Instructions for use CIPROFLOXACIN

Compound

Ciprofloxacin ear and eye drops contain ciprofloxacin hydrochloride at a concentration of 3 mg/ml (in terms of pure substance), Trilon B, benzalkonium chloride, sodium chloride, purified water.
The active substance is also contained in the eye ointment at a concentration of 3 mg/ml.

Ciprofloxacin tablets: 250, 500 or 750 mg of ciprofloxacin, MCC, potato starch, corn starch, hypromellose, croscarmellose sodium, talc, magnesium stearate, colloidal anhydrous silicon dioxide, macrogol 6000, additive E171 (titanium dioxide), polysorbate 80.

The solution for infusion contains the active substance at a concentration of 2 mg/ml. Excipients: sodium chloride, disodium edetate, lactic acid, diluted hydrochloric acid , water for injection.

Pharmacodynamics and pharmacokinetics

Is ciprofloxacin an antibiotic or not?

The antibiotic Ciprofloxacin is an early fluoroquinolone (1st generation drug) and is used mainly for hospital infections . The drug penetrates well into cells and tissues (including bacterial cells and macroorganisms) and has good pharmacokinetic parameters.

Pharmacodynamics

The mechanism of action of the drug is due to the ability to inhibit DNA gyrase (an enzyme in bacterial cells) with disruption of DNA synthesis, division and growth of microorganisms.

Wikipedia states that the use of the drug does not develop resistance to other antibiotics . This makes Ciprofloxacin highly effective against bacteria resistant to penicillins , caminoglycosides , tetracyclines , cephalosporins and a number of other antibiotics .

Shows the greatest activity against Gram (-) and Gram (+) aerobes: H. influenzae, N. gonorrhoeae, Salmonella spp., P. aeruginosa, N. meningitidis, E. coli, Shigella spp.

Effective against infections caused by: strains of staphylococci (including those producing penicillinase), certain strains of enterococci , legionella , campylobacteria , chlamydia , mycoplasmas , mycobacteria .

Active against beta-lactamase-producing microflora.

Anaerobes are moderately sensitive or resistant to the drug. Therefore, in patients with mixed anaerobic and aerobic infection, treatment with ciprofloxacin should be supplemented with lincosamides or Metronidazole .

Resistant to the antibiotic are: Ureaplasma urealyticum, Streptococcus faecium, Treponema pallidum, Nocardia asteroides.

Resistance of microorganisms to the drug develops slowly.

Pharmacokinetics

After taking the tablet, the drug is quickly and completely absorbed into the gastrointestinal tract.

Main pharmacokinetic parameters:

• bioavailability - 70%;
• TCmax in blood plasma - 1–2 hours after administration;
• T½ - 4 hours

From 20 to 40% of the substance binds to plasma proteins. Ciprofloxacin is well distributed in biological fluids and tissues of the body, and its concentration in tissues and fluids can significantly exceed plasma concentrations.

It penetrates the cerebrospinal fluid through the placenta, is excreted into breast milk, and high concentrations are recorded in bile. Up to 40% of the dose taken is eliminated unchanged within 24 hours by the kidneys, part of the dose is excreted in the bile.

Ciprofloxacin (for infusion), 1 piece, 100 ml, 2 mg/ml, solution for intravenous administration

Suction

After an intravenous infusion of the drug at a dose of 200 mg or 400 mg, Cmax is reached after 60 minutes and is 2.1 μg/ml and 4.6 μg/ml, respectively.

Distribution

Plasma protein binding - 20-40%. Vd - 2-3 l/kg. Ciprofloxacin is well distributed in body tissues (with the exception of fat-rich tissues, such as nervous tissue). The antibiotic content in tissues is 2-12 times higher than in plasma. Therapeutic concentrations are achieved in saliva, tonsils, liver, gall bladder, bile, intestines, abdominal and pelvic organs, uterus, seminal fluid, prostate tissue, endometrium, fallopian tubes and ovaries, kidneys and urinary organs, lung tissue, bronchial secretions , bone tissue, muscles, synovial fluid and articular cartilage, peritoneal fluid, skin. It penetrates into the cerebrospinal fluid in a small amount, where its concentration in non-inflamed meninges is 6-10% of that in the blood serum, and in inflamed meninges - 14-37%. Ciprofloxacin also penetrates well into the ocular fluid, bronchial secretions, pleura, peritoneum, lymph, and through the placenta. The concentration of ciprofloxacin in blood neutrophils is 2-7 times higher than in serum. The activity of ciprofloxacin is slightly reduced at acidic pH values.

Excreted in breast milk.

Metabolism

Metabolized in the liver (15-30%) with the formation of low-active metabolites (diethylciprofloxacin, sulfociprofloxacin, oxociprofloxacin, formylciprofloxacin).

Removal

With intravenous administration, T1/2 is 5-6 hours. It is excreted mainly by the kidneys by tubular filtration and tubular secretion in unchanged form (with intravenous administration - 50-70%) and in the form of metabolites (with intravenous administration - 10%), the rest - through the gastrointestinal tract. After intravenous administration, the concentration in urine during the first 2 hours after administration is almost 100 times higher than in serum, which significantly exceeds the MIC for most pathogens of urinary tract infections.

Renal clearance - 3-5 ml/min/kg; total clearance - 8-10 ml/min/kg.

Pharmacokinetics in special clinical situations

In chronic renal failure (creatinine clearance>20 ml/min), the percentage of the drug excreted through the kidneys decreases, but accumulation in the body does not occur due to a compensatory increase in drug metabolism and excretion through the gastrointestinal tract. T1/2 in chronic renal failure increases to 12 hours.

Indications for use of Ciprofloxacin

Ciprofloxacin - what are these tablets/solution for?

Ciprofloxacin is prescribed for the treatment of infectious diseases of the ENT organs, pelvic organs, bones, skin, joints, abdominal cavity, respiratory tract, urogenital and postoperative infections caused by flora sensitive to the drug.

The drug can be used in patients with immunodeficiency conditions (including conditions that develop with neutropenia , or are caused by the use of immunosuppressants ).

Ciprofloxacin (like other early fluoroquinolones) is the drug of choice for the treatment of UTIs, including but not limited to hospital-acquired infections.

Due to their ability to penetrate well into tissues and, in particular, into prostate tissue, fluoroquinolones have practically no alternative in the treatment of bacterial prostatitis .

Showing high activity against the most likely pathogens of hospital pneumonia ( Staphylococcus aureus , Enterobacteriaceae and Pseudomonas aeruginosa ), it is important for pneumonia associated with the need for artificial ventilation.

If the causative agent of the disease is P. aeruginosa, its sensitivity to ciprofloxacin should be established before prescribing the drug. This is due to the fact that in intensive care units more than a third of Pseudomonas aeruginosa are resistant to the drug.

The drug is important for intra-abdominal surgical infections and infections of the hepatobiliary system . To prevent infection, it can be prescribed to patients with pancreatic necrosis .

Fluoroquinolones are not used for CNS infections. This is due to their low penetration (penetration) into the cerebrospinal fluid. At the same time, they are effective against meningitis , the causative agents of which are Gram (-) bacteria resistant to 3rd generation cephalosplorins.

The presence of several dosage forms allows the drug to be used for step-down therapy. When switching from IV administration of Ciprofloxacin to oral administration, the oral dose should be increased in order to maintain therapeutic concentrations.

So, if a patient was prescribed 100 mg intravenously, then he should take 250 mg orally, and if 200 mg was administered intravenously, then 500 mg.

What is the medicine for in the form of eye/ear drops?

