Ciprofloxacin instructions for use tablets from what. "Ciprofloxacin" is an antibiotic or not? Description of the drug, instructions, composition, reviews. Pharmacological characteristics of the drug

Ciprofloxacin is able to effectively suppress the growth and reproduction of many pathogenic ( pathogenic) microorganisms. Some Gram-positive ( streptococci, staphylococci, enterococci) and Gram-negative bacteria ( Proteus, Shigella, Klebsiella, Enterobacter, Escherichia coli, Citrobacter, Serratia, etc.).

Release forms of ciprofloxacin

Also, ciprofloxacin has a huge number of analogues - Alcipro, Quintor, Tsifran, Tsiprolet, Tsipreks, Tsipraz, Tsiprinol, Tsiprobid, Tsipraded, Tsiprolon, Microflox, Tseprova, Tsiprosin, Tsiprobay, Betaciprol, Tsipronat, Ifitsipro, etc.

Manufacturers of ciprofloxacin

The mechanism of the therapeutic action of the drug

Ciprofloxacin inhibits a special bacterial enzyme DNA gyrase, which is responsible for the spiralization of genetic material ( DNA) microorganism. In the future, there is a violation of DNA synthesis, which leads to a cessation of growth and reproduction. Ciprofloxacin also affects the cell wall of microbes, causing pronounced changes in it, which leads to rapid death ( lysis) microorganisms.

Ciprofloxacin has a fairly low toxicity to body tissues. Stability ( resistance) microorganisms to ciprofloxacin develops very slowly. This is due to the fact that after taking this antibiotic, almost all pathogens die, and also due to the fact that bacteria do not have enzymes that would be able to neutralize the effect of ciprofloxacin. This makes it highly effective against microorganisms that are resistant to antibiotics such as penicillins, cephalosporins, tetracyclines, etc.

Ciprofloxacin tablets are quickly and completely absorbed in the mucosa. digestive tract (especially in the duodenum and jejunum). To some extent slows down the absorption of the antibiotic food intake. Ciprofloxacin is able to penetrate into almost all tissues and body fluids. Ciprofloxacin is metabolized in the liver, and excreted through the kidneys and through the gastrointestinal tract. It should be noted that ciprofloxacin can, to a certain extent, cross the placenta and also pass into breast milk. Ciprofloxacin to some extent affects the central nervous system and therefore, during treatment with this antibiotic, it is worth refusing to drive a car or work with mechanisms due to a decrease in the reaction rate.

For what pathologies is it prescribed?

The use of ciprofloxacin

How to apply the medication?

Intravenous administration of ciprofloxacin is carried out at a dosage of 200 - 400 milligrams. The frequency of administration of the drug is twice a day. The duration of treatment is selected based on the pathology and, as a rule, is 7-15 days. If necessary, the course of treatment with ciprofloxacin can be extended. Ciprofloxacin can be administered both by bolus and drip for 30 minutes ( the last way is the most preferred).

Ciprofloxacin eye drops are instilled 1-2 drops under the lower eyelid every 2-4 hours. In the future, with the improvement of the condition, the intervals between instillation are gradually increased. The course of treatment depends on the type of eye disease.

If the patient has impaired liver function, the dosage does not change. In case of impaired renal function, the dosage of this antibiotic should be changed. The required dosage is selected taking into account creatinine clearance ( the rate at which creatinine is excreted from the body by the kidneys).

Dosage of ciprofloxacin depending on creatinine clearance

It should be noted that the elderly should reduce the single and daily dosage by 25-30%.

Possible side effects

While taking ciprofloxacin, the following side effects may be detected:

• disorders of the nervous system and sensory organs;
• disorders of the cardiovascular system;
• disorders of the gastrointestinal tract;
• violations of the hematopoietic system;
• disorders of the urinary system;
• allergic manifestations;
• other manifestations.

Disorders of the nervous system and sensory organs

There are the following side effects:

• taste disorders;
• smell disorders;
• visual impairment ( double vision);
• hearing loss;
• dizziness;
• anxiety;
• fatigue;
• impaired coordination of movements;
• fear;
• boost ;
• convulsions;
• tremor;
• thrombosis of cerebral arteries;
• peripheral paralgesia.

Thrombosis of the cerebral arteries It is characterized by blockage by a thrombus of the arteries that feed the brain. In the future, thrombosis leads to a partial or complete cessation of blood supply to brain tissues, which can cause a stroke. It should be noted that this violation is extremely rare.

Peripheral paralgesia is an abnormal perception of the feeling of pain. Pain may be overly pronounced or, conversely, there may be no pain at all when the nerve is irritated.

Cardiovascular disorders

Ciprofloxacin may cause following violations from the cardiovascular system:

• heartbeat;
• heart rhythm disturbances;
• hypotension.

Heart rhythm disorders is a violation of the rhythm and frequency of contractions of the heart muscle. Most often observed sinus tachycardia, which is characterized by an increase in the number of heartbeats over 100 beats per minute.

liver necrosis characterized by complete destruction of a certain part of the liver cells. Later in place dead cells a scar is formed in the liver connective tissue).

Hematopoietic system disorders

From the side hematopoietic system the following side effects may be found:

• leukopenia;
• leukocytosis.

Anemia(anemia) is a syndrome in which there is a decrease in the total number of red blood cells ( red blood cells) and hemoglobin ( special protein that carries oxygen and carbon dioxide). Anemia is characterized by symptoms such as weakness, pallor of the skin, changes in taste preferences (addiction to salty, peppery and spicy foods), headache, dizziness, damage to the hair and nails. IN rare cases ciprofloxacin can lead to hemolytic anemia, in which there is an increased breakdown of red blood cells. With this anemia, there is a release a large number unbound bilirubin, which is distributed throughout the body, stains the skin and mucous membranes in yellow (jaundice).

