Ciprofloxacin film-coated tablets 500 mg 10 pcs. in Moscow
Due to a decrease in the activity of microsomal oxidation processes in hepatocytes, it increases the concentration and lengthens the half-life of theophylline (and other xanthines, such as caffeine), oral hypoglycemic drugs, indirect anticoagulants, and helps reduce the prothrombin index.
When combined with other antimicrobial drugs (betalactam antibiotics, 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 isoxazolylpenicillins 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.
When taken simultaneously, it enhances the effect of indirect anticoagulants.
Oral administration together with iron-containing drugs, sucralfate and antacid drugs containing magnesium, calcium and aluminum salts leads to decreased absorption of ciprofloxacin, so it should be prescribed 1-2 hours before or 4 hours after taking the above drugs.
Non-steroidal anti-inflammatory drugs (excluding acetylsalicylic acid) increase the risk of developing seizures.
Fluoroquinolones form chelate compounds with magnesium and aluminum ions of the buffer system of the dosage form of didanosine, which sharply reduces the absorption of antibiotics, so ciprofloxacin is taken 2 hours before taking didanosine or 2 hours after taking this drug
Metoclopramide accelerates absorption, which leads to a decrease in the time to reach its maximum concentration.
The combined use of uricosuric drugs leads to a slower elimination (up to 50%) and an increase in plasma concentrations of ciprofloxacin.
Increases the maximum concentration by 7 times (from 4 to 21 times) and the area under the concentration-time curve by 10 times (from 6 to 24 times) of tizanidine, which increases the risk of a pronounced decrease in blood pressure and drowsiness.
Instructions for use CIPROFLOXACIN
Severe infectious diseases and mixed infectious processes caused by gram-positive and anaerobic flora
Monotherapy with ciprofloxacin is not suitable for the treatment of severe infections and diseases that may be caused by gram-positive or anaerobic pathogenic flora. In these cases, ciprofloxacin should be prescribed simultaneously with other antibacterial drugs.
Streptococcal infection (including Streptococcus pneumoniae)
Ciprofloxacin is not recommended for the treatment of streptococcal infections due to lack of effectiveness.
Urogenital infections
Epididymo-orchitis and pelvic diseases can be caused by fluoroquinolone-resistant Neisseria gonorrhoeae. Ciprofloxacin should be co-administered with other antibacterial drugs, unless ciprofloxacin-resistant Neisseria gonorrhoeae can be excluded. If clinical improvement is not observed within 3 days, then treatment should be reconsidered.
Intraperitoneal infectious diseases
There is limited data on the effectiveness of ciprofloxacin for the treatment of postoperative intraperitoneal infections.
Traveler's diarrhea
When choosing ciprofloxacin, it is necessary to take into account information about drug resistance of the relevant pathogenic microorganism in the country being visited.
Infectious diseases of bones and joints
Ciprofloxacin should be prescribed in combination with other antimicrobial drugs and only after a microbiological study.
anthrax
Use in humans is based on in vitro susceptibility studies and animal studies. Information on the use of the drug in humans is limited. The doctor should be guided by national and/or international documents related to the treatment of this disease.
Children and teenagers
Treatment can only be prescribed by a specialist experienced in the treatment of cystic fibrosis and/or severe infectious diseases in children and adolescents. Safety data obtained from randomized, double-blind studies of ciprofloxacin in children have identified cases of possible drug-related arthropathy (identified by clinical signs and symptoms). Treatment should be started only after assessing the benefit/risk ratio, as joint-related adverse reactions may occur.
Bronchopulmonary infectious diseases
Clinical studies included children and adolescents aged 5-17 years. There are limited data regarding the treatment of children aged 1 to 5 years.
Complicated urinary tract infections and pyelonephritis
Clinical studies included children and adolescents aged 1 to 17 years. Treatment with ciprofloxacin should be considered in cases where treatment with other drugs is not possible, and only after microbiological analysis.
Other specific severe infectious diseases
Ciprofloxacin is used in the treatment of other serious infectious diseases according to official guidelines or after a careful assessment of the benefit/risk ratio in cases where other treatment is not possible or after an unfavorable outcome of conventional treatment, and only after microbiological analysis.