In ophthalmology it is used for superficial bacterial infections of the eye (s) and its appendages, as well as for ulcerative keratitis .

Indications for the use of Ciprofloxacin in otology: acute bacterial otitis of the external ear and acute bacterial otitis of the middle ear in patients with a tympanostomy tube .

Ciprofloxacin, solution for infusion 0.8 mg/ml and 2.0 mg/ml

Disabling and potentially irreversible serious adverse reactions including tendonitis and tendon rupture, peripheral neuropathy and central nervous system disorders.

Fluoroquinolones, including ciprofloxacin, have been associated with disabling and potentially irreversible serious adverse reactions across multiple body systems that can occur in the same patient. These reactions include tendinitis, tendon rupture, arthralgias, myalgias, peripheral neuropathy, and central nervous system disorders (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion). Reactions may occur within hours to several weeks after starting ciprofloxacin. They have been observed in patients of any age and even without pre-existing risk factors.

If the first signs or symptoms of any serious adverse reactions appear, treatment should be stopped immediately. In addition, it is recommended to avoid the use of fluoroquinolones, including ciprofloxacin, in patients who have experienced any of the reported serious fluoroquinolone-related adverse reactions.

Because the use of fluoroquinolones, including ciprofloxacin, has been associated with the above serious adverse reactions, ciprofloxacin should be used only as a reserve antibiotic in patients for whom there are no alternative treatment options for the following indications: exacerbation of chronic pulmonary disease, acute uncomplicated infections urinary tract, acute sinusitis (exacerbation of chronic sinusitis).

Severe infections and mixed infections caused by gram-positive bacteria and anaerobic pathogens. Ciprofloxacin monotherapy is not intended for the treatment of severe infections and infections that may be caused by gram-positive bacteria or anaerobic microorganisms. In the case of such infections, appropriate antibacterial agents should be used simultaneously with ciprofloxacin.

Streptococcal infections (including Streptococcus pheumoniae). Ciprofloxacin is not recommended for the treatment of streptococcal infections due to lack of effectiveness.

Genital tract infections. Epididymitis orchioepididymitis and pelvic inflammatory disease can be caused by fluoroquinolone-resistant Neisseria gonorrhoeae. Ciprofloxacin should be used in conjunction with other appropriate antibacterial agents unless resistance to Neisseria gonorrhoeae can be excluded. If clinical improvement does not occur after 3 days of treatment, treatment should be reconsidered.

Intra-abdominal infections. Data on the effectiveness of ciprofloxacin in the treatment of postoperative intra-abdominal infections are limited.

Travelers' diarrhea. When prescribing ciprofloxacin, information on the resistance of relevant pathogens to it in the countries visited by the patient should be taken into account.

Bone and joint infections. Ciprofloxacin should be used in combination with other antimicrobial agents, depending on the results of microbiological analysis.

Inhalation form of anthrax. The use of a drug in humans is based on in vitro susceptibility data, data from experimental animal models and a small amount of data for humans. The physician should familiarize himself with national and/or internationally recognized documentation on the treatment of anthrax.

Children

Treatment with ciprofloxacin should only be used by doctors who have extensive experience in treating cystic fibrosis and/or severe infectious diseases in children and adolescents. An experimental connection has been established between the use of ciprofloxacin and arthropathy of supporting joints in immature animals. Safety data obtained from clinical studies with ciprofloxacin in children have identified arthropathies possibly associated with treatment with this antibiotic. Therefore, ciprofloxacin therapy in children should only be started after a careful benefit/risk assessment due to possible side effects associated with the joints and/or surrounding tissues.

Bronchopulmonary infections in cystic fibrosis. Clinical trials included children and adolescents aged 5-17 years. Experience with children aged 1 to 5 years is limited.

Complicated urinary tract infections and pyelonephritis. In the treatment of urinary tract infections, ciprofloxacin should be used when other treatments are not suitable and based on the results of microbiological studies. Clinical trials included children and adolescents aged 1-17 years.

Other specific infections. For the treatment of other serious infections, ciprofloxacin is used according to official guidelines or after a careful benefit/risk assessment if other therapy is not possible, or after standard treatment has failed and if microbiological data justify the use of ciprofloxacin.

The use of ciprofloxacin for the treatment of serious infections other than those mentioned above has not been studied in clinical trials, and clinical experience is limited. Therefore, caution is recommended when treating patients with these infections.

Increased sensitivity. After a single dose of ciprofloxacin, allergic reactions may occur, including anaphylactic and anaphylactoid reactions, which can be life-threatening. If such reactions occur, the use of ciprofloxacin should be discontinued and, if necessary, appropriate medical attention should be provided.

Musculoskeletal system. Ciprofloxacin should not be used in patients with a history of tendon disease/damage associated with quinolone treatment. However, in some cases, after microbiological identification of the causative agent and a benefit-risk assessment, ciprofloxacin may be prescribed to such patients for the treatment of certain severe infections, particularly in cases of failure of standard therapy or bacterial resistance, where microbiological data may justify the use of ciprofloxacin.

Tendinitis and rupture of tendons (especially Achilles), sometimes bilateral, can occur within the first 48 hours after using ciprofloxacin. The risk of tendinopathy may increase in elderly patients or in the case of concomitant use of corticosteroids.

If any signs of tendinitis (eg, painful swelling, inflammation) occur, ciprofloxacin should be discontinued. Ciprofloxacin should be used with caution in patients with myasthenia gravis.

Photosensitivity. It has been established that ciprofloxacin can cause photosensitivity reactions. Patients using ciprofloxacin should avoid direct exposure to excessive sunlight or ultraviolet radiation during treatment.

Central nervous system. Quinolones are known to induce convulsions or reduce the threshold for their occurrence. Ciprofloxacin should be used with caution in patients with central nervous system disorders. If seizures occur, use of ciprofloxacin should be discontinued. Mental reactions may appear after the first use. In rare cases, depression or psychosis can progress to the point where the patient's behavior becomes life-threatening. In such cases, ciprofloxacin should be discontinued.

Cases of polyneuropathy (based on neurological symptoms such as pain, burning, sensory disturbances or muscle weakness, alone or in combination) have been reported in patients receiving ciprofloxacin. In patients experiencing symptoms of neuropathy, including pain, burning, tingling, numbness and/or weakness in the extremities, ciprofloxacin should be discontinued to prevent the development of an irreversible condition.

If undesirable reactions occur, including tendon pain, joint and muscle pain, tingling or tingling sensations, confusion and hallucinations, you should immediately inform your doctor!

Cardiac disorders. Due to the fact that the use of ciprofloxacin is associated with a risk of prolongation of the QT interval and the development of torsades de pointes arrhythmia, caution should be exercised when treating patients with risk factors:

- congenital long QT syndrome;

- simultaneous use of drugs that are known to prolong the QT interval (for example, IA and class III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics);

- uncorrected electrolyte imbalance (eg, hypokalemia, hypomagnesemia);

- heart disease (for example, heart failure, myocardial infarction, bradycardia).

Elderly patients and women may be more sensitive to QT prolongation.

Gastrointestinal tract. The occurrence of severe and persistent diarrhea during or after treatment (including several weeks after treatment) may indicate antibiotic-associated colitis (life-threatening and possibly fatal), which requires immediate treatment. In such cases, the use of ciprofloxacin should be stopped immediately and appropriate therapy should be initiated. In this situation, antiperistaltic drugs are contraindicated.

