSE): not recommended (as there are high levels of resistance to ciprofloxacin and newer fluoroquinolones)
  • Streptoccocus Pneumoniae (see Streptoccocus Pneumoniae, [[Streptoccocus Pneumoniae]]): newer fluoroquinolones have increased activity against Streptococcus Pneumoniae and other Gram-positive organisms, as compared to ciprofloxacin

Anerobes

  • Bacteroides (see Bacteroides, [[Bacteroides]]): not recommended (as moxifloxacin is the only current fluoroquinolone with clinically-significant anaerobic coverage)

Respiratory Pathogens

  • Chlamydophila Pneumoniae (see Chlamydophila Pneumoniae, [[Chlamydophila Pneumoniae]]): not recommended
  • Haemophilus Influezae (see Haemophilus Influezae, [[Haemophilus Influezae]]): not recommended
  • Legionella Pneumophila (see Legionellosis, [[Legionellosis]]): not recommended
  • Moraxella Catarrhalis (see Moraxella Catarrhalis, [[Moraxella Catarrhalis]]): not recommended
  • Mycoplasma Pneumoniae (see Mycoplasma Pneumoniae, [[Mycoplasma Pneumoniae]]): not recommended
  • Streptoccocus Pneumoniae (see Streptoccocus Pneumoniae, [[Streptoccocus Pneumoniae]]): newer fluoroquinolones have increased activity against Streptococcus Pneumoniae and other Gram-positive organisms, as compared to ciprofloxacin

Pharmacology

Metabolism

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Administration

  • PO:
  • IV:

Dose Adustment

  • Hepatic:
  • Renal

Adverse Effects

Cardiovascular Adverse Effects

Q-T Prolongation with Definite Association with Torsade (see Torsade, [[Torsade]])

  • Epidemiology: fluoroquinolones have a definite association with torsade
    • However, the risk of Q-T prolongation with fluoroquinolones is mainly related to additive effects with other Q-T prolonging drugs, as the risk when used alone is small
  • Physiology: dose-dependently block cardiac voltage-gated potassium channels -> delay in cardiac repolarization
    • Class Effect
  • Risk of Q-T Prolongation
    • High Risk
      • Gatifloxacin (Tequin) (see Gatifloxacin, [[Gatifloxacin]])
      • Grepafloxacin (Raxar) (see Grepafloxacin, [[Grepafloxacin]])
      • Moxifloxacin (Avelox, Avalox, Avelon) (see Moxifloxacin, [[Moxifloxacin]])
      • Sparfloxacin (Spacin, Zagam) (see Sparfloxacin, [[Sparfloxacin]])
    • Medium Risk
      • Gemifloxacin (see Gemifloxacin, [[Gemifloxacin]])
      • Levofloxacin (Levaquin) (see Levofloxacin, [[Levofloxacin]])
      • Ofloxacin (Floxin, Ocuflox) (see Ofloxacin, [[Ofloxacin]])
      • Sitafloxacin (Gracevit) (see Sitafloxacin, [[Sitafloxacin]])
      • Tosufloxacin (Ozex) (see Tosufloxacin, [[Tosufloxacin]])
    • Low Risk
      • Ciprofloxacin (Cipro)
    • Canadian Drug Safety and Effectiveness Research Network (CDSERN) Study of Sudden Death in Patients Co-Prescribed Sulfamethoxazole/Trimethoprim + Either ACE-I or ARB’s(2014) [MEDLINE]
      • Study: n = 39,879 sudden deaths -> 1027 occurred within 7 days of exposure to an antibiotic
      • Main Findings: ciprofloxacin was also associated with an increased risk of sudden death (adjusted odds ratio 1.29, 1.03 to 1.62)

Hematologic Adverse Effects

Orthopedic Adverse Effects

Other Adverse Effects

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References

  • Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population based study. BMJ. 2014;349:g6196