Ciprofloxacin

Ципрофлоксацин Drug photo

The description is actual on 20.08.2015

  • Latin name: Ciprofloxacinum
  • ATH code: S03AA07
  • Active ingredient: Ciprofloxacin (Ciprofloxacinum)
  • Producer: PAO "Farmak", CIAO "Technologist", JSC Kiyevmedpreparat (Ukraine), LLC Ozon, JSC Verofarm, JSC Sintez (Russia), C.O. Rompharm Company S.R.L. (Romania)

Structure

Ear and eye drops Ciprofloxacin contain ciprofloxacin a hydrochloride in concentration of 3 mg/ml (in terms of pure substance), Trilonum of B, a benzalkoniya chloride, sodium chloride, the purified water.

In an oculentum active agent also contains in concentration of 3 mg/ml.

Tablets Ciprofloxacin: 250, 500 or 750 mg of ciprofloxacin, MKTs, potato starch, corn starch, gipromelloz, sodium of a kroskarmeloz, talc, magnesium stearate, silicon dioxide colloid anhydrous, macrogoal 6000, E171 additive (titanium dioxide), polysorbate 80.

Solution for infusions contains active ingredient in concentration of 2 mg/ml. Excipients: sodium chloride, edetat dinatrium, lactic acid, hydrochloric diluted acid, water for and.

Release form

  • Drops eye and ear 0,3%.
  • Concentrate for infusional therapy of 2 mg/ml.
  • The tablets covered p / about 250 mg, 500 mg and 750 mg.
  • Ointment of ophthalmologic 0,3%.

The ATH code applied in otology and ophthalmology of dosage forms — S01AX13.

Pharmacological action

Bactericidal.

Pharmacodynamics and pharmacokinetics

Ciprofloxacin is antiobiotik or not?

The antibiotic Ciprofloxacin is an early ftorkhinolon (drug of the 1st generation) and is applied mainly at hospital infections. Means well gets into cells and fabrics (including cells of bacteria and macroorganisms) and has good pharmacokinetic parameters.

Pharmacodynamics

The mechanism of effect of drug is caused by ability to oppress DNK-girazu (enzyme of bacterial cells) with disturbance of synthesis of DNA, division and growth of microorganisms.

In Wikipedia it is specified that against use of drug stability to other, not belonging to group of inhibitors of a giraza, antibiotics is not developed. It does Ciprofloxacin highly effective concerning the bacteria steady against effect of penicillin, kaminoglikozid, tetracyclines, cephalosporins and some other antibiotics.

The greatest activity is shown in the relation by Gram (-) and Gram (+) aerobes: H. influenzae, N. gonorrhoeae, Salmonella spp., P. aeruginosa, N. meningitidis, E. coli, Shigella spp.

It is effective at the infections caused: strains of stafilokokk (including producing a penicillinase), separate strains of enterococci, legionell, campylobacters, chlamydias, mycoplasmas, mycobacteria.

It is active concerning the microflora producing beta lactamelements.

Anaerobe bacterias are moderately sensitive or rezistentna to drug. Therefore patients with the mixed mephitic and aerobic gangrene ciprofloxacin should supplement treatment with purpose of linkozamid or Metronidazole.

Are resistant to an antibiotic: Ureaplasma urealyticum, Streptococcus faecium, Treponema pallidum, Nocardia asteroides.

Resistance of microorganisms to drug forms slowly.

Pharmacokinetics

After reception of a tablet drug is quickly and in full absorbed in a gastrointestinal tract.

Main pharmacokinetic indicators:

  • bioavailability — 70%;
  • TCmax in a blood plasma is 1–2 h after reception;
  • T½ is 4 h.

From 20 to 40% of substance contact plasma proteins. Ciprofloxacin is well distributed in biological liquids and body tissues, and its concentration in fabrics and liquids can significantly exceed plasma.