Thrombocytopenia– decrease total number platelets or platelets. These platelets play a pivotal role in the normal coagulation process ( coagulation) blood. With a lack of platelets in the blood, bleeding gums appear, as well as bleeding from the nasal passages. Quite often with insignificant mechanical damage large bruises appear on the skin. Thrombocytopenia subjectively does not affect the general condition in any way, but can cause massive internal bleeding.

Leukocytosis is an increase in the total number of white blood cells in the blood. In addition to reducing white blood cells, ciprofloxacin may also increase them. Leukocytosis during treatment with ciprofloxacin appears in isolated cases.

Urinary system disorders

In some cases, due to the use of ciprofloxacin, the following side effects may be detected:

• hematuria;
• crystalluria;
• dysuria;
• polyuria;
• albuminuria;

Hematuria characterized by the detection of red blood cells in the urine with the naked eye ( gross hematuria). With hematuria, the color of the urine changes to red or reddish. Hematuria occurs due to deformation of the renal glomeruli, through which erythrocytes are normally ( red blood cells ) are unable to penetrate.

crystalluria is a pathology in which salt crystals form in the urine. Crystalluria occurs when the dissolved salts found in the urine precipitate ( form crystals) under the action of metabolites of ciprofloxacin.

Dysuria is a violation of the process of urination. Dysuria is characterized by frequent and painful urination.

Polyuria represents an increased production of urine ( over 1.7 - 2 liters). This pathological condition occurs due to damage to the renal tubules through which it is reabsorbed ( reabsorbed into the blood) less water.

Albuminuria or proteinuria - increased excretion of protein in the urine. Albuminuria occurs due to degenerative disorders in the renal glomeruli. It is worth noting that in some cases given state can be caused by increased physical activity, and also appear with a protein diet.

Glomerulonephritis is an inflammation of the kidney tissue with damage to the nephrons ( renal glomeruli). For this kidney disease characterized by the appearance of protein and red blood cells in the urine. Glomerulonephritis is an autoimmune disease in which immune complexes attack one's own glomeruli, causing them to become inflamed. In rare cases, the cause of glomerulonephritis may be long-term use large doses of ciprofloxacin.

Allergic manifestations

Ciprofloxacin can cause the following types of drug allergies:

• Lyell's syndrome;
• Stevens-Johnson syndrome;
• eosinophilia;
• photosensitivity;

Stevens-Johnson syndrome is a very severe form of erythema ( pronounced redness of the skin due to expansion small vessels skin). With this pathological condition, the skin, mucous membranes of the eyes, pharynx, mouth and genital organs are affected. At first allergic reaction there are strong pains in large joints, then fever appears, after which blisters appear on the body, which, when opened, leave behind bleeding areas.

Eosinophilia characterized by an increase in the total number of eosinophils ( type of white blood cells). Very often, eosinophilia appears against the background of various allergic processes. This is due to the fact that eosinophils are necessary to suppress allergies, since these cells are able to bind and suppress the action of histamine.

Hives is the most common type of allergy that occurs while taking medications. With this allergic reaction, flatly raised blisters appear on the skin, which are very itchy. Urticaria can affect both a small segment of the skin and be generalized ( skin rash spreads all over the skin). Often, urticaria is accompanied by symptoms such as abdominal pain, nausea, or even vomiting.

photosensitization characterized by increased sensitivity of the human body to sunlight (ultraviolet rays). Ciprofloxacin, penetrating the skin, can lead to photoallergy, as well as a phototoxic reaction by the type of inflammation. Influencing the skin, the sun's rays react with this antibiotic and modify its configuration. In the future, the body, due to increased individual sensitivity, perceives the new substance as an allergen, which leads to photoallergy. It should be noted that this type of allergic reaction occurs only on those segments of the skin that have been exposed to ultraviolet radiation.

Anaphylactic shock- one of the most dangerous allergic reactions, which in more than 10% of all cases leads to death. Anaphylactic shock occurs due to hypersensitivity organism to the drug. This reaction is manifested by the release of a very large amount of histamine ( immediate allergic reaction), which leads to instantaneous changes in blood circulation in organs and tissues. Anaphylactic shock is characterized by respiratory failure due to swelling of the pharynx, larynx and bronchi. There is also a state of collapse ( pronounced decrease blood pressure ). In anaphylactic shock, the provision of timely and adequate medical care is a paramount task.

Other manifestations

While taking ciprofloxacin, the following side effects may also occur:

• muscle weakness;
• excessive sweating;
• ligament breaks ( more often Achilles tendon );
• muscle pain;

Approximate cost of medication

average cost ciprofloxacin

Ciprofloxacin. In Latin, the name of the drug is Ciprofloxacinum.

ATX

Forms of release and composition

Pills. The main active ingredient of the drug is ciprofloxacin. Additional components - microcrystalline cellulose, potato starch, magnesium stearate, polysorbate.

Solution - 1 ml contains 2 mg of the main substance.

pharmachologic effect

Ciprofloxacin is active against gram-positive and gram-negative pathogens. The action of the drug lies in its ability to have an overwhelming effect on topoisomerases that occur during the life cycle of bacteria.

Pharmacokinetics

The active components of the drug are absorbed by the organs of the gastrointestinal tract, the upper intestines. The maximum plasma concentration of the main substance is reached a few hours after taking the drug. It is excreted from the body by the kidneys along with urine, part of it exits through the intestines with feces.