Kidneys and urinary tract. Cases of crystalluria have been reported associated with the use of ciprofloxacin. Therefore, patients receiving ciprofloxacin should be well hydrated. Excessive alkalization of urine should also be avoided.

Hepatobiliary system. Cases of life-threatening liver necrosis and liver failure have been reported with the use of ciprofloxacin. If any signs and symptoms of liver disease occur (eg, anorexia, jaundice, dark urine, itching, or abdominal tenderness), treatment with the drug should be discontinued.

Glucose-6-phosphate dehydrogenase deficiency. During treatment with ciprofloxacin, hemolytic reactions were observed in patients with glucose-6-phosphate dehydrogenase deficiency. Ciprofloxacin should be avoided in these patients unless the potential benefit outweighs the potential risk. In such cases, monitoring for the potential occurrence of hemolysis is recommended.

Resistance. During or after a course of treatment with ciprofloxacin, bacteria that demonstrate resistance to ciprofloxacin may be isolated, with or without clinically obvious superinfection. The risk of isolating ciprofloxacin-resistant bacteria increases during long courses of treatment and during the treatment of nosocomial infections and/or infections caused by staphylococci and Pseudomonas aeruginosa.

Cytochrome P450. Ciprofloxacin inhibits the cytochrome CYP1A2 isoenzyme and therefore may lead to increased serum concentrations of concomitantly administered substances that are metabolized by this enzyme (for example, theophylline, clozapine, ropinirole, tizanidine). The combined use of ciprofloxacin and tizanidine is contraindicated. Patients receiving ciprofloxacin concomitantly with drugs metabolized by CYP1A2 should be monitored for clinical signs of overdose, and serum concentrations of these substances (e.g., theophylline) may need to be monitored.

Methotrexate. Concomitant use of ciprofloxacin with methotrexate is not recommended (see section “Interaction with other drugs”).

Hypoglycemia. As with the use of other quinolones, cases of hypoglycemia have been reported during the use of ciprofloxacin, most often in patients with diabetes mellitus, especially in the elderly. Close monitoring of blood glucose levels is recommended in all patients with diabetes.

Visual impairment. If blurred vision or other eye problems occur, you should consult an ophthalmologist.

Interaction with tests. Under in-vitro conditions, the activity of ciprofloxacin against Mycobacterium tuberculosis may produce a false negative result in bacteriological testing of specimens collected from patients receiving ciprofloxacin.

Infusion site reactions. Local reactions have been reported in response to intravenous administration of ciprofloxacin. These reactions were more likely to occur when the infusion time was 30 minutes or less. These are local skin reactions that resolve quickly after completion of the infusion. Subsequent intravenous administration is not contraindicated unless reactions recur or worsen.

Additional information about some excipients. 100 ml of a drug with a concentration of 0.8 mg/ml contains 15.64 mmol of sodium (or 359.5 mg), 250 ml of a drug with a concentration of 0.8 mg/ml contains 39.1 mmol of sodium (or 898.75 mg), 100 ml of a drug with a concentration of 2 mg/ml contains 16.11 mmol of sodium (or 370.3 mg), 250 ml of a drug with a concentration of 2 mg/ml contains 40.28 mmol of sodium (or 925.75 mg).

Patients on a controlled sodium diet (for example, patients with congestive heart failure, renal failure, nephrotic syndrome) should pay attention to the sodium content of the drug.

Contraindications

Contraindications for systemic use:

• hypersensitivity;
• pregnancy;
• lactation;
• severe kidney/liver dysfunction ;
• indications of a history of quinolone-induced tendonitis.

Eye and ear drops are contraindicated for fungal and viral infections of the eyes/ears , intolerance to Ciprofloxacin (or other quinolones), and during pregnancy and lactation.

For children, tablets and solution for intravenous administration can be prescribed from 12 years of age, eye and ear drops - from 15 years of age.

Side effects

The drug is well tolerated. The most common side effects with intravenous administration and oral administration:

• dizziness;
• fatigue;
• headache;
• tremor;
• excitation.

The Vidal reference book reports that in isolated cases the following was recorded in patients:

• sweating;
• gait disturbances;
• peripheral sensitivity disorders;
• tides;
• intracranial hypertension;
• depression;
• feeling of fear;
• visual disturbances;
• flatulence;
• stomach ache;
• indigestion;
• nausea, vomiting;
• diarrhea;
• hepatitis;
• hepatocyte necrosis;
• tachycardia;
• arterial hypertension (rare);
• skin itching;
• the appearance of skin rashes.

Extremely rare side effects: bronchospasm , anaphylactic shock , Quincke's edema , arthralgia , Petecia , malignant exudative erythema , vasculitis , leyella syndrome , , eosinophilia, anemia , hemolytic and leukocytosis , Biliriber Biliribor , , Biliribor, Biliribor, Biliribor, Biliribor, Biliriborin. ALP, liver transaminases, creatinine .

Use in ophthalmology is accompanied by:

• often - a feeling of discomfort and/or the presence of a foreign body in the eye, the appearance of a white coating (usually in patients with ulcerative keratitis and with frequent use of drops), the formation of crystals/scales, itching and hyperemia of the conjunctiva, tingling and burning;
• in isolated cases - keratitis / keratopathy , eyelid swelling, corneal staining, hypersensitivity reactions, lacrimation, decreased visual acuity, photophobia, corneal infiltration.

Side effects that are or may be associated with the use of the drug are usually mild, harmless and go away without treatment.

In patients with ulcerative keratitis, the white plaque that appears does not have a negative effect on the treatment of the disease and visual parameters and disappears on its own. As a rule, it appears within 1-7 days after the start of the drug course and disappears immediately or within 13 days after its cessation.

Non-ophthalmological disorders when using drops: the appearance of an unpleasant taste in the mouth, in rare cases - nausea, dermatitis.

When used in otology, the following are possible:

• often - itching in the ear;
• in some cases - ringing in the ears, headache, dermatitis.

Instructions for use of Ciprofloxacin

Ciprofloxacin tablets: instructions for use

The daily dose for an adult varies from 500 mg to 1.5 g/day. It should be divided into 2 doses with an interval of 12 hours.

To prevent crystallization of salts in the urine, the antibiotic should be taken with a large volume of liquid.

A single dose is selected depending on the diagnosis:

• urogenital infections - from 2*250 to 2*500 mg for uncomplicated acute infections, from 2*500 to 2*750 mg for complicated ones;
• cystitis in women before menopause - 500 mg (once);
• respiratory tract infections (depending on the pathogen and severity of the disease) - from 2 * 500 to 2 * 750 mg;
• gonorrhea - 500 mg once for acute uncomplicated and from 2 * 500 to 2 * 750 mg mg if the patient is diagnosed with an extragenital form of the disease, as well as in cases where the disease occurs with complications;
• damage to joints and bones , severe, life-threatening, infections, septicemia, peritonitis (in particular, in the presence of Pseudomonas, Streptococcus or Staphylococcus) - 2 * 750 mg;
• gastrointestinal infections - from 2*250 to 2*500 mg;
• inhalation form of anthrax - 2*500 mg;
• prevention of invasive infections caused by N. meningitidis - 1*500 mg.

Treatment is continued until clinical symptoms are relieved, and for several more days after they disappear and body temperature normalizes. In most cases, the course lasts from 5 to 15 days, in case of damage to joints and bone tissue it is extended to 4-6 weeks, in case of osteomyelitis - up to 2 months.

Patients with renal dysfunction require dose and/or interval adjustment.

Application of ampoules

Ciprofloxacin in ampoules is recommended to be administered intravenously as a drip infusion. The dose for an adult is 200-800 mg/day. The duration of the course is on average from 1 week to 10 days.

