Search your Drugs Here

Sunday, February 6, 2011

Ciprofloxacin

Posted by Sampil 10:02 PM, under | No comments

ciprofloxacin
(si proe flox' a sin)
Ciloxan (CAN), Cipro, Cipro HC Otic, Cipro I.V., Cipro XR, Proquin XR

Pregnancy Category C

Drug classes
Antibacterial
Fluoroquinolone

Therapeutic actions
Bactericidal; interferes with DNA replication in susceptible bacteria preventing cell reproduction.

Indications
·        For the treatment of infections caused by susceptible gram-negative bacteria, including E. coli, P. mirabilis, K. pneumoniae, Enterobacter cloacae, P. vulgaris, P. rettgeri, M. morganii, P. aeruginosa, Citrobacter freundii, S. aureus, S. epidermidis, group D streptococci
·        Treatment of uncomplicated UTIs caused by E. coli, K. pneumoniae as a one-time dose in patients at low risk of nausea, diarrhea (Proquin XR)
·        Otic: Treatment of acute otitis externa
·        Treatment of chronic bacterial prostatitis
·        IV: Treatment of nosocomial pneumonia caused by Haemophilus influenzae, K. pneumoniae
·        Oral: Typhoid fever
·        Oral: STDs caused by N. gonorrheae
·        Prevention of anthrax following exposure to anthrax bacilla (prophylactic use in regions suspected of using germ warfare)
·        Acute sinusitis caused by H. influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis
·        Lower respiratory tract infections caused by E. Coli, Klebsiella, Enterobacter species, P. mirabilis, P. aeruginosa, H. influenzae, H. parainfluenzae, S. pneumoniae
·        Unlabeled use: Effective in patients with cystic fibrosis who have pulmonary exacerbations

Contraindications and cautions
·        Contraindicated with allergy to ciprofloxacin, norfloxacin or other fluoroquinolones, pregnancy, lactation.
·        Use cautiously with renal dysfunction, seizures, tendinitis or tendon rupture associated with fluoroquinolone use.

Available forms
Tablets—100, 250, 500, 750 mg; ER tablets—500, 1,000 mg; injection—200, 400 mg; powder for oral suspension—250, 500 mg/5 mL; ophthalmic ointment—3.33 mg/g; ophthalmic solution—3.5 mg/mL; otic suspension—2 mg/mL

Dosages
ADULTS
·        Uncomplicated UTIs: 100–250 mg PO q 12 hr for 3 days or 500 mg PO daily (ER tablets) for 3 days. Proquin XR—500 mg PO as a single dose.
·        Mild to moderate UTIs: 250 mg PO q 12 hr for 7–14 days or 200 mg IV q 12 hr for 7–14 days.
·        Complicated UTIs: 500 mg PO q 12 hr for 7–14 days or 400 mg IV q 12 hr or 1,000 mg (ER tablets) PO daily for 7–14 days.
·        Chronic bacterial prostatitis: 500 mg PO q 12 hr for 28 days or 400 mg IV q 12 hr for 28 days.
·        Infectious diarrhea: 500 mg q 12 hr PO for 5–7 days.
·        Anthrax postexposure: 500 mg PO q 12 hr for 60 days or 400 mg IV q 12 hr for 60 days.
·        Respiratory infections 500–750 mg PO q 12 hr or 400 mg IV q 8–12 hr for 7–14 days.
·        Acute sinusitis: 500 mg PO q 12 hr or 400 mg IV q 12 hr for 10 days.
·        Acute uncomplicated pyelonephritis: 1,000 mg ER tablets PO daily for 7–14 days.
·        Bone, joint, skin infections: 500–750 mg PO q 12 hr or 400 mg IV q 8–12 hr for 4–6 wk.
·        Nosocomial pneumonia: 400 mg IV q 8 hr for 10–14 days.
·        Ophthalmic infections caused by susceptible organisms not responsive to other therapy: 1 or 2 drops per eye daily or bid or 1/2-inch ribbon of ointment into conjunctival sac tid on first 2 days, then apply 1/2-inch ribbon bid for next 5 days.
·        Acute otitis externa: 4 drops in infected ear, tidqid.
PEDIATRIC PATIENTS
Not recommended; produced lesions of joint cartilage in immature experimental animals.
·        Inhalational anthrax: 15 mg/kg/dose PO q 12 hr for 60 days or 10 mg/kg/dose IV q 12 hr for 60 days; do not exceed 500 mg/dose PO or 400 mg/dose IV.
PATIENTS WITH IMPAIRED RENAL FUNCTION
For creatinine clearance of 30–50 mL/min, give 250–500 mg PO q 12 hr. For creatinine clearance of 5–29 mL/min, give 250–500 mg PO q 18 hr or 200–400 mg IV q 18–24 hr. For patients on hemodialysis, give 250–500 mg q 24 hr, after dialysis.

Pharmacokinetics
Route
Onset
Peak
Duration
Oral
Varies
60–90 min
4–5 hr
IV
10 min
30 min
4–5 hr

Metabolism: Hepatic; T1/2: 3.5–4 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Bile, urine

IV facts
Preparation: Dilute to a final concentration of 1–2 mg/mL with 0.9% NaCl injection
or 5% dextrose injection. Stable up to 14 days refrigerated or at room temperature.
Infusion: Administer slowly over 60 min.
Incompatibilities: Discontinue the administration of any other solutions during ciprofloxacin infusion. Incompatible with aminophylline, amoxicillin, clindamycin, floxacillin, heparin in solution.

Adverse effects
·        CNS: Headache, dizziness, insomnia, fatigue, somnolence, depression, blurred vision
·        CV: Arrhythmias, hypotension, angina
·        EENT: Dry eye, eye pain, keratopathy
·        GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain
·        Hematologic: Elevated BUN, AST, ALT, serum creatinine and alkaline phosphatase; decreased WBC, neutrophil count, Hct
·        Other: Fever, rash

Interactions
·        Decreased therapetic effect with iron salts, sucralfate
·        Decreased absorption with antacids, didanosine
·        Increased serum levels and toxic effects of theophyllines if taken concurrently with ciprofloxacin
·        Increased effects of coumarin or its derivatives
·        Increased risk of severe photosensitivity reactions if combined with St. John's wort therapy.

Nursing considerations
Assessment
·        History: Allergy to ciprofloxacin, norfloxacin or other quinolones; renal dysfunction; seizures; lactation
·        Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes, bowel sounds; LFTs, renal function tests

Interventions
·        Arrange for culture and sensitivity tests before beginning therapy.
·        Continue therapy for 2 days after signs and symptoms of infection are gone.
·        Be aware that Proquin XR is not interchangeable with other forms.
·        Ensure that the patient swallows ER tablets whole; do not cut, crush, or chew.
·        Ensure that patient is well hydrated.
·        Give antacids at least 2 hr after dosing.
·        Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity.
·        Encourage patient to complete full course of therapy.

Teaching points
·        If an antacid is needed, take it at least 2 hours before or after dose.
·        Take Proquin XR with the main meal of the day.
·        Do not touch tip of eye ointment or solution for this may contaminate the product.
·        Drink plenty of fluids while you are taking this drug.
·        You may experience these side effects: Nausea, vomiting, abdominal pain (eat frequent small meals); diarrhea or constipation; drowsiness, blurring of vision, dizziness (observe caution if driving or using dangerous equipment).
·        Report rash, visual changes, severe GI problems, weakness, tremors.

Adverse effects in Italic are most common; those in Bold are life-threatening.

0 comments:

Post a Comment

Tags

Blog Archive

Blog Archive