Cifran OD, 500 mg, extended-release film-coated tablets, 10 pcs.

Cifran OD, 500 mg, extended-release film-coated tablets, 10 pcs.

Theophylline.

When used together with ciprofloxacin, an increase in the concentration of theophylline in the blood plasma is observed. If the combined use of these drugs cannot be excluded, the level of theophylline in the blood plasma should be monitored.

Antacids containing magnesium hydroxide or aluminum hydroxide.

In the presence of these antacids, the absorption of ciprofloxacin is reduced, so the simultaneous use of these drugs should be avoided.

Probenecid and other drugs that block tubular secretion.

When used together with probenecid, the renal excretion of ciprofloxacin is reduced.

Antitumor and immunosuppressive drugs.

Absorption of ciprofloxacin after oral administration decreases after cytotoxic therapy.

Analgesics.

Combined use with NSAIDs increases the side effects of ciprofloxacin on the central nervous system.

Phenytoin.

In patients receiving therapy with ciprofloxacin and phenytoin, variability (decrease and increase) in phenytoin plasma levels was noted.

Sucralfate.

In the stomach, sucralfate releases aluminum ions, therefore the absorption of ciprofloxacin is reduced.

Oral anticoagulants.

Quinolone derivatives enhance the effect of oral anticoagulants such as warfarin and its derivatives. When used together with these drugs, blood coagulation tests should be performed regularly.

H2 receptor antagonists.

Histamine H2 receptor antagonists do not have a significant effect on the bioavailability of ciprofloxacin.

Glyburide.

In rare cases, combined use with ciprofloxacin can lead to severe hypoglycemia.

Metronidazole.

When ciprofloxacin and metronidazole were used together, no changes in their plasma concentrations were detected.

Due to a decrease in the activity of microsomal oxidation processes in hepatocytes, it increases the concentration and lengthens T1/2 of xanthines (for example, caffeine), oral hypoglycemic drugs.

Didanosine reduces the absorption of ciprofloxacin due to the formation of complexes with the aluminum and magnesium salts contained in didanosine.

Metoclopramide accelerates absorption, which leads to a decrease in the time to reach its Cmax.

Co-administration of uricosuric drugs leads to a slower elimination (up to 50%) and an increase in plasma concentrations of ciprofloxacin.

When combined with other antimicrobial drugs (beta-lactams, aminoglycosides, clindamycin, metronidazole), synergism is usually observed; can be successfully used in combination with azlocillin and ceftazidime for infections caused by Pseudomonas spp.

; with mezlocillin, azlocillin and other beta-lactam antibiotics - for streptococcal infections; with isoxazolepenicillins and vancomycin - for staphylococcal infections; with metronidazole and clindamycin - for anaerobic infections.

It enhances the nephrotoxic effect of cyclosporine, there is an increase in serum creatinine; in such patients it is necessary to monitor this indicator 2 times a week. If the use of theophylline is necessary during therapy with ciprofloxacin, theophylline concentrations should be monitored and the dosage regimen adjusted accordingly if necessary.

Cifran® OD (Cifran OD)

A broad-spectrum antimicrobial drug from the group of fluoroquinolones. Acts bactericidal. The drug inhibits the enzyme DNA gyrase of bacteria, as a result of which the replication and synthesis of bacterial cellular proteins are disrupted. Ciprofloxacin acts on gram-negative microorganisms during the period of rest and division (since it affects not only DNA gyrase, but also causes lysis of the cell wall), on gram-positive microorganisms - only during the period of division. Low toxicity for the cells of the macroorganism is explained by the absence of DNA gyrase in them. While taking ciprofloxacin, there is no parallel development of resistance to other antibacterial drugs. does not belong to the group of gyrase inhibitors, which makes it highly effective against bacteria that are resistant, for example, to aminoglycosides and penicillins. cephalosporins, tetracyclines and many other antibacterial drugs.

Resistance to ciprofloxacin develops slowly and gradually. When using ciprofloxacin, there were no cases of plasmid resistance, which often develops with the use of beta-lactam antibiotics, aminoglycosides and tetracyclines. Bacteria containing plasmids are also highly sensitive to ciprofloxacin.

During the use of ciprofloxacin, parallel resistance of pathogens to antibiotics of other groups does not develop: β-lactam antibiotics, aminoglycosides. tetracyclines, macrolides, sulfonamides, derivatives of trimethoprim or nitrofuran. Therefore, ciprofloxacin is highly effective against bacteria resistant to antibiotics of these groups.

Ciprofloxacin remains effective against pathogens resistant to other gyrase inhibitors.

Due to its chemical structure, ciprofloxacin is highly effective against strains that produce β-lactamases.

In - vitro susceptibility testing

Reproducible criteria for ciprofloxacin susceptibility testing, approved by the European Committee on Antimicrobial Susceptibility Testing (EUCAST), are presented in the table below:

European Committee on Antibiotic Susceptibility Testing. Clinical minimum inhibitory concentration (MIC) breakpoints (mg/mL) for ciprofloxacin.

1. Staphylococcus spp. — breakpoints for ciprofloxacin and ofloxacin are associated with high-dose therapy.

2. Streptococcus pneumoniae - wild type S. pneumoniae is not considered susceptible to ciprofloxacin and ofloxacin and is thus classified as intermediately susceptible.

