Ciprofloxacin

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Ciprofloxacin is a second generation quinolone antibiotic, a class of pharmaceuticals that work by killing bacteria.[1] It is sold under the brand names Cipro, Cipro XR, Ciprobay, Ciproxin, and Proquin XR.

Why It's Prescribed

Ciprofloxacin is used to treat a wide range of bacterial infections, including urinary tract infections, sinusitis, pneumonia, staph infections, skin infections, and typhoid. In the event of biological warfare, ciprofloxacin can be used to treat anthrax, plague, and tularemia (rabbit fever).[2]

Ciprofloxacin is prescribed for the following labeled uses:[3] Acute Gonococcal Cervicitis, Acute Gonococcal Urethritis, Acute Maxillary Haemophilus Influenzae Sinusitis, Acute Maxillary Moraxella Catarrhalis Sinusitis, Acute Maxillary Streptococcus Pneumoniae Sinusitis, Bacterial Pneumonia, Bacterial Urinary Tract Infection, Bone Infections, Bronchitis with Bacterial Exacerbations, Chancroid, Chronic Bacterial Prostatitis, Citrobacter Urinary Tract Infection, Complicated Bacteroides Peritonitis, Complicated E. Coli Peritonitis, Complicated Klebsiella Peritonitis, Complicated Proteus Peritonitis, Complicated Pseudomonas Aeruginosa Peritonitis, Cystitis, Diarrhea due to E. Coli, E. Coli Cystitis, E. Coli Prostatitis, E. Coli Pyelonephritis, E. Coli Urinary Tract Infection, Enteric Campylobacteriosis, Enterobacter Cloacae Urinary Tract Infection, EnterobacterJoint Infection, Enterobacter Osteomyelitis, Enterobacter Pneumonia, Enterococcus Urinary Tract Infection, Escherichia Coli Pneumonia, Gastroenteritis due to Shigella, Gram-Negative Aerobic Bacillary Pneumonia, Haemophilus Influenzae Pneumonia, Haemophilus Parainfluenzae Pneumonia, Infectious Diarrhea, Infectious Disease of Abdomen, Infectious Disorder of Joint, Intra-Abdominal Abscess, Klebsiella Pneumonia, Klebsiella Urinary Tract Infection, Lower Respiratory Infections, Moraxella Catarrhalis Bronchitis, Moraxella Catarrhalis Chronic Bronchitis, Morganella Morganii Urinary Tract Infection, Post-Exposure Anthrax Prevention, Proteus Pneumonia, Proteus Prostatitis, Proteus Urinary Tract Infection, Providencia Urinary Tract Infection, Pseudomonas Aeruginosa Joint Infection, Pseudomonas Aeruginosa Osteomyelitis, Pseudomonas Aeruginosa Pneumonia, Pseudomonas Aeruginosa Urinary Tract Infection, Serratia Joint Infection, Serratia Osteomyelitis, Serratia Urinary Tract Infection, Skin and Skin Structure Citrobacter Infection, Skin and Skin Structure E. Coli Infection, Skin and Skin Structure Enterobacter Infection, Skin and Skin Structure Infection, Skin and Skin Structure Klebsiella Infection, Skin and Skin Structure Morganella Morganii Infection, Skin and Skin Structure Proteus Infection, Skin and Skin Structure Providencia Infection, Skin and Skin Structure Pseudomonas Aeruginosa Infection, Skin and Skin Structure Streptoccous Pyogenes Infection, Staphylococcus Aureus Skin and Skin Structure Infection, Staphylococcus Cystitis, Staphylococcus Epidermidis Skin and Skin Structure Infection, Staphylococcus Epidermidis Urinary Tract Infection, Staphylococcus Saprophyticus Urinary Tract Infection, Traveler's Diarrhea, Typhoid Fever

It may also be prescribed for the following unlabeled uses:[4] Cutaneous Anthrax, Diabetic Foot Infection, Diverticulitis of Gastrointestinal Tract, Gastrointestinal Anthrax, Inhaled Anthrax, Meningitis due to Anthrax, Presumed Infection in Febrile Neutropenic Patient, Prevention of Meningococcal Meningitis, Prevention of Traveler's Diarrhea

Form, Route, and Dosage

Ciprofloxacin is available as a suspension (liquid), tablet, and an extended release tablet to take orally. It is also given as an IV. When prescribed as a tablet, it is available in the strengths 500mg and 750mg.[5] Adults are not prescribed more than 1500mg per day.[6]

Risks

Side Effects

Patients taking Ciprofloxacin may experience side effects, including the following:[7]