What helps?

Ciprofloxacin is prescribed in the treatment of the following diseases:

• a number of infections of the respiratory system;
• infectious diseases of the eyes and ears;
• infections of the genitourinary system;
• skin diseases;
• disorders of the articular and bone tissue;
• peritonitis;
• sepsis.

Ciprofloxacin is effective for prophylactic administration in patients with weakened immune system against which there is a high risk of infection. A remedy is used in complex therapy if the patient has been taking drugs from the group of immunosuppressants for a long time.

Is it possible to take with diabetes?

Ciprofloxacin is allowed to be taken by patients diagnosed with diabetes mellitus, but in this case adjustment of the dosage of drugs of the antidiabetic group is required.

Contraindications

The medicine is forbidden to take with the following contraindications:

• insufficient amount of glucose-6-phosphate dehydrogenase;
• colitis pseudomembranous type;
• age limit - under 18;
• pregnancy and lactation;
• individual intolerance to individual components of the drug and other antibiotics of the fluoroquinolone group.

Relative contraindications, in the presence of which the medication is possible only for special indications and with strict observance dosage prescribed by the doctor:

• atherosclerosis of vessels located in the brain;
• impaired cerebral circulation;
• convulsive syndrome;
• epilepsy.

Carefully

If the patient has impaired kidney function, but Ciprofloxacin is the only drug that can give a positive result, it is prescribed at half the minimum dosage. The duration of the therapeutic course is from 7 to 10 days. It is important to continue treatment for 1-2 days after the symptoms of the pathology are suppressed in order to completely destroy the pathogenic microflora.

How to take Ciprofloxacin 500?

The average recommended dosage of the drug is 250 and 500 mg. But the dosage and duration of the therapeutic course are selected individually, depending on the severity of the clinical case and the intensity of the symptomatic picture. The following schemes are common:

1. Infectious diseases of the kidneys, occurring in an uncomplicated form: 250 mg, 500 mg is allowed. Reception is carried out 2 times a day.
2. infections lower organs respiratory system of average intensity of the clinical picture - 250 mg, with severe course diseases - 500 mg.
3. Gonorrhea - the dosage is from 250 to 500 mg, with an intense symptomatic picture, an increase to 750 mg is allowed, but only for 1-2 days at the beginning of the therapeutic course.
4. Dosage in the treatment of gynecological diseases, severe colitis, prostatitis and other diseases urinary organs accompanied by an increase in body temperature, - taking the drug twice a day, dosage - 500 mg. If a person has persistent diarrhea that requires intestinal antiseptics, ciprofloxacin is used at a dosage of 250 mg twice a day.

Dosages for applying the solution:

1. Infectious diseases of the upper respiratory system - 400 mg three times a day.
2. sinusitis in chronic form, otitis media purulent and external type, malignant - 400 mg three times a day.
3. Other infectious diseases, regardless of the location of the pathogen - 400 mg 2-3 times a day.

Treatment of children with cystic fibrosis - the dosage is calculated according to the scheme: 10 mg of the main substance per kilogram of body weight, three times a day, the amount of the drug at a time should not exceed 400 mg. Complicated course of pyelonephritis - 15 mg per kilogram of body weight, twice a day.

Therapy of the organs of vision and ears in the presence of bacteria is carried out according to the following scheme - the average dosage is 1-2 drops, applied up to 4 times a day. If the patient, in addition to Ciprofloxacin, was prescribed other drops, they should be used in a complex manner, the time interval between the use of drugs should be at least 15-20 minutes.

Before meals or after

Ciprofloxacin, like other drugs with an antibacterial spectrum of action, is taken only after meals to reduce Negative influence on the organs of the gastrointestinal tract.

For diabetes

Dose adjustment is not required.

Side effects

Subject to the dosage indicated by the attending physician, and the patient has no contraindications to taking the drug, the likelihood of side symptoms is practically absent. On the part of the urinary system, hematuria, dysuria may occur, and a decrease in nitrogen excretion is rarely observed.

Gastrointestinal tract

Dyspeptic disorders, bloating, anorexia. Rarely - nausea and vomiting, pain in the stomach and stomach, the development of pancreatitis.

Hematopoietic organs

The development of anemia, leukocytosis, neutropenia, eosinophilia.

central nervous system

Headache attacks, migraine. Against the background of the use of the drug, dizziness attacks may occur, general weakness. Rarely - depressive states, impaired coordination, loss of taste and smell, tremor of the limbs, convulsive muscle contraction.

allergies

The appearance on the skin of a rash, redness, urticaria. Rarely, the development of such allergic reactions as extensive edema on the skin of the face, in the larynx, the development of erythema of the nodular type, drug fever is observed. When used in ophthalmology - itching in the eyes, redness. If these symptoms occur, the medication should be discontinued.

special instructions

In case of a severe course of an infectious disease provoked by the ingestion of staphylococcus or pneumococcus, Ciprofloxacin is prescribed in combination with other drugs of the antibacterial spectrum of action.

If after the first use of the drug there are complications in the work of the gastrointestinal tract that develop after therapy prolonged diarrhea, this should be reported to the doctor immediately, because this symptomatic picture may be a sign of severe infectious pathology flowing in a latent form.

Cases with the development of such serious illnesses, as cirrhosis of the liver and liver failure that occur against the background of the use of this drug and proceed with complications, often posing a threat to the patient's life. If during therapy there are characteristic signs, they should be immediately reported to the attending physician, and the drug should be discontinued.

Alcohol compatibility

Alcoholic and alcohol-containing drinks are strictly forbidden to take during therapy.