Hypersensitivity
After taking a single dose of the drug, hypersensitivity reactions may occur, including anaphylactic and anaphylactoid reactions. If these reactions occur, it is necessary to stop taking the drug and prescribe appropriate conservative treatment.
Musculoskeletal system
Ciprofloxacin should not be used in patients with a history of tendon disease or quinolone-related disorders. However, in rare cases, Ciprofloxacin may be prescribed to such patients for the treatment of certain severe infectious diseases after microbiological confirmation of the causative agent and assessment of the risk/benefit ratio. Because there have been isolated cases of tendinitis or tendon rupture during treatment with fluoroquinolones (primarily in elderly patients or in patients concomitantly taking corticosteroids), if any signs of this disease, for example, painful swelling or inflammation, the drug should be discontinued and immobilize the affected limb. Ciprofloxacin should also be used with caution in patients with myasthenia gravis.
Photosensitivity
Ciprofloxacin has been shown to cause photosensitivity reactions. Patients taking Ciprofloxacin should avoid direct exposure to sunlight and UV radiation.
CNS
It is known that quinolones can initiate seizures and lower the seizure threshold. Ciprofloxacin should be used with caution in patients with diseases of the central nervous system that provoke seizures, and if these phenomena occur, the drug should be discontinued.
Cases of polyneuropathy (based on neurological symptoms such as pain, burning, agitation, muscle weakness) have been reported in patients receiving ciprofloxacin. If symptoms of this disease occur, including pain, burning, tinnitus, numbness and/or weakness, the drug should be discontinued to prevent the development of an irreversible condition.
The cardiovascular system
Since the use of ciprofloxacin has been associated with cases of QT prolongation, caution should be exercised when treating patients at risk of developing TdP.
Caution should be exercised when using fluoroquinolones, including Ciprofloxacin, in patients with known risk factors for QT prolongation:
- congenital long QT interval syndrome;
- concomitant use of drugs that are known to prolong the QT interval (for example, class IA and III antiarrhythmic drugs, tricyclic antidepressants, macrolides, antipsychotics);
- electrolyte disturbances, especially uncorrected hypokalemia, hypomagnesemia;
- women and elderly patients are more sensitive to the effects of drugs that prolong the QT interval, such as Ciprofloxacin, so special caution is required;
- heart disease (for example, heart failure, myocardial infarction, bradycardia).
Gastrointestinal tract
The presence of severe and persistent diarrhea during or after treatment with the drug (including several weeks after treatment) may indicate pseudomembranous colitis (life-threatening, possibly fatal), requiring immediate treatment. In such cases, ciprofloxacin should be immediately discontinued and appropriate treatment initiated. The use of antiperistaltic drugs in this situation is contraindicated.
Renal and urinary system
During treatment with ciprofloxacin, to avoid the development of crystalluria, it is necessary to ensure that the patient receives a sufficient amount of fluid.
Hepatobiliary system
Cases of liver necrosis and life-threatening liver failure associated with the use of ciprofloxacin have been reported. If any signs or symptoms of liver disease (such as anorexia, jaundice, dark urine, itching or a tense abdomen) appear, treatment with the drug should be stopped.
Glucose-6-phosphate dehydrogenase deficiency
In patients with glucose-6-phosphate dehydrogenase deficiency, the use of ciprofloxacin may cause hemolytic reactions. It is necessary to avoid prescribing the drug to such patients, except in cases where the potential benefit outweighs the possible risk. In this case, the potential for hemolysis should be monitored.
Resistance
During long-term therapy and in cases of treatment of nosocomial infections and/or infections caused by Staphylococcus and Pseudomonas, there may be a potential risk of isolation of ciprofloxacin-resistant bacteria.
Cytochrome P450
Ciprofloxacin inhibits CYP1A2, thereby causing an increase in serum concentrations of drugs metabolized by this enzyme (for example, theophylline, clozapine, ropinirole, tizanidine). Patients taking these drugs concomitantly with ciprofloxacin should be monitored for clinical signs of overdose.
Tests
When assessing the results of bacteriological tests, the in vitro activity of ciprofloxacin against Mycobacterium tuberculosis should be taken into account.
