Name of the Antimicrobial Drugs- Inhibits DNA gyrase
1.Ciprofloxacin
| Ciprofloxacin |
| Availability Injection: 200 mg/20 ml, 400 mg/40 ml, 200 mg/100 ml premixed in dextrose 5% in water (D5W), 400 mg/200 ml premixed in D5W, 1,200 mg/120-ml bulk package Ophthalmic ointment: 3.5-g tube Ophthalmic solution: 2.5-ml and 5-ml plastic dispensers Otic solution: 0.2% (0.5 mg in 0.25 ml) in single-use container Tablets: 250 mg, 500 mg, 750 mg |
| Indications and dosages ➣ Acute sinusitis Adults: 500 mg P.O. q 12 hours or 400 mg I.V. q 12 hours for 10 days ➣ Prostatitis Adults: 500 mg P.O. q 12 hours or 400 mg I.V. q 12 hours for 28 days ➣ Intra-abdominal infections Adults: 500 mg P.O. q 12 hours or 400 mg I.V. q 12 hours for 7 to 14 days ➣ Febrile neutropenic patients Adults: 400 mg I.V. q 8 hours for 7 to 14 days ➣ Gonorrhea Adults: 500 mg P.O. as a single dose ➣ Infectious diarrhea Adults: 500 mg P.O. q 12 hours for 5 to 7 days ➣ Inhalation anthrax (postexposure) Adults: 500 mg P.O. q 12 hours for 60 days or 400 mg I.V. q 12 hours for 60 days Children: 15 mg/kg P.O. q 12 hours for 60 days (not to exceed 500 mg/dose), or 10 mg/kg I.V. q 12 hours for 60 days, not to exceed 400 mg/dose ➣ Infections of lower respiratory tract, skin and skin structures, bones, and joints Adults: 500 to 750 mg P.O. q 12 hours or 400 mg I.V. q 8 hours for 7 to 14 days. Severe bone and joint infections may necessitate up to 6 weeks of therapy. ➣ Nosocomial pneumonia Adults: 400 mg I.V. q 8 hours for 10 to 14 days ➣ Typhoid fever Adults: 500 mg P.O. q 12 hours for 10 days |
Mechanism of Action
Inhibits the enzyme DNA gyrase, which is responsible for the unwinding and supercoiling of bacterial DNA before it replicates. By inhibiting this enzyme, ciprofloxacin causes bacterial cells to die.
Pharmacokinetics
- Bioavailability (PO): ~50-85%
- Peak plasma time (PO): Immediate-release, 0.5-2 hr; extended-release, 1-2.5 hr
- Protein bound: 20-40%
- Metabolized in liver
- Half-life: 2-5 hr (children); 3-5 hr (adults)
- Excretion: Urine (30-50%), feces (15-43%)
Administration
- Administer oral drug with or without food but not with dairy products or calcium-fortified juices alone; however, drug may be taken with a meal that contains these products.
- Infuse I.V. dose over at least 1 hour, using pump to ensure 1-hour duration.
- Know that too-rapid I.V. infusion increases risk of anaphylaxis and other adverse reactions.
- Know that treatment with ophthalmic solution may be continued after 14 days if corneal re-epithelialization hasn’t occurred
Contraindications
Hypersensitivity to drug or other fluoroquinolones
Comcomitant administration of tizanidine
Precautions :
- Cirrhosis, renal impairment, underlying CNS disease
- Concurrent use of theophylline (risk of serious or fatal reactions, such as cardiac arrest, seizures, status epilepticus, and respiratory failure)
- Elderly patients
- Pregnant or breastfeeding patients
- Children younger than age 18 (except for complicated urinary tract infection, pyelonephritis, and postexposure inhalation antrax only).