Influence on the ability to control mechanisms

There are no strict restrictions regarding the management of transport during therapy with Ciprofloxacin. But this is provided that the patient does not have such side effects as bouts of dizziness, drowsiness, because an increased concentration of attention is required while driving.

Use during pregnancy and lactation

The main substance passes into breast milk, so taking the medicine by a woman who is breastfeeding a baby is not possible due to the high risk of complications. There is no experience of taking ciprofloxacin in pregnant women. Given the possible risks of complications, the drug is not prescribed during childbearing.

Prescribing Ciprofloxacin to 500 children

This medicine in the treatment of people under 18 years old is auxiliary and is used for complex treatment infectious diseases bodies urinary system, kidneys, such as pyelonephritis. Other indications for prescribing the drug to children - infectious diseases lungs caused by cystic fibrosis.

The drug is prescribed to children only in extreme cases, when it is not possible to achieve positive dynamics from other means, and its positive effect exceeds the risks of possible complications.

Use in the elderly

In the absence of diseases that are relative contraindication for use this drug, dosage adjustment is not required.

Overdose

After ingestion of a large amount of the drug in tablet form, nausea and vomiting, dizziness, tremor of the limbs, fatigue and drowsiness can develop. After the introduction of the infusion solution, there may be a change in consciousness, vomiting, overexcitation. If you are using eye drops or ear drops no cases of overdose have been identified.

Treatment of overdose is symptomatic, there is no specific antidote. Instructions for use indicate how to act in case of discomfort in the eyes when using drops. In this case, it is necessary to increase the release of eye fluid and, together with it, remove parts of the drug. To do this, it is necessary to wash the organs of vision with plenty of water.

Interaction with other drugs

With the simultaneous use of ciprofloxacin and non-steroidal anti-inflammatory drugs, dosage adjustment is required, since there is a possibility of developing muscle cramps. The solution of the drug is strictly forbidden to be mixed with other drugs, the pH level of which exceeds 7 units.

Analogues

Drugs with a similar spectrum of action that can be used instead of Ciprofloxacin if the patient has contraindications and if side symptoms occur: Teva, Cifran, Ecocifol, Levofloxacin.

APPROVED
Order of the Chairman of the Committee
control of medical and
pharmaceutical activities
Ministry of Health
Republic of Kazakhstan
from "____" ___________20 __ years
№_____________________

Instruction
for medical use
medicinal product

CIPROFLOXACIN

Tradename
CIPROFLOXACIN

Dosage form
Coated tablets, 0.25 g and 0.5 g

Compound
One tablet contains

active substance - ciprofloxacin hydrochloride monohydrate 295 mg and 590 mg, (in terms of ciprofloxacin) 250 mg and 500 mg,

Description
Tablets are white or almost white, biconvex, film-coated, one white layer is visible on the cross section. Tablets 250 mg round shape, tablets of 500 mg - oval.

Pharmacotherapeutic group
Antimicrobials for systemic use. Antimicrobials are quinolone derivatives. Fluoroquinolones. Ciprofloxacin.
Code ATXJ01MA02

Pharmacological properties
Pharmacokinetics
When taken orally, ciprofloxacin is rapidly and fairly completely absorbed from the gastrointestinal tract (GIT) (mainly in the duodenum and jejunum). Eating slows down absorption, but does not change the maximum concentration (C max) and bioavailability. Bioavailability - 50-85%, volume of distribution - 2-3.5 l / kg, connection with plasma proteins - 20-40%. The time to reach the maximum concentration (TC max) when taken orally is 60-90 minutes, C max linearly depends on the size of the dose taken and is 1.2 and 2.4 μg / ml at doses of 250 and 500 mg, respectively. 12 hours after ingestion of 250 and 500 mg, the plasma concentration of the drug decreases to 0.1 and 0.2 μg / ml, respectively.
Ciprofloxacin is well distributed in body tissues (excluding tissue rich in fats, such as nervous tissue). Concentration in tissues is 2-12 times higher than in plasma. Therapeutic concentrations are achieved in saliva, tonsils, liver, gallbladder, bile, intestines, abdominal and pelvic organs (endometrium, fallopian tubes and ovaries, uterus), seminal fluid, prostate tissue, kidneys and urinary organs, lung tissue, bronchial secretion, bone tissue, muscles, synovial fluid and articular cartilage, peritoneal fluid, skin. Penetrates into the cerebrospinal fluid (CSF) into a small amount, where its concentration in the absence of inflammation of the meninges is 6-10% of that in the blood serum, and in inflamed - 14-37%. Ciprofloxacin also penetrates well into the eye fluid, bronchial secretion, pleura, peritoneum, lymph, through the placenta. The concentration of ciprofloxacin in blood neutrophils is 2-7 times higher than in blood serum.
Activity is somewhat reduced at pH values ​​less than 6.
Ciprofloxacin is metabolized in the liver (15-30%) with the formation of inactive metabolites (diethylciprofloxacin, sulfocyprofloxacin, oxocyprofloxacin, formylciprofloxacin).
The half-life (T 1/2) is about 4 hours, in chronic renal failure (CRF) - up to 12 hours. Excreted mainly by the kidneys by tubular filtration and tubular secretion unchanged (40-50%) and in the form of metabolites (15 %), the rest with feces.
Renal clearance - 3-5 ml / min / kg; total clearance - 8-10 ml / min / kg. With chronic renal failure (creatinine clearance (CC) above 20 ml / min), the percentage of the drug excreted through the kidneys decreases, but cumulation in the body does not occur due to a compensatory increase in drug metabolism and excretion through the gastrointestinal tract.

