Ciprofloxacin: Clinical Applications, Mechanism of Action, Formulations and Side Effects

Clinical Applications

Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic formulation that has been approved by the FDA for the treatment of the following infections:

• simple or complicated urinary tract infections (UTIs) and bladder infections

• sexually transmitted infections (STIs) (gonorrhea and chancroid)

• Lung infections (chronic bronchitis, pneumonia)

• Skin and bone infections

• Joint infections

• Gastrointestinal infections

• Lower respiratory tract infections

• Prostate infections (prostatitis)

• Typhoid and anthrax infections

• Plague infection

Ciprofloxacin is also indicated for the treatment of patients with mixed infections or patients with susceptibility factors for gram-negative infections.

Mechanism of Action

Ciprofloxacin works by blocking DNA replication during bacterial proliferation. It has been shown that Ciprofloxacin inhibits DNA replication by inhibiting bacterial DNA topoisomerase and DNA-gyrase. It is most effective against Gram-negative bacteria (mainly Enterobacteriaceae, such as Escherichia coli, Salmonella, Shigella, and Neisseria). Ciprofloxacin is the most powerful of the quinolones against Pseudomonas aeruginosa.

Formulations

Ciprofloxacin is available in a variety of dosage forms including tablets (100, 250, 500, and 700 mg), suspensions (250 and 500 mg), extended-release tablets (500 and 1,000 mg), injections, ear drops, and eye drops/eye ointment. Currently, ciprofloxacin eye drops are FDA-approved for the treatment of corneal ulcers and conjunctivitis caused by susceptible strains of bacteria. And ciprofloxacin ear drops are approved for the treatment of acute otitis externa caused by susceptible strains of Pseudomonas aeruginosa or S. aureus. Its suspension gel is approved for effusive paediatric otitis media.

Side Effects

The most common side effects of Ciprofloxacin include:

• Gastrointestinal disturbances (nausea, vomiting and diarrhoea)

• Changes in liver function tests

• Headaches

• Swelling of the nose and throat

• Skin rash

Serious adverse reactions include:

• Tendon problems (swollen or torn tendons, tendonitis)

• Neuropsychiatric maladies (including muscle twitching, tremors, hallucinations, psychosis, and seizures)

• Heart rhythm changes (prolonged QT interval)

• Hyperglycaemia or hypoglycaemia

• Photosensitivity

• Aortic aneurysms and aortic coarctation

• Hepatotoxicity

• Severe allergic reactions (rapid heartbeat, difficulty breathing, swollen lymph nodes, swollen limbs and hives)

Seek medical attention if any of these serious adverse reactions occur.

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