3. Strains with MIC values ​​exceeding the sensitive/moderately sensitive threshold ratio are very rare and have not been reported to date. Identification and antimicrobial susceptibility tests should be repeated when such colonies are detected, and the results should be confirmed by colony testing at a reference laboratory. Until evidence of clinical response is available for strains with confirmed MIC values ​​above the currently used resistance threshold, they should be considered resistant. Haemophilus spp./Moraxella spp. - it is possible to identify strains of Haemophilus influenzae with low sensitivity to fluoroquinolones (MIC for ciprofloxacin - 0.125-0.5 mg/l). There is no evidence of the clinical significance of low resistance in respiratory tract infections caused by H. infuenzae.

4. Non-species-specific breakpoints were determined primarily on the basis of pharmacokinetics/pharmacodynamics data and are independent of species-specific MIC distributions. They are only applicable to species for which a species-specific susceptibility threshold has not been determined, and not to those species for which susceptibility testing is not recommended. For certain strains, the distribution of acquired resistance may vary across geographic regions and over time. Therefore, it is desirable to have local information on resistance, especially when treating local infections.

Clinical and Laboratory Standards Institute data for MIC breakpoints (mg/mL) and diffusion testing using 5 μg ciprofloxacin discs.

Clinical and Laboratory Standards Institute. Breakpoints for MIC (mg/L) and diffusion testing (mm) using disks.

A. This reproducible standard is only applicable to broth dilution tests using cationically adjusted Mueller-Hinton broth (CAMHB) incubated with air at 35±2°C for 16-20 hours for strains of Enterobacteriaceae, Pseudomonas aeruginosa, etc. bacteria not belonging to the Enterobacteriaceae family, Staphylococcus spp., Enterococcus spp., and Bacillus anthracis: 20-24 hours for Acinetobacter spp., 24 hours for Y. pestis (if growth is insufficient, incubate for another 24 hours).

b. This reproducible standard is only applicable to disc diffusion tests using air at 35±2°C for 16-18 hours.

V. This reproducible standard is only applicable to susceptibility disk diffusion tests with Heamophilus influenzae and Heamophilus parainfluenzae using broth test medium for Heamophilus spp. (NTM), which is inhibited with access to air at a temperature of 35±2°C for 20-24 hours.

d. This reproducible standard is only applicable to disc diffusion tests using NTM incubated in 5% CO2 at 35±2°C for 16-18 hours.

e. This reproducible standard is applicable only to susceptibility tests (zone disc diffusion tests and MIC agar solution) using gonococcal agar and 1% specified growth supplement at 36 ± 2°C (not exceeding 37°C) at 5 % CO2 for 20-24 hours.

e. This reproducible standard is only applicable to broth dilution tests using cationically adjusted Mueller-Hinton broth (CAMHB) supplemented with 5% sheep blood, which is incubated in 5% CO2 at 35±2°C for 20-24 hours. .

and. This reproducible standard is applicable only to broth dilution tests using cationically adjusted Mueller-Hinton broth (CAMHB) supplemented with a specified 2% growth additive, which is incubated with air at 35 ± 2°C for 48 hours.

In - Vitro sensitivity to ciprofloxacin

For certain strains, the distribution of acquired resistance may vary across geographic regions and over time. Therefore, it is desirable to have local information on resistance when testing strain susceptibility, especially when treating severe infections. If the local prevalence of resistance is such that the benefit of the drug, at least against several types of infections, is questionable, it is necessary to consult a specialist.

In-vitro activity of ciprofloxacin has been demonstrated against the following sensitive strains of microorganisms:

Aerobic gram-positive microorganisms:

Bacillus anthracis, Staphylococcus aureus (methicillin-sensitive), Staphylococcus saprophyticus, Streptococcus spp.

Aerobic gram-negative microorganisms:

Aeromonas spp., Moraxella catarrhalis, Brucella spp., Neisseria meningitidis, Citrobacter koseri, Pasteurella spp., Francisella tularensi, Salmonella spp., Haemophilus ducreyi, Shigella spp., Haemophilius influenzae, Vibrio spp., Legionella spp., Yersinia pestis.

Anaerobic microorganisms:

Mobiluncus spp.

Other microorganisms:

Chlamydia trachomatis, Chlamydia pneumoniae, Mycoplasma hominis, Mycoplasma pneumoniae.

Varying degrees of sensitivity to ciprofloxacin have been demonstrated for the following microorganisms:

Acinetobacter baumann, Burkholderia cepacia, Campylobacter spp., Citrobacter freundii, Enterococcus faecal is, Enterobacter aerogenes, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Morganella morganii, Neisseria gonorrhoeae, Proteus mirabilis, Proteus vulgaris, Providencia spp., Pseudomonas aeruginosa, Pseudomonas fluorescens, Serratia marcescens, Streptococcus pneumoniae, Peptostreptococcus spp., Propionibacterium acnes.

It is believed that Staphylococcus aureus (methicillin-resistant), Stenotrophomonas maltophilia, Actinomyces spp., Enterococcus faecium, Listeria monocytogenes, Mycoplasma genitalium, Ureaplasma urealitycum, anaerobic microorganisms (with the exception of Mobiluncus spp., Peptostreptococcus spp., Propionibacterium) have natural resistance to ciprofloxacin acnes ).