For urogenital infections , damage to joints and bones or ENT organs, the patient is administered 200-400 mg twice a day. For respiratory tract infections , intra-abdominal infections , septicemia , lesions of soft tissues and skin, a single dose for the same frequency of use is 400 mg.

For renal dysfunction, the starting dose is 200 mg, which is subsequently adjusted taking into account Clcr.

When using ampoules in a dose of 200 mg, the infusion duration is 30 minutes, when administering the drug in a dose of 400 mg - 1 hour.

Ciprofloxacin injections are not prescribed.

Ear and eye drops Ciprofloxacin: instructions for use

For ulcerative keratitis, treatment is carried out according to the following scheme:

• 1 day - in the first 6 hours, 2 drops of solution are injected into the conjunctival cavity every 15 minutes, then the intervals between instillations are increased to half an hour (the same single dose - 2 drops);
• Day 2 - 2 drops with an interval of 60 minutes between instillations;
• Days 3-14 - 2 drops with an interval of 4 hours between instillations.

Treatment for ulcerative keratitis may last longer than 14 days. The treatment regimen is selected individually by the attending physician.

For superficial bacterial infections of the eye and its appendages, the standard dose is 1-2 drops with a frequency of use of 4 times a day. In especially severe cases, in the first 48 hours the patient is instilled with 1-2 drops every 2 hours.

Treatment lasts from 7 to 14 days.

nasolacrimal occlusion is recommended to reduce systemic absorption of the drug injected into the eye .

In case of concomitant treatment with other ophthalmic drugs for topical use, 15-minute intervals should be maintained between their administration and the administration of Ciprofloxacin.

In otology, the standard dose of the drug is 4 drops into the previously cleaned ear canal of the affected ear, 2 times a day.

For patients using ear tampons, the dose is increased only when using the drug for the first time: children are given 6 drops, adults - 8 drops.

The course should not last more than 10 days. If it is necessary to extend it, the sensitivity of the local flora should be determined.

If other topical agents are used, an interval of 10-15 minutes must be maintained between their administration and the administration of Ciprofloxacin.

Dosage for children over 15 years of age: 3 drops twice a day.

The effect of renal/liver dysfunction on the pharmacokinetic parameters of the drug in the form of ear and eye drops has not been studied.

To avoid vestibular stimulation, the solution is warmed to body temperature before being introduced into the ear canal.

The patient should lie on the side opposite the affected ear. It is recommended that he remain in this position for another 5-10 minutes after instilling the solution.

It is also allowed, after local cleansing, to insert a swab made of absorbent cotton wool or gauze soaked in the solution into the ear canal for 1-2 days. To saturate the drug, it should be moistened twice a day.

To avoid contamination of the tip of the dropper bottle and solution, do not touch the dropper to the eyelids, auricle, external auditory canal, adjacent areas and any other surfaces.

Additionally

There is no fundamental difference in how to take drugs from different manufacturers: the instructions for use of Ciprofloxacin-AKOS are similar to the instructions for Ciprofloxacin-FPO , Ciprofloxacin-Promed , Vero-Ciprofloxacin or Ciprofloxacin-Teva .

For children and adolescents under 18 years of age, it is recommended to prescribe the drug only if the pathogen is resistant to other chemotherapeutic agents.

Instructions for use CIPROFLOXACIN

Severe infections and mixed infections caused by gram-positive bacteria and anaerobic pathogens

. Ciprofloxacin monotherapy is not intended for the treatment of severe infections and infections that may be caused by gram-positive bacteria or anaerobic microorganisms. In the case of such infections, appropriate antibacterial agents should be used simultaneously with ciprofloxacin.

Streptococcal infections

(including Streptococcus pneumoniae). Ciprofloxacin is not recommended for the treatment of streptococcal infections due to lack of effectiveness.

Genital tract infections.

Epididymitis orchioepididymitis and pelvic inflammatory disease can be caused by fluoroquinolone-resistant Neisseria gonorrhoeae. Ciprofloxacin should be used in conjunction with other appropriate antibacterial agents unless resistance to Neisseria gonorrhoeae can be excluded. If clinical improvement does not occur after 3 days of treatment, treatment should be reconsidered.

Intra-abdominal infections.

Data on the effectiveness of ciprofloxacin in the treatment of postoperative intra-abdominal infections are limited.

Travelers' diarrhea.

When prescribing ciprofloxacin, information on the resistance of relevant pathogens to it in the countries visited by the patient should be taken into account.

Bone and joint infections.

Ciprofloxacin should be used in combination with other antimicrobial agents, depending on the results of microbiological analysis.

Aerosol contact with anthrax pathogen.

The use of a drug in humans is based on in vitro susceptibility data, data from experimental animal models and a small amount of data for humans. The physician should familiarize himself with national and/or internationally recognized documentation on the treatment of anthrax.

Complicated urinary tract infections and pyelonephritis.

For the treatment of urinary tract infections, ciprofloxacin is used when it is impossible to resort to other types of treatment, and its use should be based on the results of a microbiological analysis.

Other specific severe infections.

For the treatment of other serious infections, ciprofloxacin is used according to official guidelines or after a careful benefit/risk assessment if other therapies are not possible, or after failure of conventional treatment and if microbiological data justify the use of ciprofloxacin.

Increased sensitivity.

After a single dose of ciprofloxacin, allergic reactions may occur, including anaphylactic and anaphylactoid reactions, which can be life-threatening. If such reactions occur, the use of ciprofloxacin should be discontinued and, if necessary, appropriate medical attention should be provided.

Musculoskeletal system.

In general, ciprofloxacin should not be used in patients with a history of tendon disease/damage associated with quinolone treatment. However, in some cases, after microbiological identification of the causative agent and a benefit-risk assessment, ciprofloxacin may be prescribed to such patients for the treatment of certain severe infections, particularly in cases of failure of standard therapy or bacterial resistance, where microbiological data may justify the use of ciprofloxacin. Tendinitis and tendon rupture (especially Achilles), sometimes bilateral, can occur within the first 48 hours after using ciprofloxacin. The risk of tendinopathy may increase in elderly patients or in the case of concomitant use of corticosteroids. If any signs of tendonitis (eg, painful swelling, inflammation) occur, ciprofloxacin should be discontinued. Ciprofloxacin should be used with caution in patients with myasthenia gravis.

Photosensitivity.

Ciprofloxacin has been shown to cause photosensitive reactions. Patients using ciprofloxacin should be advised to avoid direct exposure to excessive sunlight or ultraviolet radiation during treatment.

CNS.

Quinolones are known to induce convulsions or reduce the threshold for their occurrence. Ciprofloxacin should be used with caution in patients with central nervous system disorders who may be susceptible to seizures. If seizures occur, use of ciprofloxacin should be discontinued. Mental reactions may appear after the first use. In rare cases, depression or psychosis can progress to the point where the patient's behavior becomes threatening. In such cases, ciprofloxacin should be discontinued.

Cases of polyneuropathy (defined by neurological symptoms such as pain, burning sensation, sensory disturbances or muscle weakness, alone or in combination) have been reported with the use of ciprofloxacin.

Ciprofloxacin has an effect on prolonging the QT interval. Elderly patients have increased sensitivity to the effects of drugs that cause QT interval prolongation. Therefore, ciprofloxacin should be used with caution in combination with drugs that prolong the QT interval (eg, class IA and III antiarrhythmic drugs) or in patients at increased risk of developing AF (eg, with known QT prolongation, uncorrected hypokalemia).