Impact on the ability to drive vehicles and operate machinery
Ciprofloxacin may affect the patient's reaction speed, as a result of which the ability to drive a car or engage in other activities that require increased attention and speed of psychomotor reactions may be impaired.
Ciprofloxacin (for infusion), 2 mg/ml, solution for infusion, 100 ml, 1 pc.
Pills. Inside
, on an empty stomach, with a sufficient amount of liquid. For uncomplicated infections of the kidneys and urinary tract, lower respiratory organs - 0.25 g 2 times a day (for complicated ones - 0.5 g 2 times a day). For the treatment of gonorrhea - 250–500 mg once. For gynecological diseases, severe enteritis and colitis and high fever, prostatitis, osteomyelitis - 0.5 g 2 times a day (for the treatment of banal diarrhea - 250 mg 2 times a day). The duration of treatment is on average 7–10 days.
If renal function is impaired, correction of the dosage regimen is necessary: if creatinine Cl is more than 50 ml/min - the usual dosage regimen, 30-50 ml/min - 250-500 mg once every 12 hours, 5-29 ml/min - 250-500 mg 1 time every 18 hours, for patients on hemo- or peritoneal dialysis - after dialysis 250–500 mg 1 time every 24 hours.
Eye drops. For mild and moderately severe infections - 1-2 drops into the conjunctival sac
affected eye (or both eyes) every 4 hours. For severe infection - 2 drops every hour. After the condition improves, the dose and frequency of instillations are reduced.
Solution for infusion. IV
, drip. The infusion duration is 30 minutes at a dose of 0.2 g and 60 minutes at a dose of 0.4 g. Ready-to-use infusion solutions can be combined with 0.9% sodium chloride solution, Ringer's solution and lactated Ringer's solution, 5% and 10% glucose (dextrose) solution, 10% fructose solution, as well as a solution containing 5% glucose (dextrose) solution with 0.225% or 0.45% sodium chloride solution.
For uncomplicated urinary tract infections and lower respiratory tract infections, a single dose is 0.2 g; for complicated infections of the upper urinary tract, for severe infections (including pneumonia, osteomyelitis), a single dose is 0.4 g. If IV treatment is necessary for especially severe, life-threatening or recurrent infections caused by Pseudomonas, staphylococci or Streptococcus pneumoniae, the dose can be increased to 0.4 g with a frequency of administration up to 3 times a day. The duration of treatment for osteomyelitis can reach up to 2 months.
For chronic carriage of salmonella - 0.2 g 2 times a day; course of treatment - up to 4 weeks. If necessary, the dosage can be increased to 0.5 g 3 times a day.
For acute gonorrhea, once - 0.1 g.
For the prevention of infections during surgical interventions - 0.2–0.4 g 0.5–1 hour before surgery; if the operation lasts more than 4 hours, it is re-administered in the same dose.
Average duration of treatment: 1 day - for acute uncomplicated gonorrhea and cystitis; up to 7 days - for infections of the kidneys, urinary tract and abdominal cavity, during the entire period of the neutropenic phase - in patients with weakened body defenses, but no more than 2 months - for osteomyelitis and 7-14 days - for all other infections. For streptococcal infections, due to the risk of late complications, as well as chlamydial infections, treatment should continue for at least 10 days. In patients with immunodeficiency, treatment is carried out throughout the entire period of neutropenia.
Treatment should be continued for at least 3 more days after the temperature has normalized or clinical symptoms have disappeared.
With a glomerular filtration rate (Cl creatinine 31–60 ml/min/1.73 m2 or serum creatinine concentration 1.4–1.9 mg/100 ml), the maximum daily dose is 0.8 g.
If the glomerular filtration rate is below 30 ml/min/1.73 m2 or the serum creatinine concentration is above 2 mg/100 ml, the maximum daily dose is 0.4 g.
For elderly patients, the dose is reduced by 30%.
For peritonitis, it is permissible to use intraperitoneal administration of infusion solutions at a dose of 50 mg 4 times a day per 1 liter of dialysate.
After IV use, you can continue treatment orally.
