Urinary tract infection ciprofloxacin

McCarty JM, Richard G, Huck W, Tucker RM, Tosiello RL, Shan M, Heyd A, Echols RM. A randomized trial of short-course ciprofloxacin, ofloxacin, or trimetho-prim/sulfamethoxazole for the treatment of acute urinary tract infection in women. Ciprofloxacin Urinary Tract Infection Group. Am J Med 1999 106(3) 292-9. 

Same as ciprofloxacin, urinary tract infections, uncomplicated gonorrhea, prostatitis Same as ciprofloxacin Same as ciprofloxacin... 

The fluoroquinolones are used in the treatment of infections caused by susceptible microorganisms. The fluoroquinolones are effective in the treatment of infections caused by gram-positive and gram-negative microorganisms. They are primarily used in the treatment of susceptible microorganisms in lower respiratory infections, infections of the skin, urinary tract infections, and sexually transmitted diseases. Ciprofloxacin, norfloxacin, and ofloxacin are available in ophthalmic forms for infections in the eyes. 

Over 10000 quinolone antibacterial agents have now been synthesized. Nalidixic acid is regarded as the progenitor of the new quinolones. It has been used for several years as a clinically important drug in the treatment of urinary tract infections. Since its clinical introduction, other 4-quinolone antibacterials have been synthesized, some of which show considerably greater antibacterial potency. Furthermore, this means that many types of bacteria not susceptible to nahdixic acid therapy m be sensihve to the newer derivahves. The most important development was the introduction of a fluorine substituent at C-6, which led to a considerable increase in potency and spectrum of activity compared with nalidixic add. These second-generation quinolones are known as fluoroquinolones, examples of which are ciprofloxacin and norfloxacin (Fig. 5.19). 

Quinolones Ciprofloxacin, enoxacin, and levofloxacin Urinary tract infections... 

This class of compounds comprises a series of synthetic agents patterned after nalidixic acid, a naphthyridine derivative introduced in 1963 for the treatment of urinary tract infections. Isosteric heterocyclic groupings in this category include the quinolones (e.g., norfloxacin, ciprofloxacin, lome-floxacin, gatifloxacin, sparfloxacin, moxifloxacin, and ofloxacin), the naph-thyridones (e.g., nalidixic acid, enoxacin, and trovafloxacin), and the cin-nolones (e.g., cinnoxacin) [2] (Fig. 1). 

XR tabiets No dosage adjustment is required for patients with uncomplicated urinary tract infections receiving 500 mg ciprofloxacin XR. In patients with complicated urinary tract infections and acute uncomplicated pyelonephritis who have a Ccr of less than 30 mL/min, reduce the dose of XR tablets from... 

Earlier quinolones such as nalidixic acid did not achieve systemic antibacterial levels and were useful only for treatment of lower urinary tract infections. Fluorinated derivatives (ciprofloxacin, levofloxacin, and others Figure 46-3 and Table 46-2) have greatly improved antibacterial activity compared with nalidixic acid and achieve bactericidal levels in blood and tissues. 

An 82-year-old man and a 76-year-old man with normal renal function developed increased lactate concentrations (3.6 mmol/1 and 3.2 mmol/1 respectively) a few weeks after starting to take metformin (54). Both had a low bicarbonate concentration and high anion gap. The second patient was also taking ciprofloxacin for a urinary tract infection. In both patients lactate reached normal values after metformin was withdrawn. 

Klebsiella pneumoniae Pneumonia urinary tract infection 3rd-generation cephalosporin an aminoglycoside Cefuroxime ciprofloxacin ofloxacin ampicillin/ sulbactam amoxicillin/ clavulanate imipenem meropenem trimethoprim-sulfamethoxazole... 

Pseudomonas aeruginosa Urinary tract infection An aminoglycoside Ciprofloxacin or ofloxacin... 