Through a placenta gets into cerebrospinal liquid, it is excreted in breast milk, high concentration are fixed in bile. To 40% of the accepted dose it eliminirutsya during 24 h in not changed look by kidneys, the part of a dose is removed with bile.

Indications to Ciprofloxacin use

Ciprofloxacin — from what these tablets / solution?

Ciprofloxacin is appointed for treatment of infectious diseases of ENT organs, bodies of a small pelvis, bones, by skin, joints, an abdominal cavity, a respiratory path, urogenital and postoperative infections caused by flora, sensitive to drug.

Drug can be used at patients with immunodeficiency (including at states which develop at a neutropenia, or are caused by use of immunosuppressors).

Ciprofloxacin (as well as other early ftorkhinolona) is preferable drug at treatment of IMP, including, including, hospital infections.

Thanks to ability it is good to get into fabrics and, in particular, into tissue of a prostate gland, ftorkhinolona have practically no alternative at treatment of bacterial prostatitis.

Showing high activity concerning the most probable causative agents of hospital pneumonia (golden staphylococcus, enterobakteriya and a pyocyanic stick), is important at the pneumonia connected with need of carrying out artificial ventilation of the lungs.

If an infestant is P.aeruginosa, before purpose of drug it is necessary to establish its sensitivity to ciprofloxacin. It is connected with the fact that in intensive care units more than a third of strains of a pyocyanic stick are unreceptive to drug.

Drug is important at intraabdominal surgical infections and infections of gepatobiliarny system. For infection prevention he can be appointed the patient with a pancreatonecrosis.

Ftorkhinolona are not used at TsNS infections. It is connected with their low penetration (penetration) into cerebrospinal liquid. At the same time they are effective at meningitis which causative agents are steady against tsefalosplorina of the 3rd generation Gram (-) of a bacterium.

Existence of several dosage forms allows to use drug for carrying out step therapy. Upon transition from administration of Ciprofloxacin in/in for the purpose of maintenance of therapeutic concentration the dose for intake should be increased by oral administration.

So, if to the patient introduction of 100 mg intravenously was appointed, then inside it should accept 250 mg, and if 200 mg, then 500 mg were entered into a vein.

From what medicine in the form of eye/ear drops?

In ophthalmology it is applied at superficial bacterial infections of an eye (eyes) and its appendages, and also at an ulcer keratitis.

Indications to use of Ciprofloxacin in otology: acute bacterial otitis of an external ear and acute bacterial otitis of a middle ear at patients with a timpanostomichesky tube.

Contraindications

Contraindications at system use:

  • hypersensitivity;
  • pregnancy;
  • lactation;
  • the expressed kidneys/liver dysfunction;
  • instructions on the tendinitis caused by use of hinolon in the anamnesis.

Drops for eyes and ears are contraindicated at fungal and viral infections of eyes/ears, at intolerance of Ciprofloxacin (or other hinolon), during the periods of pregnancy and feeding by a breast.

Children of a tablet and solution for in/in introductions can appoint since 12, eye and ear drops — since 15.

Side effects

Drug differs in good tolerance. The most frequent side effects at in introduction and intake:

  • dizziness;
  • exhaustion;
  • headache;
  • tremor;
  • excitement.

In the reference book Vidal is reported that in isolated cases at patients were fixed:

  • perspiration;
  • gait disturbances;
  • peripheral disturbances of sensitivity;
  • inflow;
  • intracranial hypertensia;
  • depression;
  • sensation of fear;
  • visual disturbances;
  • meteorism;
  • abdominal pains;
  • digestion disturbance;
  • nausea/vomiting;
  • diarrhea;
  • hepatitis;
  • necrosis of hepatocytes;
  • tachycardia;
  • arterial hypertension (seldom);
  • skin itch;
  • emergence of an enanthesis.

Exclusively rare side effects: bronchospasm, acute anaphylaxis, Quincke's edema, arthralgia, petechias, malignant exudative erythema, vasculitis, Lyell's disease, leucio-and thrombocytopenia, eosinophilia, anemia, hemolitic anemia, trombo-or leukocytosis, increase of plasma concentration of LDG, bilirubin, ShchF, transaminases of a liver, creatinine.