Overdose

There are no specific symptoms for an overdose of Ciprofloxacin. The patient is advised to lavage the stomach, take emetics, create an acidic urine reaction, and administer a large volume of fluid. All activities should be carried out against the background of maintaining the function of vital systems and organs.

Peritoneal dialysis and hemodialysis help remove 10% of the dose taken.

The drug does not have a specific antidote.

Interaction

Use in combination with Theophylline helps to increase plasma concentration and increase T1/2 of the latter.

Al/Mg containing antacids help slow down the absorption of ciprofloxacin and thereby reduce its concentration in the urine and blood. Between doses of these drugs, intervals of at least 4 hours should be maintained.

Probenecid delays the elimination of the drug.

Ciprofloxacin enhances the effect of coumarin anticoagulants .

The interaction of Ciprofloxacin for use in otology and ophthalmology with other drugs has not been studied.

special instructions

Due to the likelihood of side effects from the central nervous system in patients with a history of its pathology, the drug can be used exclusively for health reasons.

Ciprofloxacin is prescribed with caution when the threshold for convulsive readiness is lowered, epilepsy , brain damage , severe cerebrosclerosis (increases the likelihood of circulatory disorders and stroke ), with serious impairment of liver/kidney function , and in old age.

During the treatment period, it is recommended to avoid UV and solar radiation and increased physical activity, control the acidity of urine and drinking regime.

of crystalluria have been reported in patients with alkaline urine . To avoid its development, it is unacceptable to exceed the therapeutic dose of the drug. In addition, the patient needs to drink plenty of fluids and maintain acidic urine.

Pain in the tendons and the appearance of signs of tenosynovitis are a signal to stop treatment, since the possibility of inflammation/rupture of the tendon cannot be excluded.

Ciprofloxacin may inhibit the speed of psychomotor reactions (especially in the presence of alcohol), which should be kept in mind by patients working with potentially dangerous devices.

If severe diarrhea , pseudomembranous colitis , because this disease is a contraindication to the use of the drug.

If simultaneous intravenous administration of barbiturates is necessary, cardiovascular function should be monitored: in particular, ECG, heart rate, and blood pressure.

The liquid ophthalmic form of the drug is not intended for intraocular injection.

Ciprofloxacin - solution

Severe infections, staphylococcal infections and infections caused by gram-positive and anaerobic bacteria Ciprofloxacin monotherapy is not an appropriate treatment for severe infections, including suspected infections caused by gram-positive and/or anaerobic microorganisms. In such cases, it is necessary to prescribe appropriate antibacterial drugs.

Infections caused by Streptococcus pneumonia Ciprofloxacin is not the drug of choice for suspected or established pneumonia caused by Streptococcus pneumonia.

Genital tract infections When treating patients with epididymo-orchitis and pelvic inflammatory diseases, it should be taken into account that these infections can be caused by strains of Neisseria gonorrhoeae that are resistant to fluoroquinolones. Empirical prescription of ciprofloxacin for the treatment of such patients is possible only in combination with other antibacterial drugs active against this pathogen (for example, cephalosporins). If there is no clinical improvement in the patient's condition during ciprofloxacin therapy within 3 days, therapy should be changed.

Urinary tract infections Local data on fluoroquinolone resistance in Escherichia coli (the most common causative agent of urinary tract infections) should be taken into account.

Abdominal infections To date, data on the effectiveness of ciprofloxacin for the treatment of patients with postoperative abdominal infections are limited.

Travelers' diarrhea Before prescribing the drug, data on the prevalence of fluoroquinolone resistance in the countries visited by the patient before developing the disease should be taken into account.

Infections of bones and joints When treating infections of this location, ciprofloxacin should be prescribed in combination with other antibacterial drugs, taking into account the results of microbiological studies.

Pulmonary anthrax Data on the effectiveness of the drug ciprofloxacin in the treatment of this disease are based mainly on data on the sensitivity of microorganisms in in vitro and animal experiments. Data on the use of the drug to treat the disease in humans are limited; national or international guidelines should be consulted.

Risk of developing superinfection During or after completion of treatment with ciprofloxacin, excessive growth of strains of resistant microorganisms is possible, including without clinical signs of superinfection.

Resistance During or after completion of treatment with ciprofloxacin, excessive growth of strains of resistant microorganisms is possible, including without clinical signs of superinfection. The risk of the emergence of resistant strains is especially high in the case of long courses of therapy, treatment of nosocomial (nosocomial) infections and/or in the case of infections caused by Staphylococcus spp. and Pseudomonas spp.

Central nervous system disorders: Cases of sensory and sensorimotor axonal polyneuropathy affecting small and/or large axons and leading to paresthesia, hypoesthesia, dysesthesia and weakness have been reported in patients using fluoroquinolones, including ciprofloxacin. Symptoms may appear soon after starting use and may be irreversible. If the patient develops symptoms of neuropathy, including pain, burning, tingling, numbness and/or weakness, or other sensory disturbances, including tactile, pain, temperature, vibration and position sense, ciprofloxacin should be discontinued immediately.

Ciprofloxacin, like other fluoroquinolones, can lower the seizure threshold and provoke the development of seizures up to the development of status epilepticus. In patients with epilepsy who have had CNS diseases (for example, a decrease in the seizure threshold, a history of seizures, cerebrovascular accidents, organic brain lesions or stroke), due to the risk of developing adverse reactions from the CNS, ciprofloxacin preparations should be used only in cases when the expected clinical effect exceeds the possible risk of developing a side effect of the drug. If seizures occur, the drug should be discontinued.

Impaired renal and urinary function Since ciprofloxacin is excreted primarily by the kidneys, dose adjustment of the drug is necessary in patients with impaired renal function. Cases of crystalluria have been reported with the use of ciprofloxacin. To avoid the development of crystalluria, it is unacceptable to exceed the recommended daily dose; sufficient fluid intake and maintaining an acidic urine reaction are also necessary.

Liver dysfunction: Cases of liver necrosis and life-threatening liver failure have been reported with the use of ciprofloxacin. If symptoms of liver disease such as anorexia, jaundice, dark urine, itching, abdominal tenderness are present, ciprofloxacin should be discontinued. Patients taking ciprofloxacin who have had liver disease may experience a temporary increase in liver transaminases, alkaline phosphatase, or cholestatic jaundice.

Disorders of the musculoskeletal system When using ciprofloxacin, cases of tendinitis and tendon rupture (mainly the Achilles tendon), sometimes bilateral, may occur within the first 48 hours after the start of therapy. Inflammation and rupture of the tendon may occur even several months after stopping treatment with ciprofloxacin. There is an increased risk of tendinopathy in elderly patients and in patients with tendon diseases who are concomitantly treated with corticosteroids. At the first signs of tendonitis (painful swelling in the joint area, inflammation), ciprofloxacin should be discontinued, physical activity should be avoided, as there is a risk of tendon rupture, and a doctor should be consulted. Ciprofloxacin should be used with caution in patients with a history of tendon diseases associated with quinolones.

Hypersensitivity Sometimes, after taking the first dose of ciprofloxacin, hypersensitivity to the drug, including allergic reactions, may develop, which should be reported to your doctor immediately. In rare cases, after the first use, anaphylactic reactions up to anaphylactic shock may occur. In these cases, the use of ciprofloxacin should be stopped immediately and appropriate treatment should be instituted.

Local reactions When ciprofloxacin is administered intravenously, a local inflammatory reaction may occur at the site of drug administration (swelling, pain). This reaction is more common if the infusion time is 30 minutes or less. The reaction quickly passes after the end of the infusion and is not a contraindication for subsequent administration of the drug, unless its course is complicated.

