Ciprofloxacin adverse reactions

A patient is prescribed ciprofloxacin for a severe respiratory infection. What serious adverse reaction(s)... 

The data on the adverse reactions of the fluoroquinolones which have received the most extensive clinical evaluation (ciprofloxacin, ofloxacin, pefloxacin, norfloxacin and enoxacin), involving about 30,000 patients, have been the subject of a review [54a], An important point noted in this review involves the difficulty in detecting an important severe adverse reaction if it is of relatively low frequency, until there has been a very large patient exposure (some examples are provided in which at least 150,000-300,000 exposures would be required to observe the importance of side-effects, resulting in an alert, which have been discovered with specific drugs). However, the majority of side-effects observed thus far with the fluoroquinolones have been minor,... 

Introduction of the first fluorinated quinolone, norfloxacin [nor FLOX a sin], has been rapidly followed by new members of this class. These agents are totally synthetic and are closely related structurally to an earlier quinolone, nalidixic acid [nal i DIX ik]. The principal member of this group is ciprofloxacin [sip ro FLOX a sin], which has the widest clinical application. Other antibiotics in this group available in the United States are primarily employed to treat urinary infections (Figure 32.1). It seems likely that the size of this class of antibiotics will increase due to its wide antibacterial spectrum, favorable pharmacokinetic properties and relative lack of adverse reactions. Unfortunately, their overuse has already led to the emergence of resistant strains resulting in limitations to their clinical usefulness. 

The American Academy of Pediatrics recommends that doxycycline not be used in children less than 9 years of age because of retarded skeletal growth in infants and discolored teeth in infants and toddlers (Inglesby et al., 2002). Because of the serious nature of anthrax infection, however, Inglesby and colleagues (2002) recommend that doxycycline, instead of ciprofloxacin, be used in children if antibiotic susceptibility testing, exhaustion of drug supplies, or adverse reactions preclude the use of ciprofloxacin. 

The frequency of adverse reactions to the topical ophthalmic fluoroquinolones is low. The most frequently reported adverse reactions to ciprofloxacin are local burning or discomfort after instillation, bitter taste after... 

Anaphylactoid reactions occurred in 3 of about 3200 students who took ciprofloxacin 500 mg for chemoprophylaxis of meningococcal meningitis two had no history of atopic illness (59). Additional adverse reactions were mild skin rashes in three students and nausea and vomiting in two. 

Anaphylactic shock associated with cinoxacin was reported in three patients by the Netherlands Center for Monitoring of Adverse Reactions to Drugs (97). Another 17 cases were reported to the WHO Collaborating Center for International Drug Monitoring. In some cases the reaction was observed immediately after the first dose of a repeat cycle of treatment. Anaphylactoid reactions to ciprofloxacin have been reported in patients with cystic fibrosis (98-100). 

Ronnau AC, Sachs B, von Schmiedeberg S, Hunzelmann N, Ruzicka T, Gleichmann E, Schuppe HC. Cutaneous adverse reaction to ciprofloxacin demonstration of specific lymphocyte prohferation and cross-reactivity to ofloxacin in vitro. Acta Derm Venereol 1997 77(4) 285-8. 

Studies suggest that SOOmg of tetracycline po q 6h could be substituted for doxycycUne. In addition, 400 mg of gatifloxicin or monifloxacin, po daily could be substituted Tf antibiotic susceptibility testing, lack of resources or adverse reactions preclude use of ciprofloxacin... 

Vaidyanalhan S, Sir G, Sett P, Watt JWH, Soni BM, Oo T. Cutaneous adverse reaction to ciprofloxacin precipitated by ingestion of alcohol in a tetraplegic patient. Spinal Cord (1999) 37, 663-4. Correction, ibid 807. 

Herrhn K, Segerdahl M, Gustafsson LL, Kalso E. Methadone, ciprofloxacin, and adverse drug reactions. Lancet 2000 356(9247) 2069-70. 

The newer fluoroquinolones (ciprofloxacin, norfloxacin, enoxadn, pefloxacin, gatifloxadn and moxi-floxacin) have similar toxicities and incidence of adverse effects. In general, compared to other antibiotics, these are relatively safe agents [190]. Gastrointestinal side-effects are the most common (0.8 to 6.8% of patients), followed by central nervous system manifestations (0.9 to 1.8%), and skin reactions (0.6 to 2.4%). Rare cases of increased serum creatinine levels have been reported [203]. Indeed, in a study of 133 febrile episodes in neutropenic patients comparing the effectiveness and safety of high-dose oral ciprofloxacin versus azlociUin and netilmicin, there were no renal ad-... 

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