Pharmacodynamics
Ciprofloxacin - antimicrobial drug a broad-spectrum, quinoline derivative, inhibits bacterial DNA gyrase (topoisomerases II and IV, responsible for the process of supercoiling of chromosomal DNA around nuclear RNA, which is necessary for reading genetic information), disrupts DNA synthesis, growth and division of bacteria; causes pronounced morphological changes (including the cell wall and membranes) and rapid death of the bacterial cell.
It acts bactericidal on gram-negative organisms during the period of rest and division (because it affects not only DNA gyrase, but also causes lysis of the cell wall), on gram-positive microorganisms - only during the half-life.
Low toxicity to macroorganism cells is explained by the absence of DNA gyrase in them. While taking ciprofloxacin, there is no parallel development of resistance to other antibiotics that do not belong to the group of gyrase inhibitors, which makes it highly effective against bacteria that are resistant to, for example, aminoglycazides, penicillins, cephalosporins, tetracyclines and many other antibiotics.
Gram-negative aerobic bacteria are sensitive to ciprofloxacin: enterobacteria (Escherichiacoli, Salmonellaspp., Shigellaspp., Citrobacterspp., Klebsiellaspp., Enterobacterspp., Proteusmirabilis, Proteusvulgaris, Serratiamarcescens, Hafniaalvei, Edwardsiellatarda, Providenciaspp., Morganellamorganii, Vibri ospp., Yersiniaspp.), other Gram-negative bacteria (Haemophilusspp., Pseudomonasaeruginosa, Moraxellacatarrhalis, Aeromonasspp., Pasteurellamultocida, Plesiomonasshigelloides, Campylobacterjejuni, Neisseriaspp.), some intracellular pathogens - Legionellapneumophila, Brucellaspp., Listeriamonocytogenes, Mycobacteriumtuberculosis, Mycobact eriumkansasii;
Gram-positive aerobic bacteria: Staphylococcus spp. (Staphylococcus aureus, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus), Streptococcus spp. (St reptococcus pyogenes, St reptococcus agalactiae). Active against Bacillus anthracis in vitro.
Most methicillin-resistant staphylococci are also resistant to ciprofloxacin. The sensitivity of Streptococcus pneumoniae, Enterococcus faecalis, Mycobacterium avium (located intracellularly) is moderate (high concentrations are required to suppress them).
Resistant to the drug: Bacteroidesfragilis, Pseudomonascepacia, Pseudomonasmaltophilia, Ureaplasmaurealyticum, Clostridium difficile, Nocardia asteroids. Not effective against Treponemapallidum.
Resistance develops extremely slowly, because, on the one hand, after the action of ciprofloxacin, there are practically no persistent microorganisms left, and on the other hand, bacterial cells there are no enzymes that inactivate it.

Indications for use
- acute and chronic (in the acute stage) bronchitis, pneumonia, bronchiectasis, infectious complications cystic fibrosis
- acute sinusitis
- cystitis, pyelonephritis
- Complicated intra-abdominal infections (in combination with metronidazole)
- chronic bacterial prostatitis
- uncomplicated gonorrhea
- typhoid fever, campylobacteriosis, shigellosis, traveler's diarrhea
- infected ulcers, wounds, burns, abscesses, phlegmon
- osteomyelitis, septic arthritis
- infections in patients with neutropenia

Children
- therapy of complications caused by Pseudomonasaeruginosa in children with pulmonary cystic fibrosis from 6 to 17 years
- prevention and treatment of pulmonary anthrax (infection with Bacillus anthracis)

Route of administration and dose
inside. The tablets should be swallowed whole with a small amount of liquid after meals. When taking the tablet on an empty stomach, the active substance is absorbed faster.
For lower respiratory infections ways of easy and moderate - 500 mg 2 times a day, in severe cases - 750 mg 2 times a day. The course of treatment is 7-14 days.
At acute sinusitis- 500 mg 2 times a day. The course of treatment is 7-14 days.
In case of infection of the skin and soft tissues of mild to moderate degree - 500 mg 2 times a day, in severe cases - 750 mg 2 times a day. The course of treatment is 7-14 days.
With infections of the bones and joints of mild and moderate degree - 500 mg 2 times a day, with severe course - 750 mg 2 times a day. The course of treatment - up to 4-6 weeks.
For infections urinary tract- 250-500 mg 2 times a day, the course of treatment is 7-14 days, with uncomplicated cystitis in women - 3 days.
In chronic bacterial prostatitis - 500 mg 2 times a day, the course of treatment is 28 days.
With uncomplicated gonorrhea - 250-500 mg once.
Infectious diarrhea - 500 mg 2 times a day, the course of treatment is 5-7 days.
At typhoid fever- 500 mg 2 times a day, course of treatment - 7 days.
With complicated intra-abdominal infections - 500 mg every 12 hours for 7-14 days.
For the prevention and treatment of the pulmonary form of anthrax - 500 mg 2 times a day.
The duration of treatment depends on the severity of the disease, clinical and bacteriological results.
CRF: with CC more than 60 ml / min, dose adjustment is not required; with CC 30-50 ml / min - 250-500 mg every 12 hours; at QC< 30 мл/мин - 250-500 мг каждые 18 ч. Если больному проводится гемодиализ или перитонеальный диализ - 250-500 мг/сут, но принимать следует после сеанса гемодиализа.
In pediatrics:
in the treatment of complications caused by Pseudomonasaeruginosa in children with cystic fibrosis of the lungs from 6 to 17 years old - 20 mg / kg 2 times a day (maximum dose 1.5 g). The duration of treatment is 10-14 days.
with the pulmonary form of anthrax (prevention and treatment) - 15 mg / kg 2 times a day. The maximum single dose is 500 mg, the daily dose is 1 g. Total duration taking ciprofloxacin - 60 days.