Enterococcus faecalis Urinary tract infection Ampicillin or amoxicillin Ciprofloxacin doxycycline levofloxacin fosfomycin... 

The fluoroquinolone subclass of antibiotics is inspired by nalidixic acid (A.35), an older antibiotic commonly used for urinary tract infections (Figure A.10). Depending on the type of infection, fluoroquinolones inhibit DNA gyrase and/or topoisomerase IV. Both enzymes are vital for DNA replication and bacterial reproduction. Both ciprofloxacin (Cipro, A.36) and levofloxacin (Levaquin, A.37) are examples of fluoroquinolone antibiotics. Ciprofloxacin received national attention in the United States in 2001. Ciprofloxacin was used to treat many anthrax-infected patients after letters containing anthrax spores were sent through the U.S. postal service. 

Ciprofloxacin is approved for use in the treatment of bone and joint infections, infectious diarrhea caused by Shigella or Campylobacter, lower respiratory tract infections, skin infections, and urinary tract infections. It is the drug of choice for the treatment of infections caused by Campylobacter jejuni. In addition, it has found off-label use as an alternative drug for the treatment of gonorrhea, salmonella, and yersinia... 

Ciprofloxacin and ofloxacin have broader spectra of activity that includes some gram-positive organisms so they have been used for a broad range of infections. Oral ciprofloxacin or ofloxacin is indicated for the treatment of complicated urinary tract infections and prostatitis. Ofloxacin is an effective therapy for chlamydial urethritis/ cervicitis and acute pelvic inflammatory disease. Oral ciprofloxacin or ofloxacin is effective in the treatment of acute diarrhea caused by enterotoxic E. coli (e.g., travelers diarrhea). Salmonella, Shigella, and Campylobacter... 

Ofloxacin (t/ 4h) has modestly greater Grampositive activity, but less Gram-negative activity than ciprofloxacin. It is indicated for urinary and respiratory tract infections and gonorrhoea. Nalidixic acid (t5 6 h) is now used principally for the prevention of urinary tract infection. It may cause haemolysis in glucose-6-phosphate dehydrogenase deficient subjects. 

Others. Leoofloxacin (t) 7h) has greater activity against Streptococcus pneumoniae than ciprofloxacin and is used for respiratory and urinary tract infection. Moxifloxacin (t) 12 h) has strong anti-Gram-positive activity, and may prove useful for respiratory tract infections including those caused by atypical pathogens and penicillin-resistant Streptococcus pneumoniae. 

Septicaemia related to urinary tract infection usually involves Escherichia coli (or other Gramnegative bacteria), enterococci gentamicin plus benzylpenicillin or cefotaxime alone (ciprofloxacin plus vancomycin). 

Headache was recorded in 8% of patients taking ciprofloxacin and 9% taking ofloxacin during short-course treatment of urinary tract infections (18). Similar rates are reported for grepafloxacin (17). 

Uncomplicated community-acquired urinary tract infection presents few problems with management. Drugs such as trimethoprim, ciprofloxacin and ampicillin are widely used. Cure rates are close to 100% for ciprofloxacin, about 80% for trimethoprim and about 50% for ampicillin—to which resistance has been steadily increasing. Treatment for 3 days is generally satisfactory and is usually accompanied by prompt control of symptoms. Single-dose therapy with amoxicillin 3 g has also been shown to be effective in selected individuals. Alternative agents include nitrofurantoin, nalidixic acid and norfloxacin, although these are not as well tolerated. Oral cephalosporins and co-amoxiclav are also used. 

Cox CE, Marbury TC, Pittman WG, et al. A randomized, double-bhnd, multicenter comparison of gatifloxacin versus ciprofloxacin in die treatment of complicated urinary tract infection and pyelonephritis. Chn Ther... 

Irvani A, Klimberg I, Briefer C, et al. A trial comparing low-dose, short-course ciprofloxacin and standard 7-day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infections. J Antimicrob Chemother 1999 43(suppl A) 67-75. 

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