Use in ophthalmology is followed:

  • often — a sensation of discomfort and/or presence of a foreign body at an eye, emergence of a white plaque (as a rule, at patients with an ulcer keratitis and at frequent use of drops), education kristallikov / scales, sverbezh and a conjunctiva hyperemia, a pricking and burning;
  • in isolated cases — a keratitis/keratopathy, the century, coloring of a cornea, hypersensitivity reaction, dacryagogue, decrease in visual acuity, photophobia, a cornea infiltration swelled.

Side effects which are connected or perhaps connected using drug are usually poorly expressed, do not pose threat and pass without treatment.

At patients with an ulcer keratitis the appearing white plaque does not exert a negative impact on treatment of a disease and parameters of sight and disappears independently. As a rule, it appears during the period of 1-7 days after the beginning of a course of use of drug and disappears at once or within 13 days after its termination.

Not ophthalmologic disturbances when using drops: emergence of unpleasant smack in a mouth, in rare instances — nausea, dermatitis.

When using in otology are possible:

  • often — sverbezh in an ear;
  • in some cases — a ring in ears, a headache, dermatitis.

Application instruction of Ciprofloxacin

Tablets Ciprofloxacin: application instruction

The daily dose for the adult varies ranging from 500 mg to 1,5 g/days. It is necessary to divide it into 2 receptions with an interval of 12 h.

For the prevention of crystallization of salts in urine the antibiotic should be accepted with large volume of liquid.

The single dose is selected depending on the diagnosis:

  • urogenital infections — from 2*250 to 2*500 mg at uncomplicated acute, from 2*500 to 2*750 mg at complicated;
  • cystitis at women before a menopause — 500 mg (once);
  • infections of a respiratory path (depending on the activator and disease severity) — from 2*500 to 2*750 mg;
  • gonorrhea — 500 mg once at acute uncomplicated and from 2*500 to 2*750 mg of mg if the extragenital form of a disease is diagnosed for the patient, and also in cases when the disease proceeds with complications;
  • damages of joints and bones, heavy, life-threatening the patient, infections, a septicaemia, 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 a malignant anthrax — 2*500 mg;
  • prevention of the invasive infections caused by N. meningitidіs — 1*500 mg.

Treatment is continued, clinical symptoms, and some more days after their disappearance and normalization of body temperature will not be stopped yet. In most cases the course lasts from 5 to 15 days, at damages of joints and a bone tissue it is prolonged till 4-6 weeks, at osteomyelitis — about 2 months.

By the patient with dysfunction of kidneys dose adjustment is required and/or to interval duration.

Use of ampoules

Ciprofloxacin in ampoules is recommended to be entered intravenously in the form of drop infusion. A dose for the adult — 200-800 mg/days. Course duration on average from 1 week to 10 days.

At urogenital infections, damages of joints and bones or ENT organs to the patient twice during the day enter 200-400 mg. At infections of a respiratory path, intra belly infections, a septicaemia, defeats of soft tissues and skin the single dose at the same frequency rate of uses makes 400 mg.

At dysfunction of kidneys a starting dose — 200 mg, adjust it afterwards taking into account Clcr.

In case of use of ampoules in a dose of 200 mg infusion duration — 30 minutes, at administration of drug in a dose of 400 mg — 1 hour.

Pricks of Ciprofloxacin are not appointed.

Ear and eye drops Ciprofloxacin: application instruction

At an ulcer keratitis treatment is carried out according to the following scheme:

  • 1 days — in the first 6 hours enter 2 drops of solution into a conjunctival cavity every 15 minutes, then intervals between instillations increase before half an hour (the same single dose — 2 drops);
  • 2 days — 2 drops with an interval between instillations 60 minutes;
  • 3-14 days — 2 drops with an interval between instillations at 4 o'clock.