Side effects
Often
- nausea, diarrhea
Sometimes
- vomiting, abdominal pain, loss of appetite
- dizziness, headache, fatigue, anxiety,
- loss of taste and smell
- leukopenia, eosinophilia
Rarely
- feeling of weakness, long-term use of an antibiotic can cause the emergence of resistant strains of bacteria and fungi
- flatulence
- tachycardia, cardiac arrhythmia, peripheral edema
- thrombocytopenia
- hypoprothrombinemia, increased activity of "liver" transaminases and alkaline phosphatase, creatinine, bilirubin and urea
- vasculitis
Very rarely
- joint pain, joint inflammation
- cholestatic jaundice (especially in patients with previous diseases liver), hepatitis, hepatonecrosis, pseudomembranous colitis
- tremor, insomnia, "nightmare" dreams, peripheral paralgesia (an anomaly in the perception of pain), sweating, increased intracranial pressure, unsteadiness when walking, anxiety, confusion, depression, hallucinations, as well as other manifestations of psychotic reactions (rarely progressing to conditions in which the patient can harm himself), migraine, syncope
- visual impairment (diplopia, change in color perception), tinnitus, hearing loss
- increased concentrations of lipase, amylase
- decrease in blood pressure, thrombosis of cerebral arteries
- granulocytopenia, anemia, leukocytosis, agranulocytosis, thrombocytosis, pancytopenia, hemolytic anemia, depression bone marrow, change in the level of prothrombin
- hypercreatininemia, hyperbilirubinemia, hyperglycemia
- peripheral neuropathy
-dyspnea, swelling of the larynx
- psychosis, occasionally with suicidal tendencies
- hematuria, crystalluria (especially with alkaline urine and low diuresis), acute renal failure, vaginal candidiasis, glomerulonephritis, dysuria, polyuria, urinary retention, albuminuria, urethral bleeding, hematuria, decreased nitrogen excretion of kidney function, interstitial nephritis
-allergic reactions: sometimes- skin itching, rarely- urticaria, swelling of the face or throat, anaphylactic shock, very rarely - blistering with bleeding and small nodules forming scabs, drug fever, petechiae on the skin (petechiae), shortness of breath, eosinophilia, vasculitis, nodular erythema, erythema multiforme exudative (including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome), photosensitivity reactions
- others: asthenia, increased photosensitivity, superinfections (candidiasis, pseudomembranous colitis), flushing of blood to the face, increased sweating, arthralgia, arthritis, tendovaginitis, tendon ruptures, myalgia, serum sickness-type reactions

Contraindications
- hypersensitivity to the drug
- simultaneous reception with tizanidine (risk of a pronounced decrease in blood pressure (BP), drowsiness)
- pregnancy and lactation
- adolescence up to 18 years (except for the treatment of complications caused by Pseudomonasaeruginosa in children with cystic fibrosis of the lungs from 6 to 17 years; prevention and treatment of pulmonary anthrax infected with Bacillusanthracis)
- lactose intolerance
- lactase deficiency
- glucose-galactose malabsorption
- epilepsy