Adverse reactions
- CNS: agitation, headache, restlessness, confusion, delirium, peripheral neuropathy, toxic psychosis
- CV: orthostatic hypotension, vasculitis
- EENT: nystagmus; with ophthalmic use—blurred vision; burning, stinging, irritation, itching, tearing, and redness of eyes; eyelid itching, swelling, or crusting; sensitivity to light
- GI: nausea, vomiting, diarrhea, constipation, abdominal pain or discomfort, dyspepsia, dysphagia, flatulence, pancreatitis, pseudomembranous colitis
- GU: albuminuria, candiduria, renal calculi Hematologic: methemoglobinemia, agranulocytosis, hemolytic anemia
- Hepatic: jaundice, hepatic necrosis
- Metabolic: hyperglycaemia, hyperkalemia
- Musculoskeletal: myalgia, myoclonus, tendinitis, tendon rupture
- Skin: rash, exfoliative dermatitis, toxic epidermal necrolysis, erythema multiforme photosensitivity
- Other: injection-site reaction, altered taste, anosmia, exacerbation of myasthenia gravis, overgrowth of nonsusceptible organisms, hypersensitivity reactions including anaphylaxis and Stevens-Johnson syndrome
Patient monitoring
- In patients with renal insufficiency, assess creatinine level before giving first dose and at least once a week during prolonged therapy. Monitor drug blood level closely.
- Watch for signs and symptoms of serious adverse reactions, including GI problems, jaundice, tendon problems, and hypersensitivity reactions.
Patient teaching
- Tell patient to take drug with or without food at the same time each day.
- Advise patient not to take drug with dairy products or calcium-fortified juices alone or with caffeinated beverages.
- Advise patient to drink 8 oz of water every hour while awake to ensure adequate hydration. 2Instruct patient to stop taking drug and notify prescriber at first sign of burning, numbness, or tingling in hands or feet; yellow eyes or skin; unusual tiredness; persistent diarrhea; rash; or tendon pain, swelling, or inflammation.
- Advise patient to avoid excessive exposure to sun or ultraviolet light and to discontinue drug and notify prescriber if phototoxicity (burning, erythema, exudation, vesicles, blistering, edema) occurs.
- Advise patient taking hormonal contraceptives to use supplemental birth control method, such as condoms,because drug reduces contraceptive efficacy.
- Inform breastfeeding patient that drug is excreted in breast milk and can affect infant’s bone growth. Advise her to consult prescriber before using drug.
- Teach patient how to use eye ointment or solution and tell patient not to touch eye dropper tip to any surface, to avoid contamination.
- Instruct patient how to use ear solution and to lie with affected ear upward for at least 1 minute after instilling solution.
- Caution patient with bacterial conjunctivitis not to wear contact lenses.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.
Nursing Considerations
- Obtain culture and sensitivity test results, as ordered, before giving ciprofloxacin.
- Use drug cautiously in patients with CNS disorders and patients who may be more susceptible to drug’s effect on QT interval, such as those taking Class IA or III antiarrhythmics or those with uncorrected hypokalemia or a history of QT-interval prolongation.
- Dilute I.V. ciprofloxacin concentrate to 1 to 2 mg/ml using D5W or sodium chloride for injection. Don’t dilute solutions that come from manufacturer in D5W before I.V. infusion. Infuse slowly over 1 hour.
- Store reconstituted solution up to 14 days at room temperature or refrigerated.
- Don’t give oral suspension by feeding tube.
- Be aware that E.R. and immediate-release tablets aren’t interchangeable and that Proquin XR and Cipro XR aren’t interchangeable.
- Patient should be well hydrated during therapy to help prevent alkaline urine, which may lead to crystalluria and nephrotoxicity.
- Assess patient’s hepatic, renal, and hematologic functions periodically, as ordered, if he’s receiving prolonged therapy.
- Monitor patient closely for diarrhea, which may reflect pseudomembranous colitis. If it occurs, notify prescriber and expect to withhold drug and treat diarrhea
- Assess patient for evidence of peripheral neuropathy. Notify prescriber and expect to stop drug if patient complains of burning, numbness, pain, tingling, or weakness in extremities or if physical examination reveals deficits in light touch, pain, temperature, position sense, vibratory sensation, or motor strength.
- Monitor patients (especially children, elderly patients, patients receiving corticosteroids, and patients who have renal failure or who have had a kidney, heart, or lung transplant) for evidence of tendon rupture, such as inflammation, pain, and swelling at the site. Be aware that tendon rupture may occur during or after ciprofloxacin therapy. Notify prescriber about suspected tendon rupture, and have patient rest and refrain from exercise until tendon rupture has been ruled out. If present, expect to provide supportive care as ordered.
- Assess patient routinely for signs of rash or other hypersensitivity reactions, even after patient has received multiple doses. Stop drug at first sign of rash, jaundice, or other sign of hypersensivitity, and notify prescriber immediately. Be prepared to provide supportive emergency care
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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