  • nausea
  • vomiting
  • stomach pain
  • heartburn
  • diarrhea
  • feeling an urgent need to urinate
  • headache
  • vaginal itching and/or discharge
  • severe diarrhea (watery or bloody stools) that may occur with or without fever and stomach cramps (may occur up to 2 months or more after your treatment)
  • rash or blisters
  • hives
  • itching
  • tingling or swelling of the face, neck, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • difficulty breathing or swallowing
  • hoarseness or throat tightness
  • wheezing
  • rapid, irregular, or pounding heartbeat
  • fainting
  • fever
  • joint or muscle pain
  • unusual bruising or bleeding
  • extreme tiredness
  • lack of energy
  • loss of appetite
  • pain in the upper right part of the stomach
  • yellowing of the skin or eyes
  • dark urine
  • flu-like symptoms
  • seizures
  • dizziness
  • confusion
  • nervousness
  • restlessness
  • anxiety
  • difficulty falling asleep or staying asleep
  • nightmares or abnormal dreams
  • not trusting others or feeling that others want to hurt you
  • hallucinations (seeing things or hearing voices that do not exist)
  • depression
  • thoughts about dying or killing yourself
  • uncontrollable shaking of a part of the body
  • pain, burning, tingling, numbness, and/or weakness in a part of the body

Warnings

Taking ciprofloxacin increases risk of developing tendinitis.[8]

As a Pollutant

Because humans and animals often do not fully metabolize pharmaceuticals in their body, they can excrete drugs or their breakdown products, which may the enter the environment.[9]

In Sewage Sludge

Ciprofloxacin has been found in sewage sludge. In the Targeted National Sewage Sludge Survey, a 2009 test of 84 samples of sewage sludge from around the U.S., the EPA found ciprofloxacin in every sample in concentrations ranging from 74.5 to 47,500 parts per billion.[10] There are no federal regulations governing how much of this drug may be present in sewage sludge applied to land as fertilizer.

Breakdown in the Environment

A 1999 study examined the biodegradability of the antibiotics cefotiam, ciprofloxacin, meropenem, penicillin G, and sulfamethoxazole as well as their toxicity to bacteria.[11] The study aimed to see how much of these drugs were breaking down in wastewater treatment plants as well as what effect they might have on creating antibiotic-resistance in bacteria. Of the drugs, only penicillin G biodegraded, and it did so only partially (35% in 40 days). The study concluded "Therefore, antibiotic drugs emitted into municipal sewage may affect the biological process in sewage treatment plants (STPs), and they may persist in the aquatic environment and contribute to the increasing resistance of pathogenic bacteria."

In 2000, another study examined the antibiotics ciprofloxacin, ofloxacin, and metronidazole to see if they biodegraded and if their genotoxicity (i.e. ability to damage DNA, potentially causing mutations or cancer) was eliminated. None of the drugs broke down and their genotoxicity was not eliminated.[12]

In Drinking Water

An Associated Press investigation found that, of 62 metropolitan areas in the U.S., only 28 tested for pharmaceuticals, and 24 found pharmaceuticals in the drinking water when they tested it.[13] Of those tested, Philadelphia tested positive for ciprofloxacin (as well as 55 other drugs).[14]

Articles and resources

Related SourceWatch articles

References

  1. Ciprofloxacin: Medline Plus, Accessed September 2, 2010.
  2. Ciprofloxacin: Medline Plus, Accessed September 2, 2010.
  3. Ciprofloxacin Oral: Dosage, Uses, and Warnings, Accessed September 2, 2010.
  4. Ciprofloxacin Oral: Dosage, Uses, and Warnings, Accessed September 2, 2010.
  5. Drugstore.com, Accessed September 2, 2010.
  6. Ciprofloxacin Oral: Dosage, Uses, and Warnings, Accessed September 2, 2010.
  7. Ciprofloxacin: Medline Plus, Accessed September 2, 2010.
  8. Ciprofloxacin: Medline Plus, Accessed September 2, 2010.
  9. O.A.H. Jones, N. Voulvoulis, and J.N. Lester, Human Pharmaceuticals in Wastewater Treatment Processes, Environmental Science and Technology, 2005.
  10. Targeted National Sewage Sludge Survey Report, US EPA website, Accessed August 28, 2010.
  11. Al-Ahmad A, Daschner FD, and Klaus Kümmerer, "Biodegradability of cefotiam, ciprofloxacin, meropenem, penicillin G, and sulfamethoxazole and inhibition of waste water bacteria", Environmental Contamination and Toxicology, August 1999.
  12. Klaus Kümmerer, al-Ahmad A, Mersch-Sundermann V., "Biodegradability of some antibiotics, elimination of the genotoxicity and affection of wastewater bacteria in a simple test", Chemosphere, April 2000.
  13. AN AP INVESTIGATION : Pharmaceuticals Found in Drinking Water, Associated Press, Accessed September 3, 2010.
  14. Pharmawater-Metros-By-Results, Associated Press, Accessed September 3, 2010.

External resources

External articles