Drug Interactions
Due to a decrease in the activity of microsomal oxidation processes in hepatocytes, ciprofloxacin increases the concentration and lengthens the T 1/2 of theophylline (and other xanthines, such as caffeine), oral hypoglycemic drugs, anticoagulants indirect action, contributes to a decrease in the prothrombin index.
When combined with other antimicrobial drugs (beta-lactam antibiotics, aminoglycazides, clindamycin, metronidazole), synergism is usually observed; can be successfully used in combination with azlocillin and ceftazidime for infections caused by Pseudomonasspp.; with mezlocillin, azlocillin and other beta-lactam antibiotics - for streptococcal infections; with isoxazolylpenicillins and vancomycin - with staphylococcal infections; with metronidazole and clindamycin - for anaerobic infections.
Ciprofloxacin enhances the nephrotoxic effect of cyclosporine, there is an increase in serum creatinine, in such patients it is necessary to control this indicator 2 times a week.
At simultaneous reception enhances the effect of anticoagulant agents of indirect action.
Oral administration together with iron-containing drugs, sucralfate and antacid drugs containing magnesium, calcium and aluminum ions leads to a decrease in the absorption of ciprofloxacin, so it should be administered 1-2 hours before or 4 hours after taking the above drugs.
Non-steroidal anti-inflammatory drugs (excluding acetylsalicylic acid) increase the risk of seizures.
Didanosine decreased absorption of ciprofloxacin due to the formation of complexes with it with aluminum and magnesium ions contained in didanosine.
Metoclopramide accelerates absorption, which leads to a decrease in the time to reach its C max .
Joint application uricosuric drugs leads to a slowdown in excretion (up to 50%) and an increase in the plasma concentration of ciprofloxacin.
Increases Cmax by 7 times (from 4 to 21 times) and the area under the concentration-time curve (AUC) by 10 times (from 6 to 24 times) of tizanidine, which increases the risk of a pronounced decrease in blood pressure and drowsiness.
Probenecid: probenecid interferes with the renal excretion of ciprofloxacin. The combined use of probenecid and ciprofloxacin increases the concentration of ciprofloxacin in plasma.
Omeprazole: the simultaneous use of ciprofloxacin and omeprazole leads to a slight decrease in the maximum plasma concentration and the average concentration in the urine of ciprofloxacin.
Theophylline: with the simultaneous use of siflox and theophylline, an increase in the concentration in the blood of the latter is possible. In such cases, it is necessary to adjust the dose of theophylline.
Tizanidine: simultaneous administration with tizanidine leads to an increase in the concentration of tizanidine in the blood serum, aggravated hypotension and increased sedation.
Caffeine: Some quinolones, including ciprofloxacin, reduce caffeine clearance and may prolong its serum half-life.
Methotrexate: renal tubular transport of methotrexate may be inhibited while taking ciprofloxacin, which may lead to an increase in plasma levels of methotrexate. As a result, the risk of toxic reactions associated with the use of methotrexate may increase. Therefore, patients taking methotrexate should be closely monitored while receiving ciprofloxacin therapy.
Phenytoin: the simultaneous use of ciprofloxacin and phenytoin can lead to an increase or decrease in plasma levels of phenytoin, therefore, their monitoring is recommended.
Antibiotics: the simultaneous use of ciprofloxacin and aminoglycosides and beta-lactam antibiotics gives an additive and synergistic effect.
Effects on CYP: Ciprofloxacin is a strong inhibitor of CYP1A2 and a weak inhibitor of CYP3A4.
Cyclosporine: with the simultaneous use of drugs containing ciprofloxacin and cyclosporine, a transient increase in plasma creatinine concentration was observed. Therefore, it is necessary to monitor plasma creatinine concentrations frequently (twice a week) in such patients.
Vitamin K antagonists: the simultaneous use of ciprofloxacin with vitamin K antagonists may enhance its anticoagulant effect.
Glibenclamide: in some cases, the simultaneous use of ciprofloxacin and glibenclamide may enhance the effect of glibenclamide (hypoglycemia).
Duloxetine: in clinical studies, it was found that the simultaneous use of duloxetine with strong inhibitors of the cytochrome P450 1A2 isoenzyme, such as fluvoxamine, can lead to an increase in the average concentration in the urine and the maximum plasma concentration of duloxetine. Although there are no clinical data for possible interaction with ciprofloxacin, similar effects can be expected with their one-time use.
Ropinirole: was established during clinical trial that the simultaneous use of ropinirole, which is an inhibitor of the cytochrome P450 1A2 isoenzyme of medium power, with ciprofloxacin leads to an increase in the average concentration in the urine and the maximum plasma concentration of ropinirole by 84% and 60%, respectively. Monitoring for side effects due to ropinirole and dosage adjustments during and after co-administration with ciprofloxacin are recommended.
Lidocaine: on healthy people it was found that the simultaneous use of drugs containing lidocaine, which is an inhibitor of the cytochrome P450 1A2 isoenzyme of medium power, with ciprofloxacin, reduces the clearance of intravenously administered lidocaine by 22%. Although therapy with lidocaine was well tolerated, possible interactions with ciprofloxacin may occur during single use, leading to side effects.
Clozapine: at the end of a single application of 250 mg of ciprofloxacin with clozapine for 7 days, plasma concentrations of clozapine and N-desmethylclozapine were increased by 29% and 31%, respectively. Recommended clinical observation and adequate dosage adjustment of clozapine during and after co-administration with ciprofloxacin.
Sildenafil: the simultaneous use of sildenafil with ciprofloxacin leads to an increase in the average concentration in the urine and the maximum plasma concentration of sildenafil approximately twice after an oral dose of 50 mg at a time with 500 mg of ciprofloxacin. Therefore, caution should be exercised when prescribing combination therapy, taking into account the risk and possible benefit.
Food and dairy products: calcium in the form of a nutrient does not significantly affect absorption. However, a one-time use of dairy products or drinks fortified minerals(e.g. milk, yogurt, mineral-fortified orange juice) with ciprofloxacin should be avoided due to possible decreased absorption of ciprofloxacin.