Diagnosis of tuberculosis In vitro, ciprofloxacin may interfere with the bacteriological study of Mucobacterium tuberculosis, inhibiting its growth, which can lead to false negative results when diagnosing this pathogen in patients taking ciprofloxacin.

Glucose-6-phosphate dehydrogenase (G-6-PDH) deficiency Hemolytic reactions have been reported in patients with G-6-PDG deficiency receiving ciprofloxacin. Prescribing ciprofloxacin to this category of patients is possible only when the potential benefits of the drug outweigh the possible risks. Careful monitoring of the patient's condition is necessary.

Hypoglycemia As with other fluoroquinolones, when using ciprofloxacin it is possible to reduce the concentration of glucose in the blood plasma, mainly in patients with diabetes, especially the elderly. When prescribing ciprofloxacin to patients with diabetes mellitus, it is necessary to carefully monitor the concentration of glucose in the blood plasma.

Use of the drug in children and adolescents It has been found that ciprofloxacin, like other drugs of this class, causes arthropathy of large joints in animals. When analyzing the current data on the safety of ciprofloxacin in children under 18 years of age, most of whom have cystic fibrosis, no connection was established between cartilage or joint damage and taking the drug. Ciprofloxacin should be prescribed to children and adolescents in strict accordance with the recommendations for the treatment of patients in this age category. For patients with cystic fibrosis, the drug should be prescribed by specialists who have experience in treating children with this pathology. The use of ciprofloxacin in children is not recommended for the treatment of diseases other than complications of cystic fibrosis (in children 5 to 17 years of age) associated with Pseudomonas aeruginosa and for the treatment and prevention of pulmonary anthrax (after suspected or proven infection with Bacillus anthracis). Due to the risk of developing undesirable effects on bones and joints, the drug should be prescribed to children only after a careful assessment of the potential benefits and risks of therapy.

Cardiac disorders Ciprofloxacin has the effect of prolonging the QT interval. Given that women have a longer average QT interval compared to men, they are more sensitive to drugs that cause QT prolongation. Elderly patients also have increased sensitivity to the effects of drugs that prolong the QT interval.

Ciprofloxacin should be used with caution in combination with drugs that prolong the QT interval (e.g., class IA and III antiarrhythmic drugs, tricyclic antidepressants, macrolides, antipsychotics) in patients with an increased risk of QT prolongation or development of arrhythmias (e.g., congenital long interval syndrome). QT, cardiac disease (heart failure, myocardial infarction, bradycardia), electrolyte imbalance (eg, hypokalemia, hypomagnesemia)).

Gastrointestinal tract If severe and prolonged diarrhea occurs during or after treatment with ciprofloxacin, the diagnosis of pseudomembranous colitis should be excluded, which requires immediate discontinuation of the drug and the appointment of appropriate treatment. The use of drugs that inhibit intestinal motility is contraindicated.

Skin During treatment, UV irradiation (including contact with direct sunlight) should be avoided. Treatment should be discontinued if photosensitivity reactions are observed (for example, if changes in the skin appear that resemble sunburn).

Cytochrome P450 Ciprofloxacin is a moderate inhibitor of CYP450 1A2 isoenzymes. Caution should be exercised during the simultaneous use of ciprofloxacin and drugs metabolized by these enzymes (including theophylline, methylxanthine, caffeine, duloxetine, clozapine, ropinirole, olanzapine), since the increase in the concentration of these drugs in the blood serum, due to inhibition of their metabolism by ciprofloxacin, may cause specific adverse reactions.

The combined use of ciprofloxacin and tizanidine is contraindicated.

Sodium chloride content The sodium chloride content of ciprofloxacin solution should be taken into account when treating patients whose sodium intake is limited (heart failure, renal failure, nephrotic syndrome).

With the simultaneous intravenous administration of ciprofloxacin and drugs for general anesthesia from the group of barbituric acid derivatives, constant monitoring of heart rate, blood pressure, and electrocardiogram is necessary.

In patients with myasthenia gravis gravis, ciprofloxacin should be used with caution as it may worsen symptoms.

During long-term therapy with ciprofloxacin, it is recommended to regularly monitor complete blood counts, kidney and liver function.

Ciprofloxacin analogs

Level 4 ATC code matches:
Norfloxacin

Synonyms: Ciprofloxacin-Teva , Basijen , Ciprofloxacin-FPO , Ificipro , Ciprofloxacin-Promed , Procipro , Ciprofloxacin-AKOS , Tsiprinol , Ciprodox , Cifran , Ecotsifol , Tseprova .

Analogues of Ciprofloxacin with a similar mechanism of action: Abaktal , Gatispan , Zanotsin , Ivacin , Levotek , Levofloxacin , Moximac , Nolitsin , Ofloxacin , Oflocid , Pefloxacin , Eleflox .

For children

In children, Ciprofloxacin can be used as a 2nd and 3rd line drug for the treatment of complicated UTIs and pyelonephritis caused by E. coli (clinical studies were conducted in children 1-17 years old), to reduce the risk of developing or progressing anthrax in case of aerogenic contact with B. anthracis.

It is also prescribed for the treatment of pulmonary complications caused by P. aeruginosa in children with cystic fibrosis (clinical studies were conducted in a group of patients 5-17 years old).

During the studies, treatment was prescribed only to patients with the above diagnoses. Experience with other indications is limited.

The dosage for children is selected depending on the diagnosis.

Ciprofloxacin solution for infusion 2 mg/ml 100 ml bottle 1 pc. in Moscow

Prescribed intravenously (drip)

for 30 minutes (200 mg) and 60 minutes (400 mg).

The dose of ciprofloxacin depends on the severity of the disease, type of infection, body condition, age, weight and kidney function of the patient.

Recommended Doses

For lower respiratory tract infections - 200-400 mg 2 times a day.

For urinary tract infections: acute uncomplicated - 100 mg 2 times a day; cystitis in women (before menopause) - 100 mg once; complicated - 200 mg 2 times a day.

For uncomplicated gonorrhea - 100 mg once; for extragenital gonorrhea - 100 mg 2 times a day.

For infectious diarrhea - 200 mg 2 times a day, course of treatment - 5-7 days.

For other infections (depending on severity) - a single dose is 200-400 mg, frequency of administration - 2 times a day.

For particularly severe life-threatening infections (streptococcal pneumonia, infectious complications of cystic fibrosis, infections of bones and joints, septicemia, peritonitis), especially those caused by Pseudomonas spp. Staphylococcus spp. and Streptococcus spp.

the dose is increased to 400 mg 3 times a day.

For the prevention of postoperative infections - 30-60 minutes before surgery, 200-400 mg intravenously; if the operation lasts more than 4 hours, it is re-administered in the same dose.

For pulmonary anthrax (treatment and prevention), 400 mg is administered 2 times a day (maximum single dose - 400 mg, maximum daily dose - 800 mg). Treatment should begin immediately after suspected or confirmed infection. The total duration of treatment with ciprofloxacin for pulmonary anthrax is 60 days.

If kidney function is impaired

With a creatinine clearance of 31 to 60 ml/min or a serum creatinine concentration of 14 to 19 mg/100 ml, the maximum dose of ciprofloxacin for intravenous administration should be 800 mg per day.

With a creatinine clearance of 30 ml/min or less or a serum creatinine concentration of 20 mg/100 ml or more, the maximum dose of ciprofloxacin for intravenous administration should be 400 mg per day.