Treatment at an ulcer keratitis can longer last 14 days. The scheme of treatment is selected individually attending physician.

At superficial bacterial infections of an eye and its appendages a standard dose — 1-2 drops at frequency rate of uses of 4 rubles/days. In especially hard cases in the first 48 hours to the patient dig in 1-2 drops every 2 hour.

Treatment lasts from 7 to 14 days.

After instillation for decrease in system absorption of the medicine entered into an eye lacrimonasal occlusion is recommended.

In case of the accompanying treatment by other ophthalmologic drugs for topical administration it is necessary to maintain 15-minute intervals between their introduction and administration of Ciprofloxacin.

In otology a standard dose of drug — 4 drops in previously cleared acoustical pass of the affected ear of 2 rubles/days.

To the patients using earplugs, the dose is raised only at the first use of drug: to children enter 6, the adult — 8 drops.

The course should not last more than 10 days. In need of its extension it is necessary to define sensitivity of native flora.

In case of use of other means for topical administration between their administration and administration of Ciprofloxacin it is necessary to maintain an interval 10-15 minutes.

Dosage to children of 15 years: on 3 drops twice within a day.

Influence of dysfunction of kidneys/liver on pharmacokinetic parameters of drug in the form of ear and eye drops was not studied.

To avoid vestibular stimulation, solution before introduction to acoustical pass is warmed up to body temperature.

The patient has to lay down on a side, opposite concerning the affected ear. In such situation it is recommended to remain within 5-10 minutes after a solution instillation.

Also it is allowed to enter after local clarification for 1-2 days into acoustical pass the tampon moistened in solution from hydroscopic cotton wool or a gauze. For saturation by drug it should be moistened twice a day.

To avoid pollution of a tip of a bottle dropper and solution, it is not necessary to touch with a dropper by the centuries, an auricle, outside acoustical pass adjoining to them to sites and any other surfaces.

In addition

Basic difference is in how to accept drugs of different producers, is not present: the application instruction of Tsiprofloksatsin-AKOS is similar to the instruction on Tsiprofloksatsin-FPO, Ciprofloxacin-pro-honey, Vero-Tsiprofloksatsin or Tsiprofloksatsin-Tev.

For children and teenagers is younger than 18 years it is recommended to appoint drug only in case of resistance of the activator to other chemotherapeutic means.

Overdose

There are no specific symptoms at overdose of Ciprofloxacin. The gastric lavage, reception of emetic drugs, creation of acid reaction of urine, introduction of large volume of liquid is shown to the patient. All events should be held against maintenance of function of the vital systems and bodies.

The peritoneal dialysis and hemodialysis promote removal of 10% of the accepted dose.

Drug has no specific antidote.

Interaction

Use in a combination with Theophylline promotes increase of plasma concentration and increase in T1/2 of the last.

Al/Mg the containing antacids promote ciprofloxacin absorption delay and by that reduce its concentration in urine and blood. Between receptions of these drugs it is necessary to maintain intervals lasting not less than 4 watch.

Probenetsid detains drug removal.

Ciprofloxacin strengthens effect of coumarinic anticoagulants.

Interaction of Ciprofloxacin for use in otology and ophthalmology with other drugs was not studied.

Terms of sale

According to the recipe.

Recipe sample on Latin:

Rp: Ciprofloxacini 0,25 (0,5)

D.t.d. N 10 in tab.

S. 250 mg (1 tablet) 2 r/d

Storage conditions

It is necessary to store drug at the room temperature, in the place unavailable to children.

Period of validity

For solution, ear and eye drops — 2 g (contents of the opened bottle have to be used within 28 days), for tablets — 3 g.

Special instructions

Because of probability of emergence of side effects from TsNS at patients with its pathology in the anamnesis drug can be used only according to vital indications.

With care appoint Ciprofloxacin at reduction of the threshold of convulsive readiness, epilepsydamages of a brain, a heavy tserebroskleroz (the probability of disturbance of blood supply and a stroke increases), at serious violations of function of livers/kidneys, at advanced age.

