Ciprofloxacin

Ciprofloxacin is a broad-spectrum antibiotic belonging to the fluoroquinolone class. It is highly effective against a wide range of bacterial infections, particularly urinary tract infections, gastrointestinal infections (including typhoid fever), respiratory infections, skin infections, and bone infections. It is one of the most widely available and commonly used antibiotics in Nigeria, available both by prescription and unfortunately through self-medication. Its widespread overuse without proper indication has contributed significantly to antibiotic resistance, including the emergence of ciprofloxacin-resistant typhoid strains in Nigeria.

• Urinary tract infections (UTIs): particularly complicated UTIs and pyelonephritis • Typhoid fever (enteric fever): though resistance is increasing; culture and sensitivity testing important • Gastrointestinal infections: bacterial gastroenteritis, infectious diarrhoea • Respiratory tract infections: lower respiratory tract infections, hospital-acquired pneumonia • Skin and soft tissue infections • Bone and joint infections (osteomyelitis) • Anthrax prophylaxis and treatment (post-exposure) • Gonorrhoea: though resistance is now widespread in Nigeria; confirm sensitivity • Prostatitis (bacterial) • Meningococcal meningitis prophylaxis in close contacts NOT appropriate for: common cold, flu, most sore throats, or any viral infection.

Dosage varies significantly by the type and severity of infection: Adults (standard dosing): • UTI (uncomplicated): 250–500 mg twice daily for 3 days • UTI (complicated)/pyelonephritis: 500 mg twice daily for 7–14 days • Typhoid fever: 500 mg twice daily for 10–14 days (check local resistance patterns) • Severe infections: 500–750 mg twice daily for 7–14 days Take on an empty stomach OR with a light meal: • Dairy products, calcium-fortified foods, and antacids significantly reduce absorption: take ciprofloxacin 2 hours before or 6 hours after these products • Drink plenty of water • Complete the full prescribed course Not recommended for children and adolescents under 18 years as a first choice (exceptions: anthrax, complicated UTI when no alternative); use safer alternatives.

Common: • Nausea and vomiting • Diarrhoea • Abdominal discomfort • Headache • Dizziness • Skin rash Important side effects to know: • Tendon damage (tendinopathy/tendon rupture): especially the Achilles tendon; risk is higher in patients over 60, taking corticosteroids, or with kidney disease; stop ciprofloxacin immediately if you develop tendon pain or swelling • Peripheral neuropathy: tingling, numbness, pain or weakness in limbs; usually reversible but can be permanent • QT interval prolongation: risk of serious heart rhythm abnormalities • Central nervous system effects: confusion, dizziness, agitation, tremors, rarely seizures (especially in elderly or patients with brain disorders) • Clostridioides difficile diarrhoea: severe, persistent or bloody diarrhoea • Photosensitivity: increased sensitivity to sunlight; avoid prolonged sun exposure and use sunscreen • Severe allergic reactions (rare)

• Antacids containing magnesium or aluminium, calcium supplements, iron supplements, multivitamins with minerals: significantly reduce ciprofloxacin absorption: take 2 hours before or 6 hours after these products • Dairy products and calcium-fortified juices: reduce absorption (less significant than antacids but still relevant) • Warfarin: ciprofloxacin significantly increases warfarin effect: increased bleeding risk; monitor INR closely • Theophylline (asthma drug): ciprofloxacin greatly increases theophylline levels: risk of serious toxicity (seizures, cardiac arrhythmias) • NSAIDs: increased risk of CNS side effects and seizures • Drugs that prolong the QT interval: additive cardiac risk • Clozapine and other antipsychotics: ciprofloxacin increases their levels

• Store at room temperature (15–30°C) away from moisture and direct sunlight • Keep out of reach of children • Do not use after the expiry date