Ciprofloxacin is a broad-spectrum, second-generation fluoroquinolone antibiotic. It is a bactericidal agent that inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, enzymes essential for DNA replication, transcription, repair, and recombination. It is widely used in the Indian healthcare system for treating a variety of bacterial infections, particularly those caused by Gram-negative organisms, but also shows activity against some Gram-positive and atypical pathogens.
Adult: 500 mg orally every 12 hours. For severe/complicated infections: 750 mg orally every 12 hours. Duration: Typically 7-14 days, depending on infection.
Note: Take orally with a full glass of water. Can be taken with or without food, but dairy products (milk, yogurt), calcium-fortified juices, or supplements containing divalent/trivalent cations (Ca, Mg, Al, Fe, Zn) should be avoided 2 hours before and 4 hours after the dose. Maintain adequate hydration. Do not crush or chew the tablet; swallow whole.
Ciprofloxacin exerts its bactericidal effect by inhibiting two critical bacterial enzymes: DNA gyrase (primarily in Gram-negative bacteria) and topoisomerase IV (primarily in Gram-positive bacteria). Inhibition of DNA gyrase prevents the relaxation of positively supercoiled DNA required for transcription and replication. Inhibition of topoisomerase IV interferes with chromosome partitioning during cell division. This dual inhibition leads to rapid degradation of bacterial DNA and cell death.
Pregnancy: Pregnancy Category C (US FDA). Animal studies show fetal arthropathy. No adequate, well-controlled studies in pregnant women. Use only if the potential benefit justifies the potential risk to the fetus. Generally avoided in pregnancy in India.
Driving: May cause dizziness, lightheadedness, or visual disturbances. Patients should be cautioned about operating machinery or driving until they are sure they are not affected.
| Antacids (Al, Mg), Sucralfate, Didanosine | Markedly reduced absorption of ciprofloxacin due to chelation. | Major |
| Iron, Zinc, Calcium, Multivitamins | Reduced absorption of ciprofloxacin. | Major |
| Warfarin | Increased anticoagulant effect and risk of bleeding. | Major |
| Theophylline | Increased theophylline levels, risk of toxicity (nausea, seizures). | Major |
| Tizanidine | Dramatically increased tizanidine levels; contraindicated. | Contraindicated |
| NSAIDs (e.g., Ibuprofen) | Increased risk of CNS stimulation and seizures. | Moderate |
| Cyclosporine | Potential increase in cyclosporine levels and nephrotoxicity. | Moderate |
| Oral Hypoglycemics (Sulfonylureas) | Enhanced hypoglycemic effect. | Moderate |
| Probenecid | Interferes with renal tubular secretion of ciprofloxacin, increasing its serum levels. | Moderate |
| Other QT-prolonging drugs (e.g., Amiodarone, Sotalol, Macrolides) | Additive risk of QT prolongation and arrhythmias. | Major |