In hemodialysis, ciprofloxacin is administered after the hemodialysis session.

During peritoneal dialysis, a solution of ciprofloxacin is added to the dialysate (intraperitoneally) at a dose of 50 mg per 1 liter of dialysate every 6 hours.

In case of liver dysfunction

No dose adjustment is required for patients with impaired liver function.

For elderly patients

Elderly patients are prescribed lower doses depending on the severity of the infection and the QC value.

In pediatrics

For pulmonary anthrax (treatment and prevention) - 10 mg/kg body weight 2 times a day (maximum single dose - 400 mg, maximum daily dose - 800 mg). The total duration of treatment is 60 days.

In the treatment of complications caused by Pseudomonas aeruginosa

in children with cystic fibrosis of the lungs aged 5 to 17 years - 10 mg/kg body weight 3 times a day (maximum daily dose - 1200 mg). The duration of treatment is 10-14 days.

Duration of treatment

For acute uncomplicated gonorrhea and cystitis - 1 day.

For infections of the kidneys, urinary tract and abdominal cavity - up to 7 days.

In patients with reduced immunity (except for cases of osteomyelitis) - throughout the entire neutropenic phase. For osteomyelitis, treatment can last no more than 2 months.

For all other infections - 7-14 days. For streptococcal infections, due to the risk of late complications, treatment should continue for at least 10 days.

Treatment should be continued for at least 3 more days after body temperature normalizes or clinical symptoms disappear.

After intravenous use, treatment can be continued orally.

Compatibility with other solutions

Ciprofloxacin infusion solution is compatible with 09% sodium chloride solution 5% or 10% glucose solution (dextrose) with a mixture of 5% glucose solution (dextrose) and 0225% sodium chloride solution with a mixture of 5% glucose solution (dextrose) and 045% sodium chloride solution 10% fructose solution, Ringer's solution, lactated Ringer's solution.

Ciprofloxacin during pregnancy

The safety and effectiveness of the drug during pregnancy have not been established.

Animal experiments showed that the drug caused arthropathy . The use of doses exceeding 6 times the average daily dose for humans in pregnant female rats and mice did not provoke any abnormalities in fetal development.

In rabbits receiving 30 and 100 mg/kg Ciprofloxacin orally, gastrointestinal dysfunction was observed and, as a consequence, weight loss and an increase in miscarriage cases. No teratogenic effect was detected.

When the drug was administered into a vein at a dose of 20 mg/kg, there was also no teratogenic effect or toxic effect on the embryo and the mother’s body.

The use of topical Ciprofloxacin during pregnancy is possible if indicated and provided that the benefits to the mother's body outweigh the risks to the fetus.

According to the FDA classification, the drug belongs to category C.

Ciprofloxacin is excreted into milk, so nursing women must decide (taking into account the importance of the drug for the mother) to stop breastfeeding or refuse treatment with Ciprofloxacin.

Local forms are used with caution during lactation, because It is unknown whether the medicine passes into breast milk in this case.

CIPROFLOXACIN

Interaction

Drugs known to prolong the QT Caution
should be exercised when ciprofloxacin (as well as other fluoroquinolones) is used concomitantly in patients receiving drugs known to prolong the QT interval (eg, class IA and III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics, see section "Special instructions"),

Theophylline

The simultaneous use of ciprofloxacin and drugs containing theophylline may cause an undesirable increase in the concentration of theophylline in the blood plasma and, accordingly, the occurrence of theophylline-induced adverse events: in very rare cases, these adverse events can be life-threatening for the patient. If the simultaneous use of these two drugs is unavoidable, it is recommended to constantly monitor the concentration of theophylline in the blood plasma and, if necessary, reduce the dose of theophylline (see section "Special instructions", cytochrome P450).

Other xanthine derivatives

The simultaneous use of ciprofloxacip and caffeine or pentoxifylline (oxpentifylline) may lead to an increase in the concentration of xanthine derivatives in the blood serum.

Tizanidine

With the simultaneous use of ciprofloxacip and drugs containing tizanidine, an increase in the concentration of tizanidine in the blood serum was detected: an increase in the maximum concentration (Cmax) by 7 (from 4 to 21) times, an increase in the AUC (area under the pharmacokinetic curve “side effect”). Careful monitoring of blood glucose levels is necessary.

Probenecid

Probenecid slows down the rate of excretion of ciprofloxacin by the kidneys. The simultaneous use of ciprofloxacin and drugs containing probenecid leads to an increase in the concentration of ciprofloxacin in the blood plasma.

Phenytoin

With the simultaneous use of ciprofloxacin and phenytoin, a change (increase or decrease) in the content of phenytoin in the blood plasma was observed. To avoid weakening of the anticonvulsant effect of phenytoin due to a decrease in its concentration, as well as to prevent adverse events associated with phenytoin overdose when stopping ciprofloxacin, it is recommended to monitor phenytoin therapy in patients, including determination of phenytoin levels in the blood plasma during the entire period of simultaneous use of both drugs and for a short time after completion of combination therapy.

Methotrexate

With the simultaneous use of methotrexate and ciprofloxacin, the renal tubular transport of methotrexate may slow down, which may be accompanied by an increase in the concentration of methotrexate in the blood plasma and the likelihood of developing side effects of methotrexate. In this regard, patients receiving concomitant therapy with methotrexate and ciprofloxacin should be closely monitored.

Omeprazole

With the combined use of ciprofloxacin and drugs containing omeprazole, there may be a slight decrease in the maximum concentration of ciprofloxacin in plasma and a decrease in the area under the pharmacokinetic curve (conSpecial instructions, cytochrome P450).

Clozapine

Concomitant use of clozapine and ciprofloxacin may increase serum concentrations of clozapine and N-desmethylclozapine. The patient's condition should be monitored and, if necessary, the dosage regimen of clozapine should be adjusted during its combined use with ciprofloxacin and for a short time after completion of combination therapy (see section "Special Instructions", cytochrome P450).

Sildenafil

With the simultaneous use of ciprofloxacin and sildenafil, the Cmax and AUC of sildenafil may increase by 2 times. In this regard, the use of this combination is possible only after assessing the benefit/risk ratio.

Vitamin K antagonists (warfarin, acenocoumarol, phenprocoumon, fluindone)

The combined use of ciprofloxacin and vitamin K antagonists may lead to an increase in their anticoagulant effect. The magnitude of this effect may vary depending on concomitant infections, age and general condition of the patient. The INR should be monitored during concomitant use of ciprofloxacin and vitamin K antagonists and for a short time after completion of combination therapy.

Cation-containing drugs

Simultaneous use of ciprofloxacin and cation-containing drugs; mineral supplements containing calcium, magnesium, aluminum, iron; sucralfate, antacids, polymeric phosphate compounds (for example, sevelamer, lanthanum carbonate) and drugs with a large buffer capacity (for example, didanosine tablets) containing magnesium, aluminum or calcium, reduce the absorption of ciprofloxacin. In such cases, ciprofloxacin should be taken either 1-2 hours before or 4 hours after taking these drugs.

Eating food and dairy products

The simultaneous use of ciprofloxacin and dairy products or drinks fortified with minerals (for example, milk, yogurt, calcium-fortified juices) should be avoided as the absorption of ciprofloxacin may be reduced. Calcium contained in regular food does not significantly affect the absorption of ciprofloxacin.

Reviews of Ciprofloxacin

Reviews about Ciprofloxacin tablets can be found very different: some consider the drug to be effective, others have the opposite opinion about it. Moreover, almost every review contains references to side effects that occurred during treatment with the drug.

