General
Description & Use
Ciprofloxacin
is a synthetic antibiotic, originally manufactured and sold by
Bayer. Generic versions are now available (Ciplox, Cifran, Lucipro,
Ciproxin by Lupin, Ranbaxy and Cipla) but Bayer continues sale
under the brand names Cipro, Ciproxin and Ciprobay belonging to
a group called fluoroquinolones. Ciprofloxacin is bactericidal.
Its mode of action depends upon blocking bacterial DNA replication
by binding itself to an enzyme called DNA gyrase, thereby inhibiting
the unwinding of bacterial chromosomal DNA during and after the
replication.
Ciprofloxacin is available for oral, parenteral
and topical use. It has a variety of indications, including lower
respiratory tract infections (such as pneumonia and acute bronchitis),
urinary tract infections, several STDs, skin and soft tissue infections,
septicemia, legionellosis, and anthrax.
Uses
Ciprofloxacin is a broad-spectrum antibiotic that is active against
both Gram-positive and Gram-negative bacteria. It is used to treat
certain infections caused by bacteria, such as pneumonia; gonorrhea;
infectious diarrhea; typhoid fever; anthrax; and bone, joint,
skin, and urinary tract infections. It functions by inhibiting
DNA gyrase, a type II topoisomerase, which is an enzyme necessary
to separate replicated DNA, thereby inhibiting cell division.
It is effective against:
Enterobacteriaceae, Vibrio, Haemophilus influenzae, Haemophilus
ducreyi, Neisseria gonorrhoeae (widespread resistance to ciprofloxacin
limits its usefulness in treating N. gonorrhea infections), Neisseria
meningitidis, Moraxella catarrhalis, Brucella, Campylobacter,
Mycobacterium intracellulare, Legionella sp., Pseudomonas aeruginosa,
Bacillus anthracis, Escherichia coli, Staphylococcus aureus (MRSA).
Weak activity against:
Streptococcus pneumoniae, Chlamydia trachomatis, Chlamydia pneumoniae
No activity against:
Bacteroides, Burkholderia cepacia, Enterococcus faecium, Ureaplasma
urealyticum, Streptococcus pyogenes and others.
Ciprofloxacin ophthalmic solution is used to treat
bacterial infections of the eye including conjunctivitis (pinkeye;
infection of the membrane that covers the outside of the eyeball
and the inside of the eyelid) and corneal ulcers (infection and
loss of tissue in the clear front part of the eye).
Use against chlamydia and mycoplasma infections
is now contraindicated; ciprofloxacin appears to be ineffective
against these organisms, merely stopping their growth (and allowing
them to resume growth after the antibiotic is withdrawn) rather
than killing them.
Adverse
effects
Manufacturer-funded studies report that approximately 9% of patients
taking the medication experience side effects ranging from mild
to moderate, with the vast majority of those relating to metabolic-nutritional
problems and the central nervous system. Compared to other fluoroquinolones
the incidence and severity of side effects from ciprofloxacin
is low; the major adverse effect most often seen with its use
is gastrointestinal irritation, as is common with many antibiotics.
Because of its general safety, potency and broad spectrum of activity,
ciprofloxacin was initially reserved as a drug of last resort
for use against difficult-to-treat and antibiotic-resistant infections.
As with any antibiotic, however, increasing time and use has led
to an increase in ciprofloxacin-resistant infections, mainly in
the hospital setting. Also implicated in the rise of resistant
bacteria is the use of lower-cost, less potent fluoroquinolones,
and the widespread addition of ciprofloxacin and other antibiotics
to the feed of farm animals, which leads to greater and more rapid
weight gain for unclear reasons.
Ciprofloxacin can cause photosensitivity reactions
and can elevate plasma theophylline levels to toxic values. It
can also cause constipation and sensitivity to caffeine. Ciprofloxacin
is also known to cause swelling of joints and cartilage, and cause
tendon rupture and chronic pain.