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

At patients with alkali reaction of urine crystalluria cases were fixed. In order to avoid its development it is inadmissible to exceed a therapeutic dose of drug. Besides, plentiful drink and maintenance of acid reaction of urine are required for the patient.

Sinew pains and emergence of symptoms of a tendovaginitis are a signal for the treatment termination as the probability of an inflammation/rupture of a sinew is not excluded.

Ciprofloxacin can brake the speed of psychomotor reactions (in particular against alcohol) what the patients working with potentially dangerous devices should remember.

At development of heavy diarrhea, it is necessary to exclude pseudomembranous colitis since the specified disease is contraindication to drug use.

In need of simultaneous in/in introductions of barbiturates it is necessary to control function CCC: in particular, indicators of an ECG, ChSS, ABP.

The liquid ophthalmologic form of drug is not intended for intraocular injections.

Analogs of Ciprofloxacin

Coincidence on the ATH code of the 4th level:

Synonyms: Tsiprofloksatsin-Tev, Basidzhen, Tsiprofloksatsin-FPO, Ifitsipro, Ciprofloxacin-pro-honey, Protsipro, Tsiprofloksatsin-AKOS, Tsiprinol, Tsiprodoks, Tsifran, Ekotsifol, Tseprova.

Analogs of Ciprofloxacin with the similar mechanism of action: Abaktal, Gatispan, Zanotsin, Ivatsin, Levotek, Levofloxacin, Moksimak, Nolicin, Ofloxacin, Oflotsid, Pefloksatsin, Elefloks.

Zdravzona

  • Ciprofloxacin 250 of mg No. 10 tablet/ozone/ozone of Ltd company
  • Ciprofloxacin solution for infusions 2mg/ml 100mlpromed Exports
  • Tsiprofloksatsin-Vero of 500 mg No. 10 tabletkiverofarm joint stock company
  • Ciprofloxacin 500 of mg No. 10 tablet/ozone/ozone of Ltd company
  • Ciprofloxacin of 0,3% of a drop eye and ear 5 ml Company bottle-kapelnitsarompharm

Drugstore of IFC

  • Tsiprofloksatsin-Tev tbl p / about 500 mg No. 10, Pharmaceutical plant of Tev Prayvet of Kovengriya
  • Drop ciprofloxacin eye 0,3% 10 ml - tubes droppers, Updating of CJSC Pfkrossiya
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Apteka24

  • Tsiprofloksatsinyuriya-Farm (Ukraine, Kiev)
  • Tsiprofloksatsinoz GNTSLS (Ukraine, Kharkiv)
  • Ciprofloxacin solution for infusions of 0.2% 100mlnovofarm-Biosintez (Ukraine, Novograd-Volynsky)
  • Tablet ciprofloxacin coated 0.5g No. 10 Technologist (Ukraine, Uman)
  • Tablet ciprofloxacin coated 0.25g No. 10 Technologist (Ukraine, Uman)

Paniapteka

  • Ciprofloxacin solution of infusional 0.2% 100mlnovofarm-Biosintez
  • Ciprofloxacin solution of infusional 0.2% 100mlnovofarm-Biosintez
  • Ciprofloxacin solution of infusional 0.2% 100mlnovofarm-Biosintez
  • Ciprofloxacin solution of infusional 0.2% 100mlnovofarm-Biosintez
  • Ciprofloxacin solution of infusional 0.2% 100mlnovofarm-Biosintez

BIOSPHERE

  • Ciprofloxacin of 0,25 g No. 10 tabl.p.o. Synthesis of joint stock company (Russia)
  • Ciprofloxacin of 0,5 g No. 10 tabl.p.o. Synthesis of joint stock company (Russia)
  • Ciprofloxacin of 200 mg 100 ml solution for infection. Kelun pharmaceutical plant (China)
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Section: Antimicrobic
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