Fluoroquinolones ciprofloxacin

See section on treatment of bacterial pneumonia. Macrolide/azalide erythromycin, clarithromycin, azithromycin. cTetracydine tetracycline hydrochloride, doxycydine. Cephalosporin cefuroxime, ceftriaxone, cefotaxime. eCarbapenem imipenem-cilastatin, meropenem. Fluoroquinolone ciprofloxacin, gatifloxacin, or levofloxacin. 

A fluoroquinolone (ciprofloxacin 0.4 g orally every 12 hours or levofloxacin 0.5—... 

For penicillin-allergic adults, use a fluoroquinolone (ciprofloxacin 0.5-0.75 g orally every 12 hours or 0.4 g IV every 12 hours levofloxacin 0.5-0.75 g orally or IV every 24 hours or moxifloxacin 0.4 g orally or IV every 24 hours). eGentamicin or tobramycin, 2 mg/kg loading dose, then maintenance dose as determined by serum concentrations, fluoroquinolone or aztreonam 1 g IV every 6 hours may be used in place of the aminoglycoside in patients with severe renal dysfunction or other relative contraindications to aminoglycoside use. 

The majority of patients can be managed with oral antimicrobial agents, such as trimethoprim-sulfamethoxazole or the fluoroquinolones (ciprofloxacin, levofloxacin). When IV treatment is necessary, IV to oral sequential therapy with trimethoprim-sulfamethoxazole or a fluoroquinolone, such as ciprofloxacin or ofloxacin, would be appropriate. 

As soon as the first case of anthrax was confirmed in Florida, a relatively new drug gained notoriety—Cipro . This fluoroquinolone (ciprofloxacin) became the mode of therapy for those people exposed to the anthrax bacillus (approved by the FDA for anthrax on July 28, 2000). Despite appeals for restraint in the use of Cipro, pharmacies in Mexican border towns reported being cleaned out of the antibiotic by Americans searching for the readily available and relatively cheap drug. Only time will tell if inappropriate, irrational use of Cipro results in loss of effectiveness in treating anthrax infection. However, the CDC did determine that 19 percent of 490 people in Florida experienced side effects 1-2 weeks after beginning therapy with Cipro. 

A fluoroquinolone (ciprofloxacin 0,4 g orally every 12 hours or levotloxacin 0.5-0.75 g orally every 24 hours) plus clindamycin 0.3-0.6 g orally every 8 hours or metronidazole 0.5 g orally every 8 hours Aminoglycoside + clindamycin 0.6-0.9 g IV every 8 hours or metronidazole 0.5 g IV every 8 hours or... 

Fluoroquinolones. Ciprofloxacin and enoxacin (Pene-trex) may markedly increase serum concentrations of medications such as theophylline by inhibiting their hepatic metabolism. Certain other fluoroquinolones, such as levofloxacin (Levaquin), are not likely to inhibit hepatic enzyme systems and interact with these medications. 

If analysis of the frequency of adverse events is based on prescription event monitoring (PEM), the rates of adverse events are usually substantially lower. In one study, over 11 000 patients taking each antibiotic were monitored (19). Among the fluoroquinolones, ciprofloxacin, norfloxacin, and ofloxacin were used. Adverse events resulted in withdrawal of norfloxacin or ofloxacin in under 1% of patients (19). 

The reactivity of 13 quinolones and fluoroquinolones (ciprofloxacin, clinafloxacin, enoxacin, gatifloxacin, levofloxacin, lomefloxacin, moxifloxacin, nalidixic acid. 

For the above reasons, a dramatic reduction in the emergence of fluoroquinolone (ciprofloxacin) resistance is seen when bacterial strains lacking efflux pumps are used for resistance selection or when selection experiments are performed in the presence of an efflux pump inhibitor (EPI) [133-136], the opposite of what is seen clinically. 

Fluoroquinolones Ciprofloxacin Norfloxacin Levofloxacin The newer quinolones have a greater spectrum of activity, including P. aeruginosa. These agents are effective for pyelonephritis and prostatitis. Avoid in pregnancy and children. Moxifloxacin should not be used owing to inadequate urinary concentrations. 

Empirical regimens containing fluoroquinolones (ciprofloxacin 0.4 g every 8-12 h + ceftazidime 1-2 g every 8 h, aminoglycoside, or vancomycin 0.5-1 g every 6-12 h) ... 

At least four different types of empirical parenteral antibiotic regimens are in use (1) monotherapy with an antipseudomonal cephalosporin (cefepime or ceftazidime) or antipseudomonal car-bapenem (imipenem-cilastatin or meropenem), (2) combination therapy with an aminoglycoside plus an antipseudomonal penicillin (piperacillin-tazobactam or ticarciUin-clavulate), an antipseudomonal cephalosporin, or an antipseudomonal carbapenem, (3) vancomycin plus an antipseudomonal cephalosporin or antipseudomonal carbapenem, with or without an aminoglycoside, and (4) a fluoroquinolone (ciprofloxacin or levofloxacin) in combination with an... 

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-... 

Fluoroquinolones Ciprofloxacin Levofloxacin, ofloxacin Moxifloxacin, sparfloxacin, trovafloxacin... 

Are there contraindications to concomitant drug use For instance, tizanidine is contraindicated in patients with concomitant use of CYP450 1A2 inhibitors such as fluvoxamine, amiodarone, mexiletine, propafenone, cimetidine, fluoroquinolones (ciprofloxacin, norfloxacin), rofecoxib, oral contraceptives, and ticlopidine [27]. 

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