CIPROFLOXACIN PILLS 250MG

Composition

Ciprofloxacin coated tablets:
1 pill contains Ciprofloxacin hydrochloride (in terms of ciprofloxacin) - 250 or 500 mg;
10, 20 pcs. packaged.

Ciprofloxacin infusion solution
1 ml of solution contains ciprofloxacin - 2 mg;
Excipients: sodium chloride, lactic acid, EDTA disodium salt, water for injection;
100 ml in bottles, 1 bottle in a carton box.

Ciprofloxacin eye drops 0.3%:
1 ml contains ciprofloxacin hydrochloride (in terms of ciprofloxacin) - 3 mg;
Excipients: ethylenediaminetetraacetic acid disodium salt (disodium edetate), mannitol (mannitol), sodium acetate 3-water (sodium acetate trihydrate), glacial acetic acid, benzalkonium chloride, water for injection;
3 or 5 ml in dark glass bottles with a dropper cap (or in a dropper bottle), 1 bottle in a carton box.

Mechanism of action

Ciprofloxacin is a broad-spectrum antimicrobial agent from the group of fluoroquinolones. Bactericidal effect. The drug inhibits the enzyme DNA gyrase of bacteria, as a result of which DNA replication and synthesis of cellular proteins of bacteria are violated. Ciprofloxacin acts both on the breeding microorganisms and on those in the resting phase.
Ciprofloxacin active against gram-negative aerobic bacteria: Escherichia coli, Salmonella spp., Shigella spp., Citrobacter spp., Klebsiella spp., Enterobacter spp., Proteus mirabilis, Proteus vulgaris, Serratia marcescens, Hafnia alvei, Edwardsiella tarda, Providencia spp., Morgan and friend, business, business, business, business, business, business, business, business, business, business, name, class, name, name, class, name, class, name, name, name, name spp., Haemophilus spp., Pseudomonas aeruginosa, Moraxella catarrhalis, Aeromonas spp., Pasteurella multocida, Plesiomonas shigelloides, Campylobacter jejuni, Neisseria spp.; intracellular pathogens: Legionella pneumophila, Brucella spp., Chlamydia trachomatis, Listeria monocytogenes, Mycobacterium tuberculosis, Mycobacterium kansasii, Mycobacterium avium-intracellulare; Gram-positive aerobic bacteria: Staphylococcus spp. (Staphylococcus aureus, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus), Streptococcus spp. (Streptococcus pyogenes, Streptococcus agalactiae). Most methicillin resistant staphylococci are also resistant to ciprofloxacin.
To drug moderately sensitive Streptococcus pneumoniae, Enterococcus faecalis.
To drug are resistant Corynebacterium spp., Bacteroides fragilis, Pseudomonas cepacia, Pseudomonas maltophilia, Ureaplasma urealyticum, Clostridium difficile, Nocardia asteroides.
The effect of the drug on Treponema pallidum is not well understood.

Indications and usage

Infectious and inflammatory diseases caused by susceptibility to the drug by microorganisms:
- respiratory tract;
- ear, nose and throat;
- kidneys and urinary tract;
- genital organs (including gonorrhea, prostatitis);
- gynecological (including adnexitis) and postpartum infections;
- digestive system (including oral cavity, teeth, jaws);
- gallbladder and biliary tract;
- skin, mucous membranes and soft tissues;
- musculoskeletal system;
- sepsis;
- peritonitis;
Prevention and treatment of infections in patients with reduced immunity (with immunosuppressant therapy).

Eye drops 0.3%:
Infectious and inflammatory diseases of the eye:
- acute and subacute conjunctivitis;
- blepharitis, blepharoconjunctivitis;
- keratitis, keratoconjunctivitis;
- bacterial corneal ulcer;
- chronic dacryocystitis;
- meybomit (barley);
- Infectious eye damage after injuries or ingress of foreign bodies;
- Pre-and postoperative prophylaxis of infectious complications in ophthalmosurgery.
In otolaryngology:
otitis externa, treatment of postoperative infectious complications.

