Ciprofloxacin nervous system

The quinolones are contraindicated in patients with a history of hypersensitivity to any drug in this family. Absorption of the fluoroquinolones is reduced by antacids, iron, and zinc salts, and thus they should not be taken concurrently. Oral ciprofloxacin and enoxacin inhibit the metabolism of theophylline, and toxicity can occur when these two drugs are administered concurrently. Oral administration of the fluoroquinolones can cause convulsions and should therefore be done with caution in patients with central nervous system disorders. These drugs are not recommended for systemic administration in children, adolescents younger than age 18 years, or pregnant women. Topical administration is contraindicated for use in patients younger than 1 year of age. 

In a retrospective analysis there were no chnically important differences in the safety profile of ciprofloxacin in patients aged under or over 65 years (65). The incidence of drug-related adverse events was higher in those under 65 years (25%) than in those aged 65 years or more (17%) the most common adverse events affected the gastrointestinal and central nervous systems. 

A review has suggested that fluoroquinolone-associated peripheral nervous system events are mild and short-term (30). Among 60 courses of quinolones in 45 patients (levofloxacin 33 courses, ciprofloxacin 11 courses, ofloxacin 6 courses, lomefloxacin 1 course, trovafloxacin 1 course in eight cases the same antibiotic was prescribed twice) there were 36 severe events that typically involved multiple organ systems. The symptoms lasted more than 3 months in 71% of cases and more than 1 year in 58%. The onset of the adverse events in the 45 patients was usually rapid 15 events began within 24 hours of the start of treatment, 26 within 72 hours, and 38 within 1 week. 

Co-administration of fenbufen and fluoroquinolones has been associated with seizures (141). The structure at the 7-position greatly affects the risk of NSAID-potentiated nervous system effects. Fluoroquinolones with unsubstituted piperazinyl rings (ciprofloxacin, enox-acin, and norfloxacin) have a strong interaction with NSAIDs (142). The increased risk of seizures is not caused by increased serum concentrations of fluoroquinolones, since their pharmacokinetics are not altered by NSAIDs (143). The mechanism has been suggested to be facilitation by fenbufen of the fluoroquinolone-induced inhibition of GABAa receptor function in the hippocampus and frontal cortex (144). 

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-... 

Nervous system An 85-year-old man developed delirium, hallucinations, and generalized myoclonic jerks 7 days after starting to take ciprofloxacin 500 mg bd for a hip infection [24 ]. His symptoms improved with ciprofloxacin withdrawal and oral clonazepam, but recurred on two occasions after reuse of ciprofloxacin. 

Nervous system Aseptic meningitis has been attributed to ranitidine 300mg/day in a 48-year-old woman, who was allergic to chromium (occupational dermatitis) and co-trimoxazole (dermatitis medicamentosa) [45 ]. However, she was also taking ibu-profen, and ciprofloxacin, and the respective roles played by the different drugs were not clear. 

Nervous system Hemibalismus and altered mental status occurred in a 59-year-old patient with cirrhosis who took a prolonged course of ciprofloxacin for a renal abscess [37 ]. 

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