Eye drops are rated by patients as having no disadvantages. They “really heal and heal quickly.”

According to doctors, the advantages of Ciprofloxacin are:

• high bactericidal activity;
• a wide spectrum of antimicrobial action, including Gram (-) and Gram (+) aerobes , mycoplasma , chlamydia , mycobacteria ;
• the ability to penetrate well into the cells and tissues of the macroorganism, creating concentrations there that exceed serum levels or are close to them;
• long T1/2 and the presence of a post-antibiotic effect (thanks to this, it is enough to take the drug only 2 times a day);
• proven effectiveness in the treatment of hospital-acquired and community-acquired infections of any (practically) localization (it is used for sore throat , UTI, infections of bones , skin, etc.);
• Possibility of use for severe infections (in a hospital setting) as
• empirical antibiotic therapy;
• good tolerance.

How much does Ciprofloxacin cost?

The average price of Ciprofloxacin in tablets of 500 mg in Ukraine is 22 UAH (package No. 10), the cost of an antibiotic in tablets of 250 mg (package No. 10) is 9-10 UAH. The price of Ciprofloxacin in the form of a solution for infusion therapy is on average 22.5 UAH. The price of an ampoule with eye/ear drops in Kharkov or Kyiv is 17-19 UAH.

In Russian pharmacies the cost of 500 mg tablets is from 33 rubles, 250 mg tablets are from 18 rubles. The solution can be purchased for an average of 35 rubles. The price of Ciprofloxacin eye drops is from 17 rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Ciprofloxacin tablets p.p.o.
  500 mg 10 pcs. Ozone LLC 41 rub. order
• Ciprofloxacin Ecotsifol tablets p.p.o 500 mg 10 pcs. JSC "AVVA RUS"

  94 RUR order

• Ciprofloxacin-AKOS eye drops 0.3% 5ml JSC Sintez

  24 RUR order

• Ciprofloxacin-optic eye drops 0.3% dropper bottle 5 ml JSC "LEKKO"

  56 RUR order

• Ciprofloxacin tablets p.p.o. 500 mg 10 pcs. Rapharma JSC

  74 RUR order

Pharmacy Dialogue

• Ciprofloxacin (tab.p.pl/vol. 500 mg No. 10) Ozone LLC

  41 rub. order

• Ciprofloxacin tablets 500 mg No. 10Teva Pharmaceutical

  112 rub. order

• Ciprofloxacin bottle 2 mg/ml 100 ml Elfa NPC CJSC/Elfa Laboratories

  32 RUR order

• Ciprofloxacin-AKOS (drops 0.3% 5ml) Sintez (Kurgan) OJSC

  22 RUR order

• Ciprofloxacin bufus (drops 0.3% 10ml)Update PFC JSC

  41 rub. order

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Pharmacy24

• Ciprofloxacin 0.2% 100 ml solution
  30 UAH. order
• Ciprofloxacin 0.25 No. 10 tablets PrAT "Technolog", Uman, Cherkasy region, Ukraine

  15 UAH order

• Ciprofloxacin 200 mg 100 ml No. 1 solution

  36 UAH order

• Ciprofloxacin 0.2% 100 ml solution

  18 UAH order

• Ciprofloxacin 500 mg No. 10 tablets PrAT "Technolog", Uman, Cherkasy region, Ukraine

  30 UAH order

PaniPharmacy

• Ciprofloxacin infusion Ciprofloxacin infusion solution 0.2% 100ml Ukraine, Novofarm-Biosintez LLC

  18 UAH order

• Ciprofloxacin infusion Ciprofloxacin infusion solution 0.2% 100ml Ukraine, Yuria-Pharm LLC

  37 UAH order

• Ciprofloxacin tablets Ciprofloxacin film-coated tablets 0.25g No. 10 Ukraine, OZ GNTsLS LLC

  13 UAH order

• Ciprofloxacin tablets Ciprofloxacin film-coated tablets 0.25g No. 10 Ukraine, Tekhnolog ChAO

  17 UAH order

• Ciprofloxacin liquid Ciprofloxacin h/o 0.3% 5ml Ukraine, OZ GNTsLS LLC

  31 UAH order

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Ciprofloxacin solution d/inf 2mg/ml 100ml No.1

Directions for use and doses

Ciprofloxacin is administered as an intravenous infusion lasting at least 30 minutes (200 mg) and 60 minutes (400 mg). The dose of ciprofloxacin depends on the severity of the disease, type of infection, body condition, age, weight and kidney function of the patient. Typically recommended doses for intravenous administration:
single dose - 200 mg (for severe infections - 400 mg), frequency of administration - 2 times a day; The duration of treatment depends on the severity of the disease - 1-2 weeks, or more if necessary.

For lower respiratory tract infections

200-400 mg 2 times a day.

For urinary tract infections:

acute uncomplicated - 100 mg 2 times a day; cystitis in women (before menopause) - once 100 mg; complicated - 200 mg 2 times a day.

For uncomplicated gonorrhea

- 100 mg once, for extragenital - 100 mg 2 times a day.

Infectious diarrhea

- 200 mg 2 times, course of treatment - 5-7 days.

Particularly severe infections

(streptococcal pneumonia, infectious complications of cystic fibrosis, infections of bones and joints, septicemia, peritonitis), especially those caused by Pseudomonas, Staphylococcus - 400 mg 3 times a day.

Pulmonary anthrax (treatment and prevention):

400 mg 2 times a day.

For the prevention of infections during surgical interventions

- 0.2-0.4 g 0.5-1 hour before surgery; if the operation lasts more than 4 hours, it is re-administered in the same dose.

Elderly patients are prescribed lower doses depending on the severity of the infection and the QC value.

In pediatrics:

In the treatment of complications caused by Pseudomonas aeruginosa in children with cystic fibrosis of the lungs

from 5 to 17 years - 10 mg/kg 3 times a day (maximum dose 1200 mg). The duration of treatment is 10-14 days.

For pulmonary anthrax (prevention and treatment)

- 10 mg/kg 2 times a day. The maximum single dose is 400 mg, daily dose is 800 mg. The total duration of taking ciprofloxacin is 60 days.

CRF:

with a glomerular filtration rate (CC 31-60 ml/min/1.73 m2 or serum creatinine concentration from 1.4 to 1.9 mg/100 ml), the maximum daily dose is 800 mg. With a glomerular filtration rate (CC below 30 ml/min/1.73 sq.m or serum creatinine concentration above 2 mg/100 ml) and during hemodialysis, the maximum daily dose is 400 mg; during hemodialysis, ciprofloxacin is administered after a hemodialysis session.

Ciprofloxacin infusion solution is added to the dialysate (intraperitoneally):

50 mg of ciprofloxacin per liter of dialysate is administered 4 times a day every 6 hours.

Average duration of treatment:

1 day - for acute uncomplicated gonorrhea and cystitis; up to 7 days - for infections of the kidneys, urinary tract and abdominal cavity; during the entire period of the neutropenic phase in patients with immunodeficiency, but not more than 2 months. - for osteomyelitis and 7-14 days - for all other infections. For streptococcal infections, due to the risk of late complications, treatment should continue for at least 10 days. Treatment is carried out for at least 3 days after normalization of body temperature or disappearance of clinical symptoms.

Ready-to-use infusion solutions can be combined with 0.9% sodium chloride solution, Ringer's solution and Ringer-lactate, 5 and 10% dextrose solution, 10% fructose solution, as well as a solution containing 5% dextrose solution with 0.225% or 0.45% sodium chloride solution.