Contraindications

- deficiency of glucose-6-phosphate dehydrogenase;
- pseudomembranous colitis;
- children's age up to 18 years (until the completion of the skeleton formation process);
- pregnancy;
- lactation period (breastfeeding);
- hypersensitivity to Ciprofloxacin or other drugs from the group of fluoroquinolones.
WITH caution should be prescribed the drug in patients with severe atherosclerosis of the brain, cerebral circulation disorders, mental illness, convulsive syndrome, epilepsy, severe renal and / or liver failure, elderly patients.

Dosage and administration

Pills
The dose of Ciprofloxacin depends on the severity of the disease, the type of infection, the condition of the body, the age, weight and kidney function of the patient. Usually recommended doses: Ciprofloxacin in the dosage form of pills 250 mg and 500 mg for oral administration:
Uncomplicated diseases of the kidneys and urinary tract - 250 mg, and in complicated cases, 500 mg, 2 times a day;
Diseases of the lower respiratory tract moderate - 250 mg, and in more severe cases, 500 mg, 2 times a day;
For the treatment of gonorrhea a single dose of Ciprofloxacin at a dose of 250-500 mg is recommended;
Gynecological diseases, enteritis and colitis with severe and high fever, prostatitis, osteomyelitis - 500 mg 2 times a day (for the treatment of banal diarrhea, you can use a dose of 250 mg 2 times a day).
The drug should be taken on an empty stomach, drinking plenty of liquids. Patients with severe impaired renal function should be given a half dose of the drug. The duration of treatment depends on the severity of the disease, but treatment should always continue for at least another two days after the disappearance of the symptoms of the disease. Usually the duration of treatment is 7-10 days.

Infusion Solution
The drug should be administered in / in the drip for 30 minutes (dose 200 mg) and 60 minutes (dose 400 mg).
The solution for infusion can be combined with 0.9% sodium chloride solution, Ringer's solution, 5% and 10% dextrose solution (glucose), 10% fructose solution, a solution containing 5% dextrose solution with 0.225% or 0.45% sodium chloride solution.
A single dose is 200 mg, with severe infections - 400 mg. The frequency of administration is 2 times / day; the duration of treatment is 1-2 weeks, if necessary, an increase in the course of treatment is possible.
With acute gonorrhea the drug is prescribed in / in a single dose of 1000 mg.
For the prevention of postoperative infections - 30–60 minutes before the IV operation at a dose of 200–400 mg.
Patients with severe renal insufficiency (CC <20 ml / min / 1.73 sq.m) It is necessary to prescribe half the daily dose.

Eye drops 0.3%
Locally. For mild to moderately severe infections, 1-2 drops are instilled into the conjunctival sac of the affected eye (or both eyes) every 4 hours,for severe infections, 2 drops every hour. After improving the condition, the dose and frequency of instillations are reduced.
With bacterial corneal ulcer: 1 drop every 15 minutes for 6 hours, then 1 drop every 30 minutes in the waking hours; on day 2 - 1 drop every hour during waking hours; From 3 to 14 days - 1 drop every 4 hours in waking hours. If, after 14 days of treatment, epithelialization has not occurred, treatment can be continued.

Adverse reactions

Gastrointestinal: nausea, diarrhea, vomiting, abdominal pain, flatulence, anorexia, cholestatic jaundice (especially in patients with previous liver diseases), hepatitis, hepatonecrosis.
Nervous system: dizziness, headache, fatigue, anxiety, tremor, insomnia, "nightmarish" dreams, peripheral paralgesia (abnormal perception of pain), sweating, increased intracranial pressure, anxiety, confusion, depression, hallucinations, manifestations of psychotic reactions (sometimes progressing to conditions in which the patient may harm themselves), migraine, syncope, cerebral artery thrombosis.
From the senses: violations of taste and smell, blurred vision (diplopia, change in color perception), tinnitus, hearing loss.
Since the cardiovascular system: tachycardia, cardiac arrhythmias, lowering blood pressure, flushing to the skin of the face.
From the hemopoietic system: leukopenia, granulocytopenia, anemia, thrombocytopenia, leukocytosis, thrombocytosis, hemolytic anemia.
From the laboratory indicators: hypoprothrombinemia, increased activity of hepatic transaminases and alkaline phosphatase, hypercreatininemia, hyperbilirubinemia, hyperglycemia.
From the urinary system: hematuria, crystalluria (primarily with alkaline urine and low diuresis), glomerulonephritis, dysuria, polyuria, urinary retention, albuminuria, urethral bleeding, hematuria, reduced nitrogen-excreting kidney function, interstitial nephritis.
From the musculoskeletal system: arthralgia, arthritis, tendovaginitis, tendon ruptures, myalgia.
Allergic reactions: pruritus, urticaria, blistering, bleeding, papules, scabbing, drug fever, point hemorrhages (petechiae), swelling of the face or larynx, shortness of breath, eosinophilia, increased photosensitivity, vasculitis, nodular erythema, exudation , toxic epidermal necrolysis (Lyell's syndrome).
Local reactions: pain and burning at the injection site, phlebitis.
Other: general weakness, superinfection (candidiasis, pseudomembranous colitis).