special instructions
Carefully: severe atherosclerosis of cerebral vessels, impaired cerebral circulation, mental illness, epilepsy, severe renal and / or liver failure, elderly age, tendon lesions with previous therapy with fluoroquinolones.
Ciprofloxacin is not the drug of choice for suspected or established pneumonia caused by Streptococcus pneumoniae.
In order to avoid the development of crystalluria, it is unacceptable to exceed the recommended daily dose, adequate fluid intake and maintenance of an acidic urine are also necessary.
Patients with epilepsy, seizures in history, vascular diseases and organic lesions of the brain, due to the threat of development adverse reactions from the side of the central nervous system (CNS), ciprofloxacin should be prescribed only for "vital" indications.
If severe and prolonged diarrhea occurs during or after treatment, the diagnosis of pseudomembranous colitis should be excluded, which requires immediate discontinuation of the drug and the appointment of appropriate treatment.
Cases of polyneuropathy (based on neurological symptoms such as pain, burning, sensory disturbances or muscle weakness, alone or in combination) have occurred in patients treated with ciprofloxacin. The drug should be discontinued in patients with symptoms of neuropathy, including pain, burning, tingling, numbness, and / or weakness, in order to prevent the development of irreversible disorders.
There are cases of serious and fatal reactions in patients concomitantly using ciprofloxacin and theophylline. These reactions included cardiac arrest, convulsions, an epileptic state, and respiratory failure. Although these reports concern similar serious adverse effects in patients receiving theophylline alone, the possibility that these reactions may be caused by ciprofloxacin has not been excluded. If concomitant use cannot be avoided, then serum theophylline levels should be checked and appropriate dosage adjustments made.
Therapy with quinolones may be associated with hypersensitivity reactions, even after a single dose. Therapy with the drug should be stopped at the first sign of an allergic reaction. Severe anaphylactic reactions require immediate emergency care.
As with other broad-spectrum antimicrobials, long-term use of the drug can lead to overgrowth non-susceptible microorganisms and superinfection. As with other potent drugs, periodic assessment of organ and system functions, including renal, hepatic, and hematopoietic functions, is recommended during long-term therapy.
CYP450: Ciprofloxacin is an inhibitor of the hepatic CYP1A2 enzyme pathway. Co-administration of ciprofloxacin with other drugs primarily metabolized by CYP1A2 (eg, theophylline, methylxanthines, tizanidine) results in increased plasma concentrations of co-administered drugs and may result in clinically significant pharmacodynamic side effects of co-administered drugs.
Severe infections and mixed infections with gram-positive and anaerobic pathogens.
Ciprofloxacin monotherapy is not indicated for the treatment of severe infections and infections possibly caused by gram-positive or anaerobic pathogens. In such infections, ciprofloxacin should be used in conjunction with other adequate antibacterial drugs.
Streptococcal infections (including those caused by Streptococcus pneumoniae).
Ciprofloxacin is not recommended for use in the treatment of streptococcal infections due to an inadequate level of efficacy.
Urinary tract infections.
Fluoroquinolone-resistant gonococcal urethritis, cervicitis, epididymo-orchitis and pelvic inflammatory disease can be caused by isolated strains of Neisseria Gonorrhoeae.
Therefore, ciprofloxacin should be used for the treatment of gonococcal urethritis or cervicitis only if ciprofloxacin-resistant organisms have been excluded.
For the treatment of epididymo-orchitis and pelvic inflammatory disease, empiric use of ciprofloxacin should only be considered in combination with other adequate antibacterial agents (eg, cephalosporin), unless ciprofloxacin-resistant organisms have been excluded based on data. If there is no clinical improvement on the third day of therapy, it should be canceled.
Urinary tract infections.
Fluoroquinolone resistance in Escherichia coli, the most common pathogen involved in the development of urinary tract infections. Physicians are advised to consider the local prevalence of fluoroquinolone-resistant Escherichia coli.
Single administration of ciprofloxacin has been estimated to be associated with lower efficacy than long-term therapy. This should also be taken into account regarding the increasing level of E. coli resistance to quinolones.
Intra-abdominal infections.
There is limited data on the effectiveness of the treatment of postoperative intra-abdominal infections.
Traveler's diarrhea.
The choice of ciprofloxacin should take into account information on ciprofloxacin resistance in relevant pathogens in the countries visited.
Infectious pathologies of bones and joints.
Ciprofloxacin should be used in combination with other antibacterial agents, depending on the results. microbiological research.
Skeletal - muscular system.
In general, ciprofloxacin should not be used in patients with a history of tendon disease/disorders associated with the use of ciprofloxacin. However, in very rare cases, after microbiological testing of the causative agent and a careful risk-benefit analysis, ciprofloxacin may be used in these patients for the treatment of certain serious infections, particularly in the event of failure of standard therapy or the presence of microbial resistance, provided that microbiological testing justifies use of ciprofloxacin.
In the context of the use of ciprofloxacin, tendonitis and tendon ruptures (especially the Achilles tendon) can develop, sometimes in a bilateral variant, and even in the first 48 hours after the start of therapy. Inflammation and rupture of the tendons can occur even several months after discontinuation of ciprofloxacin therapy. The risk of tendinopathy may be increased in elderly patients or in patients receiving concomitant corticosteroid therapy.
If any symptoms of tendonitis (eg, painful swelling, inflammation) are present, ciprofloxacin therapy should be discontinued. Rest of the affected limb should be observed.
Ciprofloxacin should be used with caution in patients with severe pseudoparalytic myasthenia gravis.
Photosensitization.
Ciprofloxacin has been shown to cause photosensitivity reactions. Patients taking ciprofloxacin should avoid direct contact with sunlight or UV exposure during treatment.
Disorders from the cardiovascular system.
Quinolones should be used with caution in patients with known risk factors for QT prolongation, such as:
- hereditary syndrome extended QT - interval;
- simultaneous use of drugs that prolong the QT - interval (for example, antiarrhythmic drugs of classes 1A and 3, tricyclic antidepressants, macrolides, antipsychotics).
- uncorrected electrolyte disturbances (eg, hypokalemia, hypomagnesemia);
- cardiac pathologies (for example, heart failure, myocardial infarction, bradycardia).
Elderly patients and women may be more sensitive to QT-lengthening drugs.
Therefore, caution should be exercised when using fluoroquinolones, including ciprofloxacin, in these populations.
Cases of crystalluria associated with ciprofloxacin have been reported. Patients receiving ciprofloxacin should drink adequate fluids, and excessive drinking should be avoided. alkaline reaction urine.
Kidney dysfunction.
Since ciprofloxacin is mainly excreted unchanged through the kidneys in patients with impaired renal function dosage adjustment is required to avoid aggravation of the side effects of the drug due to the accumulation of ciprofloxacin.
Features of the influence of the drug on the ability to drive a vehicle or potentially dangerous mechanisms
During treatment, you should refrain from driving vehicles and servicing machines and mechanisms that require increased concentration attention and speed of psychomotor reactions.
When using ciprofloxacin, direct sunlight and intense ultraviolet radiation should be avoided. In case of photosensitivity (appearance of burn-like skin reactions) the drug should be discontinued.

Overdose
Symptoms: increased side effects of the drug.
Treatment: specific antidote is unknown. Gastric lavage and other emergency measures, careful monitoring of the patient's condition, ensuring sufficient fluid intake. With the help of hemo- or peritoneal dialysis, only a small (less than 10%) amount of the drug can be removed.