Ciprofloxacin is contraindicated for use during pregnancy and lactation (breastfeeding).

If severe and prolonged diarrhea occurs during or after treatment with Ciprofloxacin, diagnosis of pseudomembranous colitis should be excluded, which requires immediate discontinuation of the drug and appropriate treatment.
If you experience pain in the tendons or the first signs of tendovaginitis appear, treatment should be stopped.
During the period of treatment with Ciprofloxacin, it is necessary to provide a sufficient amount of fluid while observing normal diuresis.
During treatment with Ciprofloxacin, avoid contact with direct sunlight.
Influence on ability to drive motor transport and control mechanisms
Patients taking Ciprofloxacin, should be careful when driving a car and doing other potentially dangerous activities that require increased attention and quickness of psychomotor reactions (especially while drinking alcohol).

Solution in the form of eye drops not intended for intraocular injections. When using other ophthalmic drugs, the interval between their administration should be at least 5 minutes. The drug can not be administered subconjunctivally or directly into the anterior chamber of the eye. If after the use of drops for a long time the conjunctival hyperemia continues or increases, then you should stop using the drug and consult a doctor. During the period of drug treatment is not recommended wearing soft contact lenses.When using hard lenses, remove them before instillation and put them on again 15-20 minutes after the instillation of the drug. Patients whose visual clarity is temporarily lost after the application are not recommended to drive a car or work with complex equipment, machines or any other complex equipment requiring clear vision immediately after instillation of the drug.
The bottle must be closed after each use.
Do not touch the eye with a pipette tip.

Treatment: specific antidote is unknown. It is necessary to carefully monitor the condition of the patient, make a gastric lavage, carry out the usual emergency measures, to ensure adequate intake of fluid. With the help of hemo- or peritoneal dialysis, only an insignificant amount (less than 10%) of the drug can be derived.

Due to a decrease in the activity of microsomal oxidation processes in hepatocytes, ciprofloxacin increases the concentration and lengthens the half-life of theophylline and other xanthines (eg, caffeine), oral hypoglycemic drugs, indirect anticoagulants, and contributes to a decrease in the prothrombin index.
With simultaneous use with NSAIDs (with the exception of acetylsalicylic acid) increases the risk of seizures.
Metoclopramide accelerates the absorption of ciprofloxacin, which reduces the time to reach the maximum concentration of the latter.
Co-administration of uricosuric drugs leads to a slower elimination (up to 50%) and an increase in the plasma concentration of ciprofloxacin.
When combined with other antimicrobial agents (beta-lactam antibiotics, aminoglycosides, Clindamycin , metronidazole), synergism is usually observed. Therefore, Ciprofloxacin 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 isoxazolpenicillins and Vancomycin - for staphylococcal infections; with Metronidazole and clindamycin - for anaerobic infections.
Ciprofloxacin enhances the nephrotoxic effect of cyclosporine, an increase in serum creatinine is also noted, so these patients need to be monitored 2 times a week.
When taken simultaneously, Ciprofloxacin enhances the effect of indirect anticoagulants.
Pharmaceutical Interaction
The infusion solution of the drug is pharmaceutically incompatible with all infusion solutions and drugs that are physically and chemically unstable in an acidic medium (pH of the infusion solution of ciprofloxacin is 3.5-4.6). You can not mix the solution for on / in the introduction of solutions having a pH of more than 7.

Store in a dark place at a temperature of 5 ° to 20 ° C in places inaccessible to children. Do not freeze!